CHRONIC sinusitis inflammation remains difficult to control, despite therapies that can suppress key inflammatory mediators.
A narrative review examining allergic rhinitis and chronic rhinosinusitis found that symptoms and routine clinical measures may not fully reflect underlying nasal and sinus inflammation. The authors highlighted the potential value of cytology, nasal secretion analysis, and tissue testing for evaluating treatment response more precisely.
Allergic rhinitis is driven predominantly by type 2 inflammation involving interleukin 4, interleukin 5, interleukin 13, mast cells, and eosinophils. Chronic rhinosinusitis is more heterogeneous and may involve type 1, type 2, or type 17 immune responses, depending on the clinical phenotype and presence of nasal polyps.
The review identified several potential methods for quantifying inflammation. Nasal cytology can determine eosinophil levels, while enzyme linked immunosorbent assays and flow cytometry can measure cytokines, chemokines, enzymes, and growth factors in nasal secretions.
Pathology and immunohistochemistry may provide further information about eosinophilic activity, epithelial damage, vascular changes, and tissue remodeling. However, nasal secretion sampling is not yet standardized, limiting comparisons between studies and routine clinical implementation.
Seasonal allergen exposure may also alter symptoms and biomarker concentrations. The authors therefore cautioned that findings in seasonal allergic rhinitis can be less consistent than those obtained in perennial disease.
Intranasal corticosteroids reduced eosinophils and several inflammatory mediators across studies included in the review. Antihistamines and combined intranasal corticosteroid and antihistamine therapy also improved clinical and cytological measures in allergic rhinitis.
For chronic rhinosinusitis, treatment must reflect disease phenotype. Options discussed included corticosteroids, saline irrigation, selected antibiotics, biologic therapy, and endoscopic sinus surgery. Continuous intranasal corticosteroid use appeared particularly important for controlling eosinophilic inflammation, including in chronic rhinosinusitis with nasal polyps.
The review also examined emerging evidence for plant extracts. Although some studies reported improvements in inflammatory markers or symptoms, these approaches require further investigation before their place in routine care can be established.
Overall, the findings suggest that combining clinical outcomes with objective inflammatory biomarkers could support more personalized treatment. However, inflammatory control in allergic rhinitis and chronic rhinosinusitis remains unsatisfactory, emphasizing the need for standardized testing and additional conservative therapies.
Reference
Perić A et al. Assessment of inflammation control in allergic rhinitis and chronic rhinosinusitis. J Inflamm Res. 2026;19:563743. DOI: 10.2147/JIR.S563743.
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