{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:07:24Z","timestamp":1784700444634,"version":"3.55.0"},"reference-count":89,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Nonsteroidal anti\u2212inflammatory drug-exacerbated respiratory disease (N\u2212ERD) is an inflammatory airway disease characterized by adult\u2212onset asthma, chronic rhinosinusitis with nasal polyps and hypersensitivity reactions to cyclooxygenase\u22121 (COX\u22121) inhibitors. The disease is driven by dysregulated eicosanoid metabolism and sustained type 2 inflammation affecting both the upper and lower airways, resulting in severe disease and limited response to conventional therapies. In recent years, biologic agents targeting key inflammatory pathways have substantially expanded therapeutic options for patients with N\u2212ERD. In this review, we summarize current evidence on the efficacy and mechanisms of action of approved biologic therapies, including omalizumab, anti\u2212IL\u22125\/IL\u22125R\u03b1 agents (mepolizumab, reslizumab, depemokimab, benralizumab), dupilumab and tezepelumab, with a particular focus on their effects on sinonasal disease, asthma control, aspirin tolerance, and patient\u2212reported outcomes. Current evidence suggests that dupilumab provides the most consistent multi-domain clinical benefit, particularly in patients with refractory disease phenotypes. We further discuss emerging concepts of personalized and integrated treatment strategies combining biologics, endoscopic sinus surgery, and aspirin desensitization. Finally, we highlight unmet needs, potential biomarkers and future research directions aimed at optimizing treatment selection and improving long\u2212term disease control in N\u2212ERD.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1890964","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:56:28Z","timestamp":1784699788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biologic therapies targeting type 2 inflammation in NSAID\u2212exacerbated respiratory disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Piotr","family":"Szatkowski","sequence":"first","affiliation":[{"name":"2nd Department of Internal Medicine, Jagiellonian University Medical College","place":["Krakow, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclfem E.","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"Private Practitioner","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Mejza","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, Division of Epidemiology, Jagiellonian University Medical College","place":["Krakow, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucyna","family":"Mastalerz","sequence":"additional","affiliation":[{"name":"2nd Department of Internal Medicine, Jagiellonian University Medical College","place":["Krakow, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/all.70243","article-title":"Updated treatment of non-steroidal anti-inflammatory drug-exacerbated respiratory disease: How to decide on aspirin therapy after desensitization or biologics? 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