Methods
Steering committee and expert meeting
attendees
A steering committee (SC) was formed that comprised seven experts from
across the Nordic region who were invited by Sanofi Genzyme based on
their expertise in their respective fields related to the treatment of
patients with type 2 inflammatory diseases. The SC members included one
allergist and clinical immunologist from Iceland, two dermatologists
from Denmark, one ENT specialist from Finland, one paediatrician from
Finland and two pulmonologists from Sweden and Denmark, respectively. In
addition to the SC, 23 experts (dermatologists [n = 10],
pulmonologists [n = 7], ENT specialists [n = 3], internal
medicine specialists/clinical immunologists/allergists [n = 2] and a
paediatrician) from across the Nordic region (Sweden [n = 8],
Finland [n = 6], Denmark [n = 5], Norway [n = 3] and Estonia
[n = 1]) were invited to participate. All were considered widely
recognised experts in their fields at least at a regional level.
Scope
The SC determined the scope of this initiative, which investigated the
extent of overlap between diseases that may be driven by type 2
inflammation (asthma, atopic dermatitis, CRSwNP, eosinophilic
esophagitis and chronic rhinitis). There are other relevant conditions,
such as food allergy and chronic urticaria, that were not included.
Literature search
To improve the knowledge base for the discussion, a non-systematic
literature search was performed using the PubMed database to identify
published work related to the objectives of this study and to identify
needs for consensus. The literature search was conducted between January
and June 2020 and included multiple combinations of the following search
terms: ‘atopic dermatitis’, ‘atopic eczema’, ‘childhood eczema’,
‘paediatric eczema’, ‘asthma’, ‘rhinitis’, ‘eosinophilic esophagitis’,
‘chronic rhinosinusitis’ and ‘polyps’, with ‘morbidities’ added as a
qualifier. Searches for ‘atopic march’ and ‘allergic rhinitis and its
impact on asthma (ARIA)’ were also conducted. Publications were only
considered if they were written in English, had a human/clinical focus
and were published after 1 January 2005.
The most relevant papers were identified based on review of abstracts;
relevant data regarding the prevalence of overlap between type 2
inflammatory conditions were extracted and tabulated according to
primary diagnosis. Reference lists of key papers and papers of interest
provided by the SC were also reviewed.
Modified Delphi process
The Delphi process is a recognised facilitation technique used to obtain
consensus between specialists in a particular field where expert opinion
is important for clinical guidance, especially if limited evidence is
available.48 This approach provides experts with the
opportunity to alter their response based on their peers’ opinions, thus
increasing the likelihood for opinions to converge. The modified Delphi
process used in this initiative is outlined in Figure 2.