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Clinical relevance of type 2 inflammation as a driver of multi-organ disease: A Delphi consensus initiative
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  • Unnur Steina Björnsdóttir,
  • Mette Deleuran,
  • Christer Janson,
  • Mika Makela,
  • Celeste Porsbjerg,
  • Sanna Toppila-Salmi,
  • Kasper Aanæs,
  • Tove Agner,
  • Lars Ahlbeck,
  • Alan Altraja,
  • Leif Bjermer,
  • Maria Bradley,
  • Lars Olaf Cardell,
  • Sven-Erik Dahlén,
  • Kilian Eyerich,
  • Gunilla Hedlin,
  • Theis Huldt-Nystrøm,
  • Stein Øyvind Jørstad,
  • Hannu Kankaanranta,
  • Jussi Karjalainen,
  • Laura Korhonen,
  • Lauri Lehtimäki,
  • Johanna Mandelin,
  • Anita Remitz,
  • Andreas Sonesson,
  • Sverre Steinsvåg,
  • Simon Francis Thomsen,
  • Charlotte Ulrik,
  • Christian Vestergaard,
  • Jacob Thyssen
Unnur Steina Björnsdóttir
Department of Pulmonary Medicine and Allergy/Clinical Immunology University of Iceland Reykjavík Iceland

Corresponding Author:[email protected]

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Mette Deleuran
Department of Dermatology and Venereology Åarhus University Hospital Åarhus Denmark
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Christer Janson
Department of Medical Sciences Uppsala University Uppsala Sweden
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Mika Makela
Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Celeste Porsbjerg
Department of Respiratory Medicine Bispebjerg Hospital Copenhagen Denmark
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Sanna Toppila-Salmi
Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Kasper Aanæs
Department of Otorhinolaryngology Head and Neck Surgery and Audiology University of Copenhagen Copenhagen Denmark
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Tove Agner
Department of Dermatology Bispebjerg University Hospital Copenhagen Denmark
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Lars Ahlbeck
Allergy Center University Hospital Linköping Sweden
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Alan Altraja
Department of Pulmonology University of Tartu and Lung Clinic Tartu University Hospital Tartu Estonia
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Leif Bjermer
Department of Respiratory Medicine and Allergology Skåne University Hospital Lund Sweden
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Maria Bradley
Dermatology and Venereology Unit Department of Medicine Karolinska University Hospital Stockholm Sweden
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Lars Olaf Cardell
Department of Clinical Sciences Intervention and Technology Karolinska Institutet Stockholm Sweden
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Sven-Erik Dahlén
Experimental Asthma and Allergy Research Karolinska Institutet Stockholm Sweden
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Kilian Eyerich
Dermatology and Venereology Unit Department of Medicine Karolinska University Hospital Stockholm Sweden
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Gunilla Hedlin
Department of Women’s and Children’s Health and Centre for Allergy Research Karolinska Institutet Stockholm Sweden
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Theis Huldt-Nystrøm
Hudpoliklinikken Namsos Norway
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Stein Øyvind Jørstad
Southern and Eastern Norway Regional Health Authority Fredrikstad Norway
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Hannu Kankaanranta
Department of Respiratory Medicine Seinäjoki Central Hospital Seinäjoki Finland
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Jussi Karjalainen
Allergy Centre Tampere University Hospital Tampere Finland
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Laura Korhonen
Department of Dermatology Tampere University Hospital Tampere Finland Faculty of Medicine and Health Technology University of Tampere Tampere Finland
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Lauri Lehtimäki
Allergy Centre Tampere University Hospital Tampere Finland
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Johanna Mandelin
Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Anita Remitz
Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Andreas Sonesson
Department of Dermatology and Venereology Clinical Sciences Skåne University Hospital Lund University Lund Sweden
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Sverre Steinsvåg
Department of Otolaryngology Sørlandet Hospital Kristiansand Norway
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Simon Francis Thomsen
Department of Dermatology Bispebjerg University Hospital Copenhagen Denmark
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Charlotte Ulrik
Department of Respiratory Medicine Copenhagen University Hospital-Hvidovre Hvidovre Denmark
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Christian Vestergaard
Department of Dermatology and Venereology Åarhus University Hospital Åarhus Denmark
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Jacob Thyssen
Department of Dermatology Bispebjerg University Hospital Copenhagen Denmark
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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.