Comorbid Chronic Rhinosinusitis and Asthma: Shared Risk Factors and Treatment Implications-An EAACI Task Force Report

Sanna Toppila-Salmi; Sietze Reitsma; Valérie Hox; Simon Gane; Philippe Gevaert; Juan Maza-Solano; Alma Helevä; Ida Sulku; Kaisa Santala; Iiris Kangasniemi; Ludger Klimek; Adam Chaker; Aspasia Karavelia; Michael Rudenko; Oliver Pfaar; Laura Van Gerven; Shaari Ariana; Michele Schiappoli; Marie Lundberg; Jan Hagemann; Ibon Eguíluz-Gracia; Andre Moreira

doi:10.1111/all.70237

Comorbid Chronic Rhinosinusitis and Asthma: Shared Risk Factors and Treatment Implications-An EAACI Task Force Report

Allergy. 2026 Feb 5. doi: 10.1111/all.70237. Online ahead of print.

Authors

Sanna Toppila-Salmi^{1

2

3}, Sietze Reitsma⁴, Valérie Hox⁵, Simon Gane⁶, Philippe Gevaert⁷, Juan Maza-Solano^{8

9}, Alma Helevä³, Ida Sulku¹, Kaisa Santala¹, Iiris Kangasniemi¹, Ludger Klimek¹⁰, Adam Chaker¹¹, Aspasia Karavelia¹², Michael Rudenko¹³, Oliver Pfaar¹⁴, Laura Van Gerven^{15

16

17}, Shaari Ariana¹⁸, Michele Schiappoli¹⁹, Marie Lundberg²⁰, Jan Hagemann¹⁰, Ibon Eguíluz-Gracia²¹, Andre Moreira^{22

23

24}

Affiliations

¹ Department of Otorhinolaryngology, University of Eastern Finland, Joensuu and Kuopio, Finland.
² Department of Otorhinolaryngology, Wellbeing Services County of Pohjois-Savo, Kuopio, Finland.
³ Department of Allergology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴ Department of Otorhinolaryngology/Head-Neck Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁶ Royal National Ear, Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK.
⁷ Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium.
⁸ Rhinology and Skull Base Unit, Department of Otolaryngology, University Hospital Virgen del Rocío, Seville, Spain.
⁹ Department of Surgery, University of Seville, Seville, Spain.
¹⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
¹¹ Department of Otorhinolaryngology and Center for Allergy and Environment, Technical University of Munich, Munich, Germany.
¹² ENT Department, General Hospital of Kalamata, Kalamata City, Greece.
¹³ London Allergy and Immunology Centre, London, UK.
¹⁴ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
¹⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
¹⁶ Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.
¹⁷ Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
¹⁹ Allergy Department & Asthma Center Medico Chirurgo, Azienda Ospedaliera Universitaria Integrata Verona, Università degli Studi di Padova, Verona, Veneto, Italy.
²⁰ Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²¹ Allergy Unit, Hospital Regional Universitario de Malaga, IBIMA-Plataforma BIONAND, RICORS Enfermedades Inflamatorias, Malaga, Spain.
²² Centro Hospitalar Universitário São João, Porto, Portugal.
²³ Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
²⁴ EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.

PMID: 41645639
DOI: 10.1111/all.70237

Abstract

Chronic rhinosinusitis (CRS) and asthma are prevalent conditions that often coexist. These diseases share common inflammatory mechanisms, such as T-helper cell 2 (T2)-high inflammation, driven by interleukin (IL)-4, IL-5, and IL-13 cytokines. The frequent comorbidity between CRS, especially CRS with nasal polyps (CRSwNP), and asthma exacerbates disease severity, impairs quality of life, and complicates treatment. Patients with NSAID-exacerbated respiratory disease (N-ERD) represent a severe phenotype of this disease, characterized by the coexistence of CRSwNP, asthma, and NSAID hypersensitivity, which poses unique therapeutic challenges. This EAACI Task Force explores the shared risk factors, including genetic predispositions, epithelial barrier dysfunction, microbiome dysbiosis, underlying CRS, and asthma. It also evaluates current therapeutic strategies such as biologics, aspirin therapy after desensitization (ATAD), and endoscopic sinus surgery (ESS). Biologics have shown their effectiveness and safety in the treatment of asthma and CRS. Dupilumab, mepolizumab, depemokimab, and omalizumab have emerged as transformative therapies, particularly for patients with severe type 2 inflammation. Tezepelulumab is effective for both T2-high and T2-low asthma and CRSwNP. Itepekimab has shown its effect in asthma and is under investigation for CRSwNP. Omalizumab is effective in allergic asthma and CRSwNP. ATAD provides an additional disease-modifying approach for N-ERD, though patient adherence and tolerability remain critical challenges. ESS significantly improves asthma control, reduces medication use, and enhances sinonasal outcomes, particularly in severe asthma cases; however, these patients often need recurring surgeries. Despite these advances, treatment outcomes vary based on individual phenotypes and endotypes, underscoring the need for personalized approaches. The report highlights gaps in the literature, such as the lack of head-to-head trials comparing biologics, ATAD, and surgery. Future research should focus on refining treatment algorithms, identifying biomarkers for treatment selection, and assessing long-term outcomes to optimize care for patients with CRS, asthma, and N-ERD.

Keywords: ENT (rhinitis, sinusitis, nasal polyps…); asthma; asthma treatment.

Abstract

Grants and funding