“Biological therapies that block interleukin 5 (Il-5) have proven to be very effective in both the management of severe asthma and nasal polyposis. The two diseases, in fact, share the same inflammatory pathway and often coexist. In patients with severe asthma, it is estimated that 45-50% also have nasal polyposis, a high figure compared to the prevalence of polyposis in the general population, which is 2-3%. On the other hand, 70-80% of patients with nasal polyposis also has asthma, although not always severe. Being able to treat both pathologies with a single drug that acts on a central mechanism such as interleukin 5 is a precious therapeutic opportunity.” Enrico Heffler, director of the School of Specialization in Allergology and Clinical Immunology at Humanitas University Milan, said this to Adnkronos Health on the occasion of the Siaaic congress, the Italian Society of Allergology, Asthma and Clinical Immunology, which took place in Rome.
“Severe asthma and nasal polyposis – explains Heffler – are two chronic inflammatory diseases of the respiratory tract. In both, in the vast majority of cases, the inflammation is type 2. This inflammation is characterized by an important infiltrate of eosinophils, cells that normally we have in our immune system, but when they are overexpressed in the tissues, especially in the respiratory airways and in the nasal-sinus tissue, as regards polyposis, they cause a series of local damages with characteristic clinical manifestations”.
The heart of the problem is inflammation. “In asthma – continues the specialist – it causes bronchial hyperreactivity, i.e. the bronchi become more reactive to external stimuli and tend to close more easily, causing bronchospasm with shortness of breath which is followed by other symptoms. In nasal polyposis, however, where there are no muscles, as in the bronchi, the infiltrate of eosinophils and other cells forms growths called polyps which occupy the nasal cavity and paranasal sinuses, causing significant obstruction, loss of smell and consequences such as worsening of the quality of sleep , due to breathing difficulties.”
In this inflammatory context, the role of interleukin 5 is fundamental. “It is a cytokine, a protein produced by different cell types, in particular by T lymphocytes and cells called Innate Lymphoid Cells 2 – explains Heffler – This cytokine is central for the birth, growth, maturation and activation of eosinophils. Thanks to interleukin 5, eosinophils mature in the bone marrow, enter the bloodstream and then into target tissues, such as the bronchi and paranasal sinuses eosinophils not only migrate into tissues, but become activated, releasing toxic substances that damage the surrounding environment. Since both diseases share the same inflammatory pathway, it is possible to treat them with a single biologic drug.”
At an international level “there are already guidelines and recommendations for both severe asthma and nasal polyposis, which help us consider biological therapy for eligible patients – specifies Heffler – The choice of drug depends on the phenotyping of the patient, i.e. from the study of its inflammatory components, and from how much interleukin 5 is the main target or whether another approach is necessary. There are also disease registers to monitor the progress of the pathologies and the response to the different treatments Sani registry (Severe Asthma Network Italy) for severe asthma and the Rinet registry (Rhinosinusitis Italian Network) for nasal polyposis”.
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