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Inflammatory Signatures Beyond Th1/Th2 Endotypes Provide Insights Into Postoperative Recurrence in Chronic
Liyona Kampel1,2, Narin N Carmel1,2, Shaun Edalati2
1Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
International Forum of Allergy & Rhinology
|June 24, 2026
Summary
Elevated IL-33 and lymphoplasmacytic inflammation correlate with chronic rhinosinusitis recurrence. However, asthma remains the sole independent predictor of refractory disease, highlighting the need for targeted therapies.
Area of Science:
- Immunology
- Otolaryngology
- Molecular Biology
Background:
- Chronic rhinosinusitis (CRS) presents diverse inflammatory endotypes driven by T helper (Th) cell responses.
- High recurrence rates necessitate advanced characterization beyond traditional phenotypes for personalized treatment.
Purpose of the Study:
- To investigate the association between inflammatory endotypes, cytokine profiles, and clinical outcomes in CRS patients.
- To identify predictors of postoperative recurrence in chronic rhinosinusitis.
Main Methods:
- Sinonasal tissue samples from 105 CRS patients undergoing endoscopic sinus surgery were analyzed.
- Histopathology classified inflammatory patterns; multiplex immunoassay quantified Th1, Th2, Th17, and epithelial cytokines.
- Clinical, radiologic, and follow-up data were correlated with inflammatory and cytokine profiles.
Main Results:
- Type 2 CRS (62%) showed elevated IL-5, IL-13, and TSLP; non-type 2 CRS had higher IL-8.
- Recurrence (21%) linked to asthma, anosmia, prior steroid use, lymphoplasmacytic inflammation, IL-13, and IL-33.
- Asthma was the only independent predictor of recurrence (HR 2.48, p=0.049).
Conclusions:
- Elevated IL-33 and lymphoplasmacytic inflammation are associated with CRS recurrence.
- Epithelial-immune signaling plays a role in persistent mucosal inflammation.
- Comorbid asthma is the primary independent predictor of refractory CRS.
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