Rhinosinusitis, nasal polyposis, and allergy: guidelines and resourses
Expert Care for Chronic Nasal Conditions: Allergic and Non-Allergic
Chronic nasal problems like rhinitis, sinusitis, and nasal polyps often have similar symptoms, whether caused by allergies or other factors. Our dedicated team provides comprehensive care to accurately diagnose and effectively treat the root cause of your discomfort.
A Precise Diagnosis for Effective Treatment
To provide a clear diagnosis, our specialists use advanced techniques:
· Nasal Endoscopy: Our ENT surgeons use a thin, flexible tube with a light and camera to examine your nasal passages comfortably and in detail. This quick, in-clinic procedure causes minimal discomfort and is vital for identifying structural issues, polyps, or signs of infection.
· Allergy Testing: Our allergy consultants perform tests to confirm or rule out allergies as the primary cause of your symptoms. This ensures your treatment plan is precisely targeted.
A Full Spectrum of Treatment Options
We offer the complete range of modern treatments, tailored to your specific condition:
· Medical Management: From simple nasal sprays to advanced medical therapies.
· Surgical Solutions: Our collaborating ENT surgeons offer sophisticated, minimally invasive surgical techniques when necessary.
· Biological Treatments: If your ENT consultant recommends it, our immunologists can assess your suitability for innovative biological treatments.
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If you are seeking a new diagnosis or require a specialist opinion, please register as a new patient and book your initial appointment online.
A constantly runny or blocked nose can be frustrating. While allergies are a common cause, many non-allergic conditions can mimic them. Our experts are here to tell the difference and get you the right treatment.
Our Team of Specialists: Working Together for You
· Allergy Consultants who expertly diagnose and manage allergic triggers.
· ENT Surgeons (Ear, Nose & Throat) who specialize in the structural and non-allergic conditions of the nose and sinuses.
How We Find the Source of the Problem
We use special tests to see what’s happening inside:
· Nasal Endoscopy: Think of this as a tiny camera on a soft, flexible tube. Our ENT surgeon gently guides it through your nostril to get a clear, magnified view of your nasal passages. It’s not as uncomfortable as it sounds and is incredibly effective at finding the true cause of the issue.
· Allergy Testing: Simple skin or blood tests help us understand if allergies are playing a role, allowing us to tailor your plan accordingly.
Personalised Treatment From Simple to Advanced
We believe in creating a treatment plan that works for you and your condition. Options range from:
· First-step remedies like nasal drops and sprays.
· Specialized medical treatments.
· Minimally invasive surgery for lasting relief.
· We also collaborate closely to review patients for advanced options like biological treatments, if recommended.
Ready for Relief?
If you’ve been struggling with nasal symptoms, our consultants can help. Book your initial appointment online today to start your journey to better breathing.
Recent data on biologics
Recent advances in managing airway diseases have underscored the potential benefits of introducing biologic therapies early. The importance of biologic agents is further highlighted by the observation that chronic rhinosinusitis with nasal polyps (CRSwNP) often precedes the development of severe asthma—reflecting shared type 2 (T₂) inflammatory mechanisms in both upper and lower airway diseases. This provides a strong rationale for early biologic intervention in this patient population.
Management of nonsteroidal anti-inflammatory drug (NSAID)–exacerbated respiratory disease should incorporate biologic therapy, coupled with consideration of peripheral eosinophil counts and the severity of concurrent chronic rhinosinusitis. Escalation to T₂-targeting biologics—such as anti–interleukin-5 or anti–interleukin-4 receptor agents (e.g., dupilumab)—may be warranted based on eosinophil trends and disease progression.
A crucial distinction exists between clinical remission—defined as sustained disease control while on biologic therapy—and cure remission, which is sustained disease control after stopping therapy.
Safety monitoring is essential, particularly due to the possibility of transient peripheral eosinophilia during treatment, such as with dupilumab. Cross-disciplinary collaboration—especially between respiratory specialists and ENT clinicians—is vital to better characterise the temporal relationship between CRSwNP and asthma.
Additionally, there is a pressing need for adequately powered, prospective clinical studies to evaluate combination therapies and refine monitoring protocols for patients at risk of persistent eosinophilia. Standardising remission definitions and developing advanced biomarker algorithms in well-phenotyped cohorts will improve diagnostic accuracy and therapeutic stratification.
References:
- McDowell PJ, McDowell R, Patel M, et al. Clinical remission in severe asthma with biologic therapy: an analysis from the UK Severe Asthma Registry. Eur Respir J. 2023;62(6):2300819. doi:10.1183/13993003.00819-2023
- Chipps BE, Lugogo N, Carr W, et al. On-treatment clinical remission of severe asthma with real-world longer-term biologic use. J Allergy Clin Immunol Pract. 2024;!(observational study from CHRONICLE).
- Oishi K, et al. Early initiation of biologics in severe asthma could modify clinical course and prognosis: predictors of deep remission. J Clin Med. 2023; observational real-world evidence.
- Pérez de Llano L, et al. Remission definitions and patient characteristics in the International Severe Asthma Registry: early biologic initiation increases remission likelihood. Am J Respir Crit Care Med. 2024; longitudinal cohort.
- Ozdemir I, Bayar Muluk N, Yazır M, Cingi C. How does asthma coexistence affect the strategic selection of biologic therapies in CRSwNP management? Front Allergy. 2025;6:1579224. doi:10.3389/falgy.2025.1579224
- Neuland H, et al. Prospective study of NSAID tolerance after biologic therapy in NSAID-exacerbated respiratory disease: comparing benralizumab, mepolizumab, dupilumab, omalizumab. 2023. J Allergy Clin Immunol Pract. (Pilot trial)
Resources
EPOS Guidelines http://www.thepcrj.org/journ/vol17/17_2_79_89.pdf
ARIA Guidelines http://www.thepcrj.org/journ/vol11_1/0018_0019_bousquet.pdf
BSACI Guidelines for management of rhinosinusitis and nasal polyposis http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2007.02889.x/pdf
BSACI Guidelines for the management of allergic and non-allergic rhinitis http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2007.02888.x/pdf
Literature
- Bousquet J, Van Cauwenberge P, Khaltaev N, and the ARIA group. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;108(5 Suppl):S147-334.
- Price D, Bond C, Bouchard J, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: Management of allergic rhinitis. Prim Care Respir J 2006;15:58-70. doi: 10.1016/j.pcrj.2005.11.002
- Scadding GK, Fokkens WJ. Fast Facts: Rhinitis. Oxford: 2007. p46, p69, p89, p95
- Fokkens W, Lund V, Mullol J, on behalf of the European Position Paper on Rhinosinusitis and Nasal Polyps group. European Position Paper on Rhinosinusitis and Nasal Polyps 2007. Rhinology 2007;20(Suppl):1-136.
- Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis.Clinical and Experimental Allergy 2008;38:19-42.