{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T16:53:27Z","timestamp":1791132807755,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare necrotizing vasculitis involving upper\u2010 and lower\u2010airways. Despite biologics, sinonasal disease often persists. Evidence on ENT trajectories under anti\u2010IL5 treatment and role of endoscopic sinus surgery (ESS) remains limited and is often described without standardized assessment tools. This study provides a systematic, multidimensional evaluation of sinonasal outcomes under biologic therapy and analyzes the role of ESS in a real\u2010life cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 52 EGPA patients with a 24\u2010month follow\u2010up on mepolizumab. Sinonasal disease was assessed by Nasal Polyp Score (NPS), Lund\u2013Kennedy Score (LKS), Lund\u2013Mackay score (LMK), and SNOT\u201022, while systemic activity was assessed by Birmingham Vasculitis Activity Score (BVAS). Patients were stratified by mepolizumab regimen (100\u00a0mg, 300\u00a0mg, and\n                      <jats:italic>step\u2010down<\/jats:italic>\n                      ). Predictors of adjunctive ESS were explored through multivariate logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Systemic remission occurred in &gt;90% of patients, with marked eosinophil suppression (median 700 \u2192 59.5 cells\/\u00b5L) and BVAS = 0. Conversely, NPS and LKS remained stable [IQR]: (NPS 4 [3\u20135] \u2192 4 [2\u20135]; LKS 6 [4\u20138] \u2192 5 [2\u20137.75]. Polyps persisted in 64% and mucosal edema\/discharge in 92% of population. Continuous 100 mg therapy showed the greatest endoscopic improvement. Higher baseline sinonasal burden, more extensive surgical history, and mepolizumab dose variation were associated with adjunctive ESS (28.8%), whereas BVAS and eosinophils showed no correlation with ENT severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sinonasal disease may persist despite systemic remission, suggesting a partially independent inflammatory niche. Comprehensive assessment should combine systemic markers with dedicated ENT evaluation, while management may require integrated biologic\u2013surgical strategies in chronic structural disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.70184","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:42:21Z","timestamp":1778672541000},"page":"1142-1151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Rhinosinusitis With Nasal Polyposis in EGPA: A Real\u2010Life Multidimensional Analysis Through Mepolizumab Dosing and Role of Adjunctive Endoscopic Sinus Surgery (ESS)"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1739-4179","authenticated-orcid":false,"given":"Bright Oworae","family":"Howardson","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery IRCCS San Raffaele 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