From the Guidelines
Evidence of type 2 inflammation is characterized by the presence of cytokines IL-4, IL-5, and IL-13, as well as activation and recruitment of eosinophils and mast cells, which can be identified through biomarkers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), serum IgE, and periostin levels 1.
Key Features of Type 2 Inflammation
- Elevated levels of specific biomarkers, including:
- Blood eosinophils
- Fractional exhaled nitric oxide (FeNO)
- Serum IgE
- Periostin levels
- Clinical manifestations, such as:
- Allergic conditions like asthma, atopic dermatitis, allergic rhinitis, and chronic rhinosinusitis with nasal polyps
- Histological features, including:
- Eosinophilic infiltration
- Increased expression of type 2 cytokines (IL-4, IL-5, and IL-13)
Diagnostic Considerations
The diagnosis of type 2 inflammation can be supported by the presence of comorbid allergic conditions and a family history of atopy, as well as the response to targeted biologic therapies, such as dupilumab, mepolizumab, benralizumab, or reslizumab, and omalizumab 1.
Treatment Implications
The identification of type 2 inflammation is crucial, as it can inform the use of targeted biologic therapies, which have the potential to revolutionize the treatment of chronic rhinosinusitis (CRS) and other related conditions 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evidence of Type 2 Inflammation
The following are considered evidence of type 2 inflammation:
- High blood eosinophils 2, 3, 4
- High fractional exhaled nitric oxide (FeNO) 2, 5, 4, 6
- Expression of IL-13 inducible genes, such as 15LOX1, POSTN, CLCA1, SERPINB2, CCL26, and NOS2 2
- Presence of nasal polyps 3
- Eosinophilic airway inflammation 4
- Sputum eosinophil ratio ≥2% 4
- High levels of immunoglobulins E (IgE) 3
Biomarkers of Type 2 Inflammation
Biomarkers that can be used to assess type 2 inflammation include:
- FeNO 5, 4, 6
- Blood eosinophil count (b-EOS) 4
- IL-13 inducible gene expression 2
- Sputum eosinophil ratio 4
Clinical Characteristics of Type 2 Inflammation
Type 2 inflammation is often associated with: