Epicascade | Epithelial-Driven Inflammation Quiz

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IL=interleukin; TSLP=thymic stromal lymphopoietin.

REFERENCES

1. Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy. 2016;9:45-53. 2. Ha J-G, Cho H-J. Unraveling the role of epithelial cells in the development of chronic rhinosinusitis. Int J Mol Sci. 2023;24(18):14229. 3. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 4. Calvén J, Ax E, Rådinger M. The airway epithelium—a central player in asthma pathogenesis. Int J Mol Sci. 2020;21(23):8907. 5. Peters A, Zhao X, Near AM, et al. Real-world outcomes following biologic initiation in US patients with chronic rhinosinusitis with nasal polyps. Adv Ther. 2025;42(4):1783-1799. 6. Bachert C, Zhang N, Cavaliere C, Weiping W, Gevaert E, Krysko O. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020;145(3):725-739.

CRSwNP=chronic rhinosinusitis with nasal polyps.

REFERENCES

*Data refers to patients starting a biologic targeting downstream mediators.

CRSwNP=chronic rhinosinusitis with nasal polyps; INCs=intranasal corticosteroids; OCS=oral corticosteroid.

REFERENCES

1. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 2. Peters A, Han J, Spahn J, et al. Real-world outcomes following biologic initiation in US patients with chronic rhinosinusitis with nasal polyps. Presented at: ACAAI Annual Scientific Meeting; October 24-28, 2024; Boston, MA. 3. Bachert C, Zhang N, Cavaliere C, Weiping W, Gevaert E, Krysko O. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020;145(3):725-739. 4. Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic rhinosinusitis with nasal polyps: quality of life in the biologics era. J Allergy Clin Immunol Pract.
2022;10(6):1434-1453.e9. 5. van der Veen J, Seys SF, Timmermans M, et al. Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral
centre. Allergy. 2017;72(2):282-290. 6. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-555. 7. Claeys N, Teeling MT, Legrand P, et al. Patients unmet needs in chronic rhinosinusitis with nasal polyps care: a patient advisory board statement of EUFOREA. Front Allergy. 2021;2:761388. 8. Starry A, Hardtstock F, Wilke T, et al. Epidemiology and treatment of patients with chronic rhinosinusitis with nasal polyps in Germany—a claims data study. Allergy. 2022;77(9):2725-2736.

1. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 2. Peters A, Han J, Spahn J, et al. Real-world outcomes following biologic initiation in US patients with chronic rhinosinusitis with nasal polyps. Presented at: ACAAI Annual Scientific Meeting; October 24-28, 2024; Boston, MA. 3. Bachert C, Zhang N, Cavaliere C, Weiping W, Gevaert E, Krysko O. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020;145(3):725-739.
4. Mullol J, Azar A, Buchheit KM,
Hopkins C, Bernstein JA. Chronic rhinosinusitis with nasal polyps: quality of life in the biologics era. J Allergy Clin Immunol Pract.
2022;10(6):1434-1453.e9. 5. van der
Veen J, Seys SF, Timmermans M, et al. Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre. Allergy. 2017;72(2):282-290. 6. DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-555. 7. Claeys N, Teeling MT, Legrand P, et al. Patients unmet needs in chronic rhinosinusitis with nasal polyps care: a patient advisory board statement of EUFOREA. Front Allergy. 2021;2:761388. 8. Starry A, Hardtstock F, Wilke T, et al. Epidemiology and treatment of patients with chronic rhinosinusitis with nasal polyps in Germany—a claims data study. Allergy. 2022;77(9):2725-2736.

Image adapted from Kato A, et al. 2022² and Bachert C, et al. 2020.⁷
CRSwNP=chronic rhinosinusitis with nasal polyps; IL=interleukin; ILC2=type 2 innate lymphoid cell; Th=T helper; TSLP=thymic stromal lymphopoietin.

REFERENCES

1. Ha J-G, Cho H-J. Unraveling the role of epithelial cells in the development of chronic rhinosinusitis. Int J Mol Sci. 2023;24(18):14229. 2. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 3. Calvén J, Ax E, Rådinger M. The airway epithelium—a central player in asthma pathogenesis. Int J Mol Sci. 2020;21(23):8907. 4. Laulajainen-Hongisto A, Toppila-Salmi SK, Luukkainen A, Kern R. Airway epithelial dynamics in allergy and related chronic inflammatory airway diseases. Front Cell Dev Biol. 2020;8:204. 5. Stevens WW, Peters AT, Tan BK, et al. Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis. J Allergy Clin Immunol Pract. 2019;7(8):2812-2820.e3. 6. Staudacher AG, Peters AT, Kato A, Stevens WW. Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis. Ann Allergy Asthma Immunol. 2020;124(4):318-325. 7. Bachert C, Zhang N, Cavaliere C, Weiping W, Gevaert E, Krysko O. Biologics for chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2020;145(3):725-739.

CRSwNP=chronic rhinosinusitis with nasal polyps; EoE=eosinophilic esophagitis.

REFERENCES

1. Langdon C, Mullol J. Nasal polyps in patients with asthma: prevalence, impact, and management challenges. J Asthma Allergy. 2016;9:45-53. 2. Ha J-G, Cho H-J. Unraveling the role of epithelial cells in the development of chronic rhinosinusitis. Int J Mol Sci. 2023;24(18):14229. 3. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 4. Calvén J, Ax E, Rådinger M. The airway epithelium—a central player in asthma pathogenesis. Int J Mol Sci. 2020;21(23):8907. 5. Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: physiological interface and target of intervention for preventing and treating allergic diseases. Allergy. 2024;79(6):1485-1500.

EoE=eosinophilic esophagitis.

REFERENCES

1. Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: physiological interface and target of intervention for preventing and treating allergic diseases. Allergy. 2024;79(6):1485-1500. 2. Hill DA, Muir AB. The immune-epithelial interface in eosinophilic esophagitis: a conversation. Front Allergy. 2023;4:1270581. 3. Salvador Nunes VS, Straumann A, Salvador Nunes L, Schoepfer AM, Greuter T. Eosinophilic esophagitis beyond eosinophils – an emerging phenomenon overlapping with eosinophilic esophagitis: Collegium Internationale Allergologicum (CIA) update 2023. Int Arch Allergy Immunol. 2023;184(5):411-420. 4. Bredenoord AJ, Patel K, Schoepfer AM, et al. Disease burden and unmet need in eosinophilic esophagitis. Am J Gastroenterol. 2022;117(8):1231-1241. 5. Dellon ES, Rothenberg ME, Collins MH, et al. N Engl J Med. 2022;387(25):2317-2330. 6. Dellon ES. Management of refractory eosinophilic oesophagitis. Nat Rev Gastroenterol Hepatol. 2017;14(8):479-490. 7. Simon D, Radonjic-Hösli S, Straumann A, Yousefi S, Simon HU. Active eosinophilic esophagitis is characterized by epithelial barrier defects and eosinophil extracellular trap formation. Allergy. 2015;70(4):443-452.

CRSwNP=chronic rhinosinusitis with nasal polyps; EoE=eosinophilic esophagitis.

REFERENCES

1. Hill DA, Muir AB. The immune-epithelial interface in eosinophilic esophagitis: a conversation. Front Allergy. 2023;4:1270581. 2. Salvador Nunes VS, Straumann A, Salvador Nunes L, Schoepfer AM, Greuter T. Eosinophilic esophagitis beyond eosinophils – an emerging phenomenon overlapping with eosinophilic esophagitis: Collegium Internationale Allergologicum (CIA) update 2023. Int Arch Allergy Immunol. 2023;184(5):411-420. 3. Dellon ES, Muir AB, Katzka DA, et al. ACG clinical guideline: diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol. 2025;120(1):31-59. 4. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491-1503. 5. Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: physiological interface and target of intervention for preventing and treating allergic diseases. Allergy. 2024;79(6):1485-1500. 6. Calvén J, Ax E, Rådinger M. The airway epithelium—a central player in asthma pathogenesis. Int J Mol Sci. 2020;21(23):8907. 7. Ha J-G, Cho H-J. Unraveling the role of epithelial cells in the development of chronic rhinosinusitis. Int J Mol Sci. 2023;24(18):14229. 8. Dellon ES, Kim HP, Sperry SLW, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79(4):577-585.e4.

*Data from an observational cross-sectional study of 147 US adults with EoE. Adaptive eating behaviors were defined as taking smaller bites, chewing more, eating slowly, or drinking more water during meals.²
^†Data from a web-based survey of 184 US adults with EoE. Data showed the impact of perceived stigma over the past 12 months in adults.³
^‡Data from the US Nationwide Emergency Department Sample were used to estimate weighted annual EoE-associated ED visits from 2009 to 2019.⁴
^‖Retrospective study of 721 patients across 15 Dutch hospitals (1996-2015). Percentage of patients who presented with features of endoscopic fibrostenosis increased with longer diagnostic delay, from 56% (delay ≤2 years) to 92% (delay ≥21 years). Percentage of patients who presented with esophageal stricture also increased with diagnostic delay, from 19% (≤2 years) to 52% (≥20 years).⁸
^¶TSLP expression was calculated using an ordinal scoring system (0=none, 1=mild, 2=medium, 3=strong, 4=very strong) to represent how widely the cytokine marker was expressed in tissue sections, while nuclear expression of IL-33 and IL-25 was calculated by counting the number of infiltrating cytokine-positive cells in the area.¹¹

ED=emergency department; EoE=eosinophilic esophagitis; IL=interleukin; PPI=proton pump inhibitor; TSLP=thymic stromal lymphopoietin.

REFERENCES

1. Young E, Philpott H. Pathophysiology of dysphagia in eosinophilic esophagitis: causes, consequences, and management. Dig Dis Sci. 2022;67(4):1101-1115. 2. de Rooij WE, Evertsz FB, Lei A, Bredenoord AJ. General well-being and coping strategies in adult eosinophilic esophagitis patients. J Neurogastroenterol Motil. 2022;28(3):390-400. 3. Gold BD, Goodwin B, Davis K, et al. Health-related quality of life and perceived stigma in eosinophilic esophagitis: a real-world, US, web-based survey. Gastro Hep Adv. 2024;3(8):1087-1097. 4. Lam AY, Lee JK, Coward S, et al. Epidemiologic burden and projections for eosinophilic esophagitis-associated emergency department visits in the United States: 2009-2030. Clin Gastroenterol Hepatol. 2023;21(12):3041-3050.e3. 5. Dellon ES. Management of refractory eosinophilic oesophagitis. Nat Rev Gastroenterol Hepatol. 2017;14(8):479-490. 6. Dellon ES, Rothenberg ME, Collins MH, et al. N Engl J Med. 2022;387(25):2317-2330. 7. Bredenoord AJ, Patel K, Schoepfer AM, et al. Disease burden and unmet need in eosinophilic esophagitis. Am J Gastroenterol. 2022;117(8):1231-1241. 8. Warners MJ, Oude Nijhuis RAB, de Wijkerslooth LRH, Smout AJPM, Bredenoord AJ. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort. Am J Gastroenterol. 2018;113(6):836-844. 9. Syverson EP, Hait E. Update on emerging pharmacologic therapies for patients with eosinophilic esophagitis. Gastroenterol Hepatol (N Y). 2022;18(4):207-212. 10. Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: physiological interface and target of intervention for preventing and treating allergic diseases. Allergy. 2024;79(6):1485-1500. 11. Simon D, Radonjic-Hösli S, Straumann A, Yousefi S, Simon HU. Active eosinophilic esophagitis is characterized by epithelial barrier defects and eosinophil extracellular trap formation. Allergy. 2015;70(4):443-452.

EoE=eosinophilic esophagitis; IgE=immunoglobulin E; IL=interleukin; T2=type 2 disease; TSLP=thymic stromal lymphopoietin.

REFERENCES

1. Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: physiological interface and target of intervention for preventing and treating allergic diseases. Allergy. 2024;79(6):1485-1500. 2. Bredenoord AJ, Patel K, Schoepfer AM, et al. Disease burden and unmet need in eosinophilic esophagitis. Am J Gastroenterol. 2022;117(8):1231-1241. 3. Salvador Nunes VS, Straumann A, Salvador Nunes L, Schoepfer AM, Greuter T. Eosinophilic esophagitis beyond eosinophils – an emerging phenomenon overlapping with eosinophilic esophagitis: Collegium Internationale Allergologicum (CIA) update 2023. Int Arch Allergy Immunol. 2023;184(5):411-420.

IN EoE, CRSwNP, AND SEVERE ASTHMA,

HELP PROTECT AGAINST A FLOOD OF DOWNSTREAM MEDIATORS BY TAKING A CLOSER LOOK AT THE TOP OF THE CASCADE— EPITHELIAL-DRIVEN INFLAMMATION^1-5

This information is intended for Healthcare Professionals only.

MORE THAN A BARRIER

The epithelium is where the inflammatory cascade may begin across EoE, CRSwNP, and severe asthma^3,5

EXPLORE DIFFERENT DISEASES

Eosinophilic esophagitis

Chronic rhinosinusitis with nasal polyps

Severe asthma

Think you know about
epithelial-driven
inflammation?

IN EoE, CRSwNP, AND SEVERE ASTHMA,

HELP PROTECT AGAINST A FLOOD OF DOWNSTREAM MEDIATORS BY TAKING A CLOSER LOOK AT THE TOP OF THE CASCADE— EPITHELIAL-DRIVEN INFLAMMATION1-5

This information is intended for Healthcare Professionals only.

MORE THAN A BARRIER

The epithelium is where the inflammatory cascade may begin across EoE, CRSwNP, and severe asthma3,5

EXPLORE DIFFERENT DISEASES

Eosinophilic esophagitis

Chronic rhinosinusitis with nasal polyps

Severe asthma

Think you know about epithelial-driven inflammation?

HELP PROTECT AGAINST A FLOOD OF DOWNSTREAM MEDIATORS BY TAKING A CLOSER LOOK AT THE TOP OF THE CASCADE— EPITHELIAL-DRIVEN INFLAMMATION^1-5

The epithelium is where the inflammatory cascade may begin across EoE, CRSwNP, and severe asthma^3,5

Think you know about
epithelial-driven
inflammation?