Clinical relevance of type 2 inflammation as a driver of multi-organ
disease: A Delphi consensus initiative
Abstract
Background: This initiative aimed to elucidate the clinical
relevance of type 2 (T2) inflammation as a driver of asthma, atopic
dermatitis, chronic rhinitis, chronic rhinosinusitis with nasal polyps
(CRSwNP) and eosinophilic esophagitis. Methods: A steering
committee (SC) conducted a non-systematic literature search to inform
the design of a Delphi questionnaire including 23 consensus statements,
which was circulated to 30 experts including the SC. Experts rated their
agreement with each statement on a 9-point Likert scale and provided
optional feedback that was used to develop a second Delphi
questionnaire. On 22 October 2020, a meeting was held to discuss the
conclusions from the questionnaires and explore how this initiative may
impact the management of patients with T2 inflammation-driven disease.
Post meeting, a consensus statement on the role of T2 inflammation in
eosinophilic esophagitis was circulated to the experts.
Results: It was agreed that T2 inflammation may be an
underlying driver of asthma, atopic dermatitis, chronic rhinitis, CRSwNP
and eosinophilic esophagitis, and that the published evidence suggests
that these diseases overlap. Some of this overlap may include related
multimorbid conditions driven by T2 inflammation. Thus, in patients with
multiple T2 inflammation-driven diseases, a cross-speciality approach is
warranted to provide effective care. A question guide with input from
relevant experts was proposed, to identify comorbidities and facilitate
appropriate holistic patient management. Conclusions: These
consensus recommendations should be used as a framework to further
understand the extent of T2 inflammation-driven multi-organ disease and
to improve the holistic management and care of these patients.