Abstract
Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.
Highlights
Nasal polyps (NPs) were already known at the time of the Egyptians, but their first description dates back to ancient Hindu doctors, 150 years before Hippocrates introduced the term “polyp” and described the first procedures for their removal
The prevalence of the triad, currently known as non-steroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (N-ERD), among adult patients with CRSwNP is reported as 16% [64], but this condition is not a prerogative of adulthood, since it has been reported in adolescents and children as young as 7 years old, so the diagnosis of N-ERD should be suspected in this age group in the case of severe NPs with frequent need for sinus surgery [69]
Similar to cystic fibrosis (CF), in primary ciliary dyskinesia (PCD), chronic rhinosinusitis (CRS) develops in childhood and lasts through adulthood, so virtually all PCD patients demonstrate pansinusitis on computed tomography (CT) scans, and NPs are reported in 10% of children and 75% of adults [74]
Summary
Nasal polyps (NPs) were already known at the time of the Egyptians, but their first description dates back to ancient Hindu doctors, 150 years before Hippocrates introduced the term “polyp” and described the first procedures for their removal. Many studies on the pathophysiology and management of NPs are available, primarily in adult populations, which have led to a recent update of the European position paper on this topic (“European Position Paper on Rhinosinusitis and Nasal Polyps 2020”—EPOS 2020; the previous version was published in 2012) [1]. NPs are relatively common in the adult population, while they are rare in children younger than 10 years old. It should be noted that many cases of adult NPs might represent the manifestation of a process likely to have started in childhood or adolescence, similar to what is the current understanding of other common conditions in adulthood, such as chronic obstructive pulmonary disease [3]. We sought to outline the most recent findings on pediatric NPs, focusing on multiple NPs, and provide suggestions for personalized approaches for both the diagnosis and management of NPs in children
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