Severe Asthma, Allergen Sensitization, and Chronic Rhinosinusitis: A 10-Year Real-Life Cohort Study

Öz

Background: Severe asthma frequently coexists with allergen sensitization and chronic rhinosinusitis (CRS), both of which contribute to disease burden. Real-life data describing sensitization patterns and CRS characteristics in severe asthma remain limited. Objective: To evaluate allergen sensitization profiles, clinical and CT-confirmed CRS, and nasal polyp characteristics in a real-life cohort of patients with severe asthma. Methods: This retrospective study included adult patients with severe asthma followed over a 10-year period. Demographic characteristics, asthma-related features, sensitization patterns, sinonasal assessments, nasal polyp scores, and laboratory parameters were analyzed. Results: A total of 160 patients were included. Atopy was present in 71.9% of cases and was significantly less frequent in patients treated with benralizumab compared with other biologic therapies (p < 0.001). Clinical CRS was detected in 60.1%, while CT-confirmed CRS was present in 70.7%. Monosensitized patients had significantly lower rates of both clinical and CT-confirmed CRS (p = 0.048 and p = 0.002, respectively). Nasal polyps were identified in 19.3% of patients, with a recurrence rate of 30.9%. Dermatophagoides farinae and Dermatophagoides pteronyssinus were the most common sensitizations. Conclusion: Allergen sensitization and CRS/CRSwNP are highly prevalent in severe asthma and shape the clinical phenotype of the disease. Comprehensive evaluation of upper-airway involvement and sensitization is essential in the management of severe asthma.

Anahtar Kelimeler

• Severe asthma
• biologic therapy
• omalizumab
• mepolizumab
• benralizumab
• allergen sensitization
• chronic rhinosinusitis

Ağır Astımda Alerjen Duyarlanması ve Kronik Rinosinüzit: 10 Yıllık Gerçek Yaşam Kohort Çalışması

Öz

Giriş: Ağır astım sıklıkla alerjen duyarlanması ve kronik rinosinüzit (KRS) ile birliktelik göstermekte olup, bu durumlar hastalık yükünü artırmaktadır. Ağır astım hastalarında alerjen duyarlanma paternleri ile klinik ve görüntüleme ile doğrulanmış KRS özelliklerini tanımlayan gerçek yaşam verileri sınırlıdır. Gereç ve Yöntemler: Bu retrospektif çalışmaya, 10 yıllık izlem süresince takip edilen ağır astım tanılı erişkin hastalar dahil edildi. Demografik özellikler, astıma ait klinik parametreler, alerjen duyarlanma paternleri, sinonazal değerlendirmeler, nazal polip skorları ve laboratuvar bulguları analiz edildi. Sonuç: Toplam 160 hasta çalışmaya dahil edildi. Olguların %71,9’unda atopi saptandı ve benralizumab tedavisi alan hastalarda atopi sıklığı diğer biyolojik tedavilere kıyasla anlamlı olarak daha düşüktü (p < 0,001). Klinik KRS %60,1 oranında, bilgisayarlı tomografi ile doğrulanmış KRS ise %70,7 oranında saptandı. Monosensitize hastalarda hem klinik hem de BT ile doğrulanmış KRS sıklığı anlamlı olarak daha düşüktü (sırasıyla p = 0,048 ve p = 0,002). Nazal polipler hastaların %19,3’ünde izlenirken, polip nüks oranı %30,9 olarak bulundu. En sık saptanan duyarlanmalar Dermatophagoides farinae ve Dermatophagoides pteronyssinus idi. Tartışma: Alerjen duyarlanması ile KRS ve nazal polipli KRS, ağır astım hastalarında yüksek prevalansa sahiptir ve hastalığın klinik fenotipini belirgin şekilde etkilemektedir. Ağır astım yönetiminde üst hava yolu tutulumu ve alerjen duyarlanmasının kapsamlı olarak değerlendirilmesi büyük önem taşımaktadır.

Anahtar Kelimeler

• Ağır astım
• Biyolojik Terapi
• Omalizumab
• Mepolizumab
• Benralizumab
• Allerjen Duyarlılığı
• Kronik rinosünizit

Kaynakça

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