Three T2 inflammatory diseases in adolescents: asthma, eosinophilic esophagitis, and chronic polypous rhinosinusitis (clinical case)


Volume 70 • Issue 3 • September 2022, pp. 34-41

Received: 07.06.2022​ | Accepted for publication: 31.07.2022 | ​Publication date: 20.09.2022

ORCID logo D. Sh. Macharadze​1 , ORCID logo B. G. Kulumbegov2

1 Peoples’ Friendship University of Russia, 6, Miklukho-Maklaya str., Moscow, 117198, Russia
2 Caucasus International University, 2, Lubliana str., 0719, Tbilisi, Georgia

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It has long been known that comorbid diseases such as chronic polypous rhinosinusitis and obesity adversely affect the pathophysiology of asthma, impair response to therapy and reduce the quality of life of patients. Identification and effective treatment of comorbidities will improve asthma control and reduce the frequency of exacerbations. There are more and more studies that indicate a close pathophysiological relationship with allergic diseases of eosinophilic esophagitis. According to the latest data in the development of allergic diseases (asthma, allergic rhinitis, atopic dermatitis, food allergy), chronic polypous rhinosinusitis, and eosinophilic esophagitis, the key is the T2 immune response (T2 inflammation) in both children and adults.

Timely diagnosis of inflammatory states of T2 inflammation can help in choosing the optimal treatment for such patients. Here we describe the comorbid conditions that occur in an adolescent with controlled asthma and discuss the features of their clinical course.

The purpose of this work is to raise the awareness of practitioners about comorbid diseases — eosinophilic esophagitis and chronic polypous rhinosinusitis in children with bronchial asthma. Each of these comorbid diseases has clear diagnostic criteria, although they are underdiagnosed by medical specialists.


1. Ponte EV, Franco R, Nascimento HF. et al. Lack of control of severe asthma is associated with co-existence of moderate-to-severe rhinitis. Allergy. 2008; 63 (5): 564–569. doi: 10.1111/j.1398-9995.2007.01624.x.

2. Wallace DV, Dykewicz MS, Bernstein DI. et al.; Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug; 122 (2 Suppl): S. 1–84. doi: 10.1016/j.jaci.2008.06.003. Erratum in: J Allergy Clin Immunol. 2008 Dec; 122 (6): 1237.

3. Magnan A, Meunier JP, Saugnac C, Gasteau J, Neukirch F. Frequency and impact of allergic rhinitis in asthma patients in everyday general medical practice: a French observational cross-sectional study. Allergy. 2008; 63 (3): 292-298. doi: 10.1111/j.1398-9995.2007.01584.x.

4. Akdis C, Bachert C, Cingi C. et al. Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2013; 131: 1479–1490. doi: 10.1016/j.jaci.2013.02.036.

5. Fokkens W, Lund V, Hopkins C. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020; 58 (Suppl. S29): 1–464. doi: 10.4193/Rhin20.401.

6. Tyler MA, Russell CB, Smith DE. et al. Large-scale gene expression profiling reveals distinct type 2 inflammatory patterns in chronic rhinosinusitis subtypes. J Allergy Clin Immunol. 2017; 139 (3): 1061–4.e4. doi:10.1016/j.jaci.2016.09.048.

7. Stevens WW, Peters AT, Tan B. et al. Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis. J Allergy ClinImmunol Pract. 2019; 7 (8): 2812–20.e3. doi: 10.1016/j.jaip.2019.05.009.

8. Bachert C, Maurer M, Palomares O, Busse WW. What is the contribution of IgE to nasal polyposis? J Allergy Clin Immunol. 2021 Jun; 147 (6): 1997–2008. doi: 10.1016/j.jaci.2021.03.016.

9. Kinoshita Y, Oouchi S, Fujisawa T. Eosinophilic gastrointestinal diseases — pathogenesis, diagnosis, and treatment. Allergol Int. 2019; 68 (4): 420–429. doi: 10.1016/j.alit.2019.03.003.

10. Arias Á, Lucendo AJ. Molecular basis and cellular mechanisms of eosinophilic esophagitis for the clinical practice. Expert Rev Gastroenterol Hepatol. 2019; 13 (2): 99–117. doi: 10.1080/17474124.2019.1546120.

11. Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017; 5 (3): 335–358. doi: 10.1177/2050640616689525.

12. Dellon ES, Liacouras CA, Molina-Infante J. et al. Updated International Consensus Diagnostic Critеria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018; 155 (4): 1022–1033.e10. doi: 10.1053/j.gastro.2018.07.009.

13. Helman S, Barrow E, Edwards T. et al. The Role of Allergic Rhinitis in Chronic Rhinosinusitis. Immunol Allergy Clin North Am. 2020; 40 (2): 201–214. doi:10.1016/j.iac.2019.12.010.

14. Bao K, Reinhardt R. The differential expression of IL-4 and IL-13 and its impact on type-2 immunity. Cytokine. 2015; 75 (1): 25–37. doi: 10.1016/j.cyto.2015.05.008.

15. Poddighe D, Brambilla I, Licari A, Marseglia G. Pediatric rhinosinusitis and asthma. Respir. Med. 2018; 141: 94–99. doi: 10.1016/j.rmed.2018.06.016.

16. Villwock J, Kuppersmith R. Diagnostic Algorithm for Evaluating Nasal Airway Obstruction. Otolaryngol Clin N Am. 2018; 51: 867–872. doi: 10.1016/j.otc.2018.05.002.

17. Caimmi D, Matti E, Pelizzo G. et al. Nasal polyposis in children. J Biol Regul Homeost Agents. 2012 Jan-Mar; 26 (1 Suppl): S. 77–83.

18. Brietzke S, Shin J, Choi S. et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014; 151 (4): 542–553. doi. org/10.1177/0194599814549302.

19. Martin L, Franciosi J, Collins M. et al. Pediatric Eosinophilic esophagitis Symptom Scores (PEESS v2.0) identify histologic and molecular correlates of the key clinical features of disease. J Allergy Clin Immunol. 2015; 135 (e8): 1519–1528. doi: 10.1016/j.jaci.2015.03.004.

20. Ram G, Lee J, Ott M. et al. Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis. Ann Allergy Asthma Immunol 2015; 115: 224–228. doi: 10.1016/j.anai.2015.07.004.

21. Hill D, Grundmeier R, Ramos M, Spergel J. Eosinophilic esophagitis is a late manifestation of the allergic march. J Allergy Clin Immunol Pract. 2018; 6: 1528–1533. doi: 10.1016/j.jaip.2018.05.010.

22. Muñoz-Bellido FJ, Moreno E, Dávila I. Dupilumab: A Review of Present Indications and Off-Label Uses. J Investig Allergol Clin Immunol. 2022 Apr 19; 32 (2): 97–115. doi: 10.18176/jiaci.0682.


Macharadze DSh, Kulumbegov BG. Three T2 Inflammatory Diseases in Adolescents: Asthma, Eosinophilic Esophagitis, and Chronic Polypous Rhinosinusitis (Clinical Case). Allergology and Immunology in Pediatrics. 2022; 3: 34–41. (In Russ.)

For correspondence:

Dali Sh. Macharadze

Doctor of Medical Sciences, Professor of the Department of Nursing at the Peoples’ Friendship University of Russia

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Supporting agencies:

There is no source of funding

Сonflict of interest:

D.Sh. Macharadze is a member of the editorial board