Chronic Rhinosinusitis and Nasal Polyps in Eosinophilic Granulomatosis With Polyangiitis: A Scoping Review

Chronic rhinosinusitis (CRS) is one of the most common manifestations of eosinophilic granulomatosis with polyangiitis (EGPA), often preceding the diagnosis of systemic vasculitis by several years. The sinonasal presentation of EGPA typically resembles CRS with nasal polyps (CRSwNP), making it clinically indistinguishable from those without EGPA. This overlap frequently contributes to significant diagnostic delays. This scoping review summarizes the prevalence, diagnosis, management, and outcomes of CRSwNP and CRS without nasal polyps (CRSsNP) in EGPA.

We searched MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science from inception to June 4, 2025, for studies reporting CRS in patients with EGPA. Eligible designs included trials, cohorts, case series, and narrative reviews. Non-English studies without translation and articles without primary data were excluded. Outcomes included CRS prevalence, diagnostic modalities, management strategies, and sinonasal outcomes. This study is registered with the Open Science Framework (DOI: 10.17605/OSF.IO/DA5CK).

Eighty-three full-text and 26 abstracts were included, for a total of 109 studies, of which 88 studies (74 full-text and 14 abstracts were included in the analysis). Across the analyzed studies, 1087 patients with CRS and EGPA were included. Median age was 53 years (range: 14.5-75; n = 154), and 189 (48.5%; n = 390) were male. CRSwNP and CRSsNP occurred in 753 (69.3%) and 334 (30.7%) of patients, respectively. The median time from CRS onset to EGPA diagnosis was 66 months (range: 1-120; n = 35). Among 857 patients, EGPA was classified using ACR 1990 criteria (51.7%), ACR/EULAR 2022 (2.7%), and combined frameworks (45.6%). Diagnostic modalities included CT sinus (97.6%), nasal endoscopy (94.7%), and sinus biopsy (91.8%). Biopsy-proven vasculitis was confirmed in three (1.3%) patients. Systemic steroids were used in 362 (91%; n = 398) patients, immunosuppressants in 290 (86.6%; n = 336) patients, and biologics in 154 (58.9%; n = 262) patients, primarily mepolizumab (73.3%), dupilumab (23.4%), and benralizumab (11.7%). Complete CRS remission was achieved in 106 (67.9%) patients following medical therapy and in 11 (18.2%) patients after combined surgical and medical treatment. Among those receiving dupilumab (n = 15), mean SNOT-22 improved by 25.2 (n = 9), with complete remission in six (83.3%) patients.

CRSwNP is the predominant sinonasal phenotype of EGPA. Management is shifting toward targeted biologics with evidence supporting mepolizumab and benralizumab for systemic disease control. Standardized outcome reporting and prospective comparative studies are needed to optimize management and reduce diagnostic delays.