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Purpose of the Review The coexistence of Obstructive Sleep Apnea (OSA) and chronic rhinitis, two very frequent entities with different relevance in terms of morbidity and mortality in general population, is well-known. This review summarizes the relationship of both, and how different treatments for chronic rhinitis can contribute significantly to the management of OSA. The connection between nasal inflammation and continuous positive airway pressure is also characterized. Recent Findings Nasal tolerance to Continous Airway Positive Pressure (CPAP) is sometimes problematic, and the occurrence of nasal irritation may lead to the abandonement of a useful alternative; however, it has been demonstrated through local biomarker measurements, improvement in the inflammation characteristic of chronic rhinitis, after the sustained use of CPAP. The biological markers that explain systemic inflammation in OSA (IL-1, IL-6, TNFα), are related to the development and perpetuation of rhinitis [ 1 •, 2 ••]. Among the rhinitis treatments that improve OSA, nasal corticosteroids should be mentioned in first place, with proven efficacy, especially in the group affected by allergic rinitis, with improvement in the quality of life but not in the apnea and hypopnea index (AHI). Allergic rhinitis is associated with high house dust mites’ concentrations in the CPAP filters [ 3 ] and the addition of nasal steroids improves the associated symptoms. Leukotriene receptor antagonists reduce inflammatory parameters in the pediatric population, and contribute synergistically with nasal steroids, thus reducing the severity of the sleep apnea symptoms [ 4 – 6 ]. Summary This review focuses on chronic rhinitis treatments and their clinical efficacy in reducing the severity of OSA, in adult and pediatric populations, emphasizing on the pathophysiology from Starling’s obstructive model, and on the common inflammatory nature of both clinical conditions. Reducing the load of local inflammatory mediators that cause nasal congestion improves patients with mild OSA, although it is not as effective in patients with moderate and severe symptoms, in whom CPAP remains the best alternative.

Purpose of the Review The classic treatment of non-steroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (NERD) includes aspirin desensitization (AD). Introduction of biologics in the treatment of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) has raised the question: which of the two options may be the most suitable for NERD? Recent Findings NERD is a highly eosinophilic disease. Monoclonal antibodies targeting IL-5 or the IL-5 receptor, involved in eosinophil recruitment, have been shown to be effective in asthma and CRSwNP. However, no difference in clinical efficacy was observed between NERD and aspirin-tolerant patients. Dupilumab, an IL-4 alpha receptor antagonist, demonstrated greater efficacy in NERD than in aspirin-tolerant patients for some clinical symptoms in a sub-analysis. Patients with NERD respond very rapidly to omalizumab with improvement in asthma and CRSwNP symptoms associated with reductions in prostaglandin D2 and cysteinyl leukotrienes release. Furthermore, omalizumab and dupilumab partially or totally restored tolerance to aspirin in NERD patients. Summary The decision to treat a NERD patient with AD or a biologic depends on many variables, such as differences between countries in the use of AD treatment in specialized units, limitations in accessing very expensive treatment in low-income countries and in countries where insurance systems do not cover or partially cover the cost of treatment. Patients who live in countries with public health systems that fully fund biologic treatments are more likely to benefit from biologic treatment. The limited data available so far suggest that, among current biologics, dupilumab ranks best for the treatment of CRSwNP associated with NERD.

Purpose of ReviewRecent research efforts have spurred great progress in the diagnosis and management of eosinophilic esophagitis (EoE). Nonetheless, challenges remain in addressing disease burden and impairment in the growing EoE population. We highlight work from the Cincinnati Center for Eosinophilic Disorders, the Consortium of Eosinophilic Gastrointestinal Disease Researchers, and others that address these ongoing challenges.Recent FindingsNew tools for characterizing EoE disease activity include the EoE Histology Scoring System (EoEHSS), endoscopic alternatives, validated patient-reported outcome (PRO) questionnaires, and investigational biomarkers. These diagnostic and monitoring strategies have been complemented by advances in EoE therapy. Treatment modalities have refined the traditional approaches of dietary elimination, swallowed steroids, and proton pump inhibitors (PPI), and biologics offer promise for future treatment.SummaryThis review summarizes EoE advances in disease management and newly defined EoE endotypes that may serve as the foundation for EoE-personalized medicine.