Rhinitis, rhinosinusitis, nasal polyps. In chronic forms, these diseases can interfere with and affect the life of the patient, greatly reducing the quality of life. In addition to the classic therapeutic strategies, both medical and surgical, there are solutions that can provide only temporary relief without unfortunately being decisive. The new biological drugs of the latest generation may be able to change the current scenario. We talked about it with Dr. Enrico Heffler, of Personalized Medicine: Asthma and Allergology in Humanitas and Professor at Humanitas University, recently elected President of the Italian Academy of Nasal Cytology (AICNA).
Types of pathologies of the nose
“Rhinitis is a very frequent disease, and among these the most frequent allergic rhinitis,” says Dr. Enrico Heffler, of Personalized Medicine: Asthma and Allergology in Humanitas and professor at Humanitas University, recently elected President of the Italian Academy of Nasal Cytology. “Then there are the chronic rhinosinusitis, without nasal polyposis, usually infectious, or with nasal polyposis, expression of an important inflammation. Finally, we have non-allergic rhinitis, often diagnosed once the other forms are excluded. In reality, for these cases a simple and non-invasive examination, the nasal cytology, allows to distinguish different types of non-allergic rhinitis, detecting the inflammatory characteristics, useful information to customize the therapy.
A new therapy: biological drugs
To treat rhinitis and rhinosinusitis, one can switch from different therapies, from the pharmacological one (antihistamines, cortisone, some vasoconstrictor) to the surgical one. If, however, both fail, a road that is being explored is represented by biological drugs.
“By biological drugs we mean substances that instead of acting on the inflammation already in place work upstream, where the inflammatory process begins – said Dr. Heffler -. For allergic rhinitis we already have for many years specific immunotherapy, the so-called ‘vaccine for allergies’, which modifies the immune response by inducing tolerance towards allergens. In non-allergic forms with a significant inflammation and presence of a particular type of cells, eosinophils, often involved in the presence of polyposis, are studying the effects of biological drugs already used for asthma. One of these is a monoclonal antibody that acts against a substance, interleukin 5 (IL-5), which causes it to grow, mature, reach the tissues and activate eosinophils. Previously published experiences show that blocking IL-5 results in a reduction in the size of nasal polyps and symptoms, with a better overall quality of life for patients.
Experimental studies still in progress at Humanitas
The new biological drugs are not yet on the market, but there are experimental studies underway, including in Humanitas: “We are about to start our second clinical trial with a monoclonal antibody against the IL-5 receptor, and we have just finished a search with monoclonal antibodies that block another two cytokines, IL-4 and IL-13, with an even more upstream action in the inflammatory cascade and that and therefore manage to be effective in patients where the blockage of IL-5 alone may not be enough – continued Dr. Heffler -: We can say that we are faced with an increasing customization in the choice of therapy: based on the inflammatory characteristics detected, the severity of the clinical picture and the extent of nasal polyposis.