When to test for parasitic infections before beginning treatment with biologics in patients with CRSwNP?

The development of type-2 biologics allows successfull treatment of patients with recurring, severe chronic rhinosinusitis with nasal polyps. The selective effect mechanism of biologics also targets the part of our immunosystem, that contributes to our physiological defense against parasitic diseases.

We analyzed retrospectively patients who were referred to our hospital within the last 12 months to begin treatment with biologics due to an underlying typ 2 respiratory disease.

15 Patiens underwent testing for parasitic infections. This subgroup showed a blood eosinophilia percentage of 12,5% (SD 4,4) with blood eosionphils of 888/µl (SD 323). 6 of the 15 patients had a history of travelling to tropical regions multiple times with long term residencies. One patient had a history of increased occupational exposition for parasitic infections (cattle breeder). 2 patients could be diagnosed with parasitic infections (Toxocara and Stongyloides).

Our dataset doesn’t allow to define a specific threshold for blood eosinophila which should lead to testing for parasitic infections. Due to the underlying type-2 respiratory diseases a symptom based approach also does’t seem to be useful. In order to to determine when to test for parasitic infections before beginning therapy with typ-2 biologics we suggest a combined approach taking patient history of exposure (occupational, travel and immigration) and a theresholf of blood eosinophila into account. Further investigation of populatio based data is neccessary to validate this approach.

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Artikel online veröffentlicht:
24. Mai 2022