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

Yıl 2026, Cilt: 9 Sayı: 1, 150 - 158, 17.03.2026

İsmet Bulut , Zeynep Yegin Katran , Özge Argin

https://izlik.org/JA67WE43RE

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

https://izlik.org/JA67WE43RE

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

• 1. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2023. Erişim tarihi: 3 Ocak 2024. https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-23_07_06-WMS.pdf
• 2. Global Initiative for Asthma. Difficult-to-treat and severe asthma in adolescent and adult patients: diagnosis and management. Nisan 2019. Erişim tarihi: 3 Ocak 2024. https://ginasthma.org/wp-content/uploads/2019/04/GINA-Severe-asthma-Pocket-Guide-v2.0-wms-1.pdf
• 3. Gyawali B, Georas SN, Khurana S. Biologics in severe asthma: a state-of-the-art review. Eur Respir Rev. 2025;34(175):240088. Crossref
• 4. Couillard S, Jackson DJ, Pavord ID, Wechsler ME. Choosing the right biologic for the right patient with severe asthma. Chest. 2025;167(2):330-342. Crossref
• 5. Addo-Yobo EO, Custovic A, Taggart SC, Craven M, Bonnie B, Woodcock A. Risk factors for asthma in urban Ghana. J Allergy Clin Immunol. 2001;108(3):363-368. Crossref
• 6. Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Hamelmann E, et al. Allergy in severe asthma. Allergy. 2017;72(2):207-220. Crossref
• 7. Chen Z, He Y, Bu H. Association between sensitization to common fungi and severe asthma. Front Public Health. 2025;13:1582643. Crossref
• 8. Côté A, Beaulé R, Boulay MÈ, Guertin J, Boulet LP, Godbout K, et al. Poor agreement among asthma specialists on the choice and timing of initiation of a biologic treatment for severe asthma patients. J Allergy Clin Immunol Pract. 2025;13(6):1358-1366.e9. Crossref
• 9. Miranda C, Busacker A, Balzar S, Trudeau J, Wenzel SE. Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation. J Allergy Clin Immunol. 2004;113(1):101-108. Crossref
• 10. Ciprandi G, Cirillo I. Monosensitization and polysensitization in allergic rhinitis. Eur J Intern Med. 2011;22(6):e75-e79. Crossref
• 11. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. Crossref
• 12. Souza TMO, Fernandes JS, Santana CVN, Lessa MM, Cruz ÁA. Aeroallergen sensitization patterns among patients with chronic rhinitis with or without concomitant asthma. Braz J Otorhinolaryngol. 2024;90(2):101351. Crossref
• 13. Jura-Szołtys E, Niemiec-Górska A, Glück J, Branicka O, Gawlik R. Evaluation of rhinological symptoms and quality of life in patients with allergic or eosinophilic severe uncontrolled asthma treated with anti-IgE or anti-IL5 therapy: a real-life study. Int Arch Allergy Immunol. 2025;186(11):1033-1043. Crossref
• 14. Navarro-Cascales T, Colque-Bayona M, Fernandez-Concha I, Laorden D, Quirce S, Domínguez-Ortega J. A comparison of the impact of anti-IL5/5r therapies in allergic versus non-allergic patients with severe eosinophilic asthma in a real-life setting. J Asthma. 2025;62(2):319-327. Crossref
• 15. Sousa-Pinto B, Louis G, Vieira RJ, Pereira AM, Gemicioglu B, Kupczyk M, et al. Assessment of the underreporting of rhinitis in patients with asthma: a MASK-air® real-world study. Pulmonology. 2025;31(1):2419216. Crossref
• 16. Maselli DJ, Sherratt J, Adams SG. Comorbidities and multimorbidity in asthma. Curr Opin Pulm Med. 2025;31(3):270-278. Crossref
• 17. Lee JK, Pollard SJ, Liu MC, Schleich F, Pelaia G, Almonacid C, et al. Mepolizumab real-world effectiveness in severe asthma with an eosinophilic phenotype and overlapping severe allergic asthma. Ann Allergy Asthma Immunol. 2025;135(1):37-46. Crossref
• 18. Okwuofu EO, Yong ACH, Lim JCW, Stanslas J. The era of multiple biologics: is combination and switching an option in the management of severe asthma? Pulm Pharmacol Ther. 2025;90:102375. Crossref
• 19. Kleine-Tebbe J, Mailänder C. Patterns of allergen sensitization in patients with severe asthma in Germany. J Allergy Clin Immunol Pract. 2020;8(2):744-746.e3. Crossref
• 20. Roberts G, Fontanella S, Selby A, Howard R, Filippi S, Hedlin G, et al. Connectivity patterns between multiple allergen specific IgE antibodies and their association with severe asthma. J Allergy Clin Immunol. 2020;146(4):821-830. Crossref
• 21. Larenas-Linnemann D, Diamant Z, Jesenak M, Navarrete-Rodríguez EM, Kappen J, Porsbjerg C. Combination of allergen-specific immunotherapy with biologics in severe asthma: counterintuitive or rational? J Allergy Clin Immunol Pract. 2025;13(7):1581-1596. Crossref
• 22. Agache I, Lau S, Akdis CA, Smolinska S, Bonini M, Cavkaytar O, et al. EAACI guidelines on allergen immunotherapy: house dust mite-driven allergic asthma. Allergy. 2019;74(5):855-873. Crossref
• 23. Woehlk C, Von Bülow A, Ghanizada M, Søndergaard MB, Hansen S, Porsbjerg C. Allergen immunotherapy effectively reduces the risk of exacerbations and lower respiratory tract infections in both seasonal and perennial allergic asthma: a nationwide epidemiological study. Eur Respir J. 2022;60(5):2200446. Crossref
• 24. Gradman J, Halken S. Preventive effect of allergen immunotherapy on asthma and new sensitizations. J Allergy Clin Immunol Pract. 2021;9(5):1813-1817. Crossref