Dr. Thaler: There is more work to be done. These patients are not one phenotype. How many NPs, where are they located, is the asthma significantly exacerbated, can it be managed with periodic bursts of steroids? I would consult an allergist regarding aspirin desensitization.
Explore This IssueJune 2019
Dr. Smith: I would do postop steroid irrigations and consider aspirin desensitization. The vast majority will do well with the things we’ve already discussed, and you would never have to contemplate an expensive, life-long, systemic therapy. Regarding olfaction, it is important to determine which cytokines were present at the time of surgery that might be impacting the olfactory cleft. If we just start randomly giving different biologics, then it’s not personalized medicine.
Dr. Han: Because this patient is likely to have elevated levels of IL-4 and eosinophils, the patient will benefit from anti IL4 and anti IL5 biologics.