In the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), the immunological endotype in Western populations predominantly involves which cytokine axis?
- A Th2 axis with IL-4, IL-5, IL-13, eosinophilia, elevated IgE, and epithelial alarmins (TSLP, IL-33) ✓
- B Th1 axis with IFN-γ, IL-12, and neutrophilia
- C Th17 axis with IL-17A, IL-22, and neutrophilia (predominant in Asian populations)
- D Mixed Th1/Th17 biofilm-driven inflammation with dominant bacterial superantigen activation
Correct answer: A. Th2 axis with IL-4, IL-5, IL-13, eosinophilia, elevated IgE, and epithelial alarmins (TSLP, IL-33)
Explanation
CRSwNP in Western populations is predominantly a Type 2 (Th2) endotype characterised by IL-4, IL-5, IL-13 overproduction, tissue eosinophilia, elevated total and specific IgE, and upregulation of epithelial-derived alarmins TSLP and IL-33. This underpins the use of biologics: dupilumab (anti-IL-4Rα blocking IL-4/IL-13), mepolizumab/benralizumab (anti-IL-5/IL-5Rα), and omalizumab (anti-IgE). In contrast, Asian CRSwNP is frequently Th1/Th17-skewed with neutrophilia — explaining lower biologic response rates in Asian cohorts.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.