Background. Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a negative impact on quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating repeated courses of antibiotics, systemic corticosteroids, and multiple surgeries. Objective. The aim of this study was to investigate if the use of biologics can improve symptoms including facial pain and reduce use of rescue treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis. Materials and Methods. This is a real-life, observational, no-profit case series. Between November 2022 and December 2023, we enrolled cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated to invalidating facial pain measured by MIDAS score and that were treated with dupilumab 300 mg every 2 week and followed for at least 12 months. Results. the mean MIDAS score decreased from 45.6±10.7 at baseline to 1.3±2.3 at 6 months (p<0.05). The same trend was observed for VAS craniofacial pain: from 7.3±1.6 at baseline to 1.2±1.5 at 6 months (p<0.05). The use of systemic corticosteroids and analgesics was significantly reduced. No patient needed oral corticosteroids during treatment with dupilumab (p<0.05), and the use of analgesics decreased from 9.6±3.1 mean brief cycles of NSAIDs at baseline to 0.6±1.3 at 1 year of follow-up (p<0.05). Discussion. Our results demonstrated that use of an anti-type-2 inflammatory pathway biologic can improve symptom control including recurrent craniofacial pain and reduce the need for rescue medical treatments in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.

Introduction |Shellfish allergy is an important cause of food allergies worldwide. Both in vivo and in vitro diagnostics failure nowadays is caused by the poor quality of the extracts associated with the scarce availability of allergenic molecules in the market. It is known that not all patients with shellfish allergies experience adverse reactions to mollusks. It is still unclear how to detect and diagnose correctly these patients. Aim |To investigate the features of shrimp-allergic patients either reactive or tolerant to mollusks, with the currently available diagnostic methods. Methods| Nineteen centers, scattered throughout Italy, participated in the study, enrolling patients allergic to shrimp with or without associated reactions to mollusks. Patients underwent skin tests using commercial extracts or fresh raw and cooked foods, and IgE reactivity to currently available allergenic extracts and molecules was measured in vitro. Results| Two hundred and forty-seven individuals with a history of adverse reaction to crustaceans participated in the study. Only 47.8% of them reacted after cephalopod or bivalve ingestion. None of the tests used, either in vivo or in vitro, was able to detect all selected patients. Accordingly, a great heterogeneity of results was observed with an agreement between in vivo and in vitro tests ranging between 52% and 62% of cases. Skin tests were able to identify the cephalopod and bivalve reactors (p <0.001), also using fresh cooked or raw food (p <0.001). The reactivity profile of mollusk reactors was dominated by Pen m 1, over Pen m 2 and Pen m 4 compared to the tolerant subjects, but 33% of patients allergic to shellfish were not detected by any of the available molecules. A higher frequency of shrimp hypersensitivity was recorded in northern Italy, while mollusk reactivity was more frequent in the center-south. Conclusion |The current diagnostic methods are inadequate to predict the cross-reactivity between crustaceans and mollusks. The detection of mollusks hypersensitivity must still rely on skin tests with fresh material. There is no need to exclude mollusks from shrimp allergic patients’ diet unless clinical history, the available diagnostic instruments, and/or tolerance tests support such a decision. Primary sensitization to mollusks seems possible.