Assessment of Inflammation Control in Allergic Rhinitis and Chronic Rhinosinusitis

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) in their non-polypous (CRS without nasal polyps - CRSsNP) and polypous (CRS with nasal polyps - CRSwNP) main phenotypes are chronic inflammatory diseases of the nasal mucosa and/or paranasal sinuses with a whole series of unknowns regarding etiology, pathogenesis, clinical manifestations, and therapeutic modalities. Although intranasal and oral antihistamines and intranasal corticosteroids are the main drugs in AR therapy, emerging evidence on the effects of herbal and biological drugs may add a new dimension to the treatment of these patients. CRS is a far more heterogeneous disease with numerous clinical phenotypes that require completely different approaches. In addition to endoscopic sinus surgery (ESS), which remains the mainstay of treatment, intranasal and systemic corticosteroids, macrolide antibiotics, and tetracyclines, as well as nasal irrigation with saline solutions, are the main modalities, especially in the period after surgical treatment. Recently, there has been increasing evidence for the beneficial effects of herbal medicines and biological therapy. However, to assess how well conservative treatment of AR and CRS keeps chronic inflammation under control, numerical parameters derived from cytological findings, biochemical analysis of nasal secretions by enzyme-linked immunoassay (ELISA), flow cytometry, and pathohistological and immunohistochemical analyses of tissue samples are necessary. This narrative review of the literature was done through a critical approach, which included our long-term experience in researching the effects of various drugs, as well as the results of other authors. The results of numerous studies have shown that the application of these drugs can significantly change the profile of inflammatory mediators (cytokines, chemokines, enzymes, growth factors) and thus direct the course of inflammation to a less intense form. Nevertheless, in spite of everything, the control of AR and CRS is still not at a satisfactory level, which directs us towards finding new modalities of conservative therapy, especially in the field of application of biological drugs and plant extracts.