For the purposes of simplification, the underlying immunopathology of
type 2 inflammation can be considered as Th2 cell and/or ILC2
activation, with expression of type 2 inflammation cytokines, including
interleukin (IL)‐4, IL‐5 and IL‐13, and can often be characterised by
the elevation of certain biomarkers, including (but not limited to)
allergen-specific immunoglobulin (Ig)Es, elevated levels of blood and/or
tissue eosinophils, and, in asthma, elevated fractional exhaled nitric
oxide (FeNO).
|
Consensus
(Second Delphi questionnaire)
|
All experts
|
Type 2 inflammation may be considered as an underlying
immunopathological driver of some phenotypes of asthma.
|
Consensus
(First Delphi questionnaire)
|
Respiratory subgroup
|
Type 2 inflammation may be considered as an underlying
immunopathological driver of some types of chronic rhinitis.
|
Consensus
(Second Delphi questionnaire)
|
Respiratory subgroup
|
Type 2 inflammation may be considered as an underlying
immunopathological driver of chronic rhinosinusitis with nasal
polyps.
|
Consensus
(First Delphi questionnaire)
|
Respiratory subgroup
|
Type 2 inflammation may be considered as an underlying
immunopathological driver of atopic dermatitis.
|
Consensus
(First Delphi questionnaire)
|
Dermatology subgroup
|
Type 2 inflammation may be considered as an underlying
immunopathological driver of eosinophilic esophagitis.
|
Consensus
(Third Delphi questionnaire circulated after the virtual meeting)
|
All experts
|
Epidemiological evidence suggests that, in ADULTS, there is an overlap
in the occurrence of asthma, chronic rhinitis with or without nasal
polyps, atopic dermatitis and eosinophilic esophagitis.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
However, most of the epidemiological studies are too heterogeneous to
draw accurate conclusions about the exact extent of the overlap.
Therefore, more evidence is required.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Epidemiological evidence suggests that, in CHILDREN, there is an overlap
in the occurrence of asthma, chronic rhinitis, atopic dermatitis and
eosinophilic esophagitis.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
However, most of the epidemiological studies are too heterogeneous to
draw accurate conclusions about the exact extent of the overlap.
Therefore, more evidence is required.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Atopic dermatitis and asthma can coexist in adults and children.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Asthma and chronic rhinitis can coexist in some patients.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Asthma and chronic rhinosinusitis with nasal polyps can coexist in some
adult patients.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Adult-onset asthma with chronic rhinosinusitis with nasal polyps is a
distinct subset of asthma and presents clinically with a disease that is
more difficult to control compared with other subsets of asthma
|
Consensus
(First Delphi questionnaire)
|
Respiratory subgroup
|
In my clinical experience, the presence of more than one atopic
condition such as asthma, chronic rhinitis, chronic rhinosinusitis with
nasal polyps, atopic dermatitis and eosinophilic esophagitis may often
predispose patients, especially adult patients, to more severe disease
compared with having only a single atopic condition.
|
Consensus
(Second Delphi questionnaire)
|
All experts
|
In my clinical experience, type 2 inflammation may drive mild, moderate
and severe forms of asthma, chronic rhinitis, chronic rhinosinusitis
with nasal polyps, atopic dermatitis and eosinophilic esophagitis.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
In my clinical experience, some overlapping types of asthma, chronic
rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis
and eosinophilic esophagitis may be considered as a set of related
multimorbid conditions driven by underlying type 2 inflammation.
|
Consensus
(Second Delphi questionnaire)
|
All experts
|
Patients presenting with a primary type 2 inflammatory condition should
be asked about symptoms related to other type 2 inflammatory comorbid
conditions.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
Biomarkers, such as eosinophils, IgE and FeNO for asthma, should be used
in the clinic to assess the status of type 2 inflammation.
|
Consensus
(First Delphi questionnaire)
|
Respiratory subgroup
|
It would be useful to have validated biomarkers of type 2 inflammation
relevant to atopic dermatitis.
|
Consensus
(Second Delphi questionnaire)
|
Dermatology subgroup
|
Where clinical settings allow for this, specialists should work together
across functions when managing patients with severe signs and symptoms
of multiple concurrent type 2 inflammatory conditions.
|
Consensus
(Second Delphi questionnaire)
|
All experts
|
Patients with a severe refractory type 2 inflammatory condition and
additional type 2 inflammatory conditions will benefit from having their
cases discussed at cross-functional multidisciplinary team
conferences.
|
Consensus
(First Delphi questionnaire)
|
All experts
|
The pattern of overlap in asthma, rhinitis, chronic rhinosinusitis with
nasal polyps, atopic dermatitis and eosinophilic esophagitis, captured
in previous statements, is reflective of my clinical experience.
|
Near consensus
(Experts could abstain from voting)
|
All experts
|
The pattern of overlap in asthma, rhinitis, chronic rhinosinusitis with
nasal polyps and atopic dermatitis captured in previous statements, is
reflective of my clinical experience. |
No consensus |
All
experts |
The combined symptoms related to multiple moderate type 2 inflammatory
conditions may be more burdensome for a patient compared with the
symptoms of a single severe type 2 inflammatory condition. |
No
consensus |
All experts |
While the most serious cases should take priority in cross-functional
multidisciplinary team conferences, some patients with multiple
concurrent refractory moderate type 2 inflammatory conditions may
benefit from having their cases discussed in this setting. |
No
consensus |
All experts |