{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T05:21:27Z","timestamp":1788067287812,"version":"build-2784847793"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T00:00:00Z","timestamp":1575331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic rhinosinusitis (CRS) is a frequently observed condition in patients with immunodeficiency secondary to tumor necrosis factor alpha inhibitors (TNF\u03b1is). The histologic features of CRS caused by TNF\u03b1is have yet to be determined and may have important implications in understanding the pathophysiology of the disease process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured histopathology report was used to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). These structured histopathology variables were compared among patients with CRS on TNF\u03b1i (CRS\u03b1i), CRS without nasal polyps (CRSsNP) patients, and CRS with nasal polyps (CRSwNP) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen CRS\u03b1i, 91 CRSwNP, and 113 CRSsNP patients undergoing FESS were analyzed. Compared to CRSsNP, CRS\u03b1i patients exhibited increased mucosal ulceration (16.7% vs 0.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.008), increased fibrosis (100% vs 34.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and increased presence of Charcot\u2010Leiden crystals (16.7% vs 0%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.002). Compared to CRSwNP, CRS\u03b1i patients demonstrated increased fibrosis (100% vs 54.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), decreased presence of subepithelial edema (44.4% vs 69.2%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.043), decreased eosinophil aggregates (22.2% vs 47.3%\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.042), and fewer eosinophils per high\u2010power field (44.4% vs 73.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.017).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CRS\u03b1i exhibits structured histopathology more similar to CRSsNP. In the appropriate clinical context, it may be reasonable that the medical regimen for these patients be focused on a more antineutrophilic, macrolide\u2010based approach. This study provides insight into the inflammatory environment of patients with CRS\u03b1i and may have implications for disease management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.22462","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T10:55:01Z","timestamp":1575370501000},"page":"23-28","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Chronic rhinosinusitis precipitated by tumor necrosis factor alpha inhibitors is the phenotype of chronic rhinosinusitis without nasal polyps"],"prefix":"10.1002","volume":"10","author":[{"given":"Peter","family":"Papagiannopoulos","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Devins","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4471-5134","authenticated-orcid":false,"given":"Charles Ching Lick","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Yver","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-9130","authenticated-orcid":false,"given":"Neil N.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4276-1193","authenticated-orcid":false,"given":"Hannah N.","family":"Kuhar","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center  Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John V.","family":"Bosso","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Kohanski","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby A.","family":"Tajudeen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center  Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-0718","authenticated-orcid":false,"given":"Edward C.","family":"Kuan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California, Irvine  Irvine CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pete S.","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery Rush University Medical Center  Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noam A.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Montone","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithin D.","family":"Adappa","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000510"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21989"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21032"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.10.005"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892418811210"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892418762863"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21943"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892418793522"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21895"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215116001067"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin13.074"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815574247"},{"issue":"1","key":"e_1_2_6_14_1","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1002\/alr.21695","article-title":"International Consensus Statement on Allergy and Rhinology: rhinosinusitis","volume":"6","author":"Orlandi RR","year":"2016","journal-title":"Int Forum Allergy Rhinol"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2016.30.4297"}],"container-title":["International Forum of Allergy &amp; 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