Background. Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a negative impact on quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating repeated courses of antibiotics, systemic corticosteroids, and multiple surgeries. Objective. The aim of this study was to investigate if the use of biologics can improve symptoms including facial pain and reduce use of rescue treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis. Materials and Methods. This is a real-life, observational, no-profit case series. Between November 2022 and December 2023, we enrolled cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated to invalidating facial pain measured by MIDAS score and that were treated with dupilumab 300 mg every 2 week and followed for at least 12 months. Results. the mean MIDAS score decreased from 45.6±10.7 at baseline to 1.3±2.3 at 6 months (p<0.05). The same trend was observed for VAS craniofacial pain: from 7.3±1.6 at baseline to 1.2±1.5 at 6 months (p<0.05). The use of systemic corticosteroids and analgesics was significantly reduced. No patient needed oral corticosteroids during treatment with dupilumab (p<0.05), and the use of analgesics decreased from 9.6±3.1 mean brief cycles of NSAIDs at baseline to 0.6±1.3 at 1 year of follow-up (p<0.05). Discussion. Our results demonstrated that use of an anti-type-2 inflammatory pathway biologic can improve symptom control including recurrent craniofacial pain and reduce the need for rescue medical treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.

Background: allergic rhinitis is a common childhood disease in industrialized countries that is responsible for a major impact on quality of life and health care resources. The objective of this review was to provide a systemic review of experimental and clinical evidence linking allergy to rhinosinusitis in children including common cold. Furthermore, we questioned if anti-allergy treatment may prevent the occurrence of rhinosinusitis or improve outcomes of its specific management. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process to identify experimental and clinical articles about allergy and acute or chronic rhinosinusitis in children published since January 2000. The research was performed in April 2020 including only English-language peer-reviewed papers. Our search yielded 7103 that were finally screened. This resulted in 30 publications of which the full texts were assessed and included in a qualitative analysis per different phenotypes of rhinosinusitis. Results: The evidence suggests that allergy may lead to overall impairment of mechanical and immunological defense function of the nasal mucosa against viruses and that anti-allergy treatment may significantly decrease the number and severity of upper respiratory tract infections including common colds in children. It was not possible to perform the analysis for allergy and post viral acute rhinosinusitis, bacterial acute rhinosinusitis and recurrent acute rhinosinusitis because of paucity and heterogeneity of data. We found interesting data linking allergy to chronic rhinosinusitis: although there is no definitive proof of causation studies lead to suppose that anti-allergy treatment may improve outcomes of specific CRS treatments. Conclusion: We summarized conclusions in a practical algorithm taking into account different phenotypes of rhinosinusitis in order to elucidate when prompt and accurate diagnosis of allergy is recommended. We lastly focused attention on the needs for future research.