The following is a summary of White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA published June 2022 in Frontiers in Allergy.

Atopic Dermatitis (AD)

AD, sometimes referred to as eczema, can cause frequent dry, scaly skin and red or dark rashes that cause intense, persistent itching. As many as one in ten people worldwide have AD, making it one of the most common long-term conditions.1-3 

Asthma

Asthma is a disease associated with chronic airway inflammation that makes it difficult to breathe.4 Some asthma cases are classified as severe and can be harder to control, impacting daily life.4 Globally, more than 339 million people live with asthma.5  

Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP)

People with CRSwNP, often called nasal polyps, have non-cancerous growths in their sinuses that lead to frequent runny noses, difficulty breathing, facial pain and congestion. While the number of people who have CRSwNP globally is not well documented, more than 900,000 people in the European Union and the United States live with CRSwNP.6 

Understanding the underlying cause: type 2 inflammation

Type 2 inflammation is a specific type of immune response.7 Its normal function is to eliminate irritants or triggers that can lead to infection, however, when it does not work correctly it causes inflammation that can harm healthy tissue and is linked to allergic and atopic diseases.7,8,9 

Globally, the occurrence of type 2 inflammatory diseases is increasing with CRSwNP, asthma and AD currently affecting up to 3%, 18% and 10% of the population respectively.4,10,11  For some people, type 2 inflammation can be the cause of more than one condition at the same time. This is known as a co-existing condition. People with CRSwNP, asthma and AD frequently have co-existing type 2 inflammatory diseases; for example, asthma also occurs in up to 65% of people with CRSwNP and in almost 50% of people with AD.12,13,14 

Although several studies have investigated the unmet needs of people living with each disease individually, little is known about the experiences and needs of people who live with co-existing type 2 inflammatory diseases.  

The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) – an organization focused on preventing and reducing the burden of allergies and airway diseases through the implementation of optimal care – set out to better understand the common needs of people living with more than one type 2 inflammatory disease. 

Methodology

Seven university centers in seven European countries (Belgium, The Netherlands, United Kingdom, Greece, Switzerland, Germany and Denmark) agreed to have patients participate in interviews with EUFOREA about living with more than one type 2 inflammatory disease. 

The analysis consisted of 70 interviews including 28 people initially diagnosed with CRSwNP, 21 people initially diagnosed with asthma and 21 people initially diagnosed with AD.  

Barriers to care

The results of the interviews revealed that participants with asthma, AD and CRSwNP experienced similar barriers in their disease journey including impacts to their quality of life, treatment dissatisfaction and the need for coordinated care. Overall, specific perceived unmet needs overlapped between all three diseases, but unique needs exist for each condition as well.     

Image adapted from reference 15

Call to action 

Participants also provided similar suggestions and proposed solutions to the shortcomings in their care. Education for patients and healthcare providers was one of the most common recurring themes. 

Along with education and awareness efforts, the participants asked for clear guidelines and consistent treatment strategies among different specialists and even among different countries.  

Regarding the health care system, they also requested that politicians reach a unified and straightforward agreement on reimbursement and availability of care for type 2 inflammatory diseases in Europe.  

An overview of the key shortcomings and suggestions: 

Image adapted from reference 15

With these insights and recommendations, EUFOREA aims to help improve care pathways and increase awareness of type 2 inflammatory diseases with physicians, the academic community and health policy makers. 

Take your own action! If you or someone you know has one or more of these diseases, it’s important to be your own advocate throughout your care journey. Be empowered! Ask your doctor about the underlying cause of your disease or diseases to ensure you are receiving the best care possible. 

References:  
1. Bieber T. Ann Dermatol 2010; 22: 125–137. 
2. Weidinger S et al. Lancet 2016; 387: 1109-1122.  
3. Leung et al. J Clin Invest 2004; 113:651–657. 
4. Global Initiative for Asthma (GINA). “Global Strategy for Asthma Management and Prevention,” 2022. Available at: https://ginasthma.org/gina-reports/. Accessed July 2022. 
5. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59. 
6. Sanofi Data on File. 
7. Oyesola OO, Tait Wojno ED. Prostaglandin regulation of type 2 inflammation: From basic biology to therapeutic interventions. Eur J Immunol. 2021 Oct;51(10):2399-2416. doi: 10.1002/eji.202048909. Epub 2021 Sep 7. PMID: 34396535; PMCID: PMC8843787. 
8. Franciosi JP, Liacouras CA. Eosinophilic esophagitis. Immunol Allergy Clin North Am 2009; 29(1): 19-27. 
9. Padia R, Curtin K, Peterson K, Orlandi RR, Alt J. Eosinophilic esophagitis strongly linked to chronic rhinosinusitis. Laryngoscope. 2016 Jun;126(6):1279-83. doi: 10.1002/lary.25798. Epub 2015 Nov 26. PMID: 26606888. 
10. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020; 58:1–464. 
11. Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. The Journal of Allergy and Clinical Immunology. 2013; 132:1132–8. 
12. Khan A, Vandeplas G, Huynh TMT, Joish VN, Mannent L, Tomassen P, et al. The Global Allergy and Asthma European Network (GALEN) rhinosinusitis cohort: A large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps. Rhinology. 2019; 57:32–42. 
13. Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo controlled, parallel-group phase 3 trials. Lancet. 2019; 394:1638–50. 
14. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma & Immunology. 2018; 121:604-612. 
15. De Prins L, Raap U, Mueller T, Schmid-Grendelmeier P, Haase CH, Backer V, Fokkens W, Benoist LB, Prokopakis E, Hopkins C, Claeys N, Teeling T, Cypers L, Cools L, Bjermer LH, Diamant Z, Wahn U, Scadding G, Bachert C, Patel SR, Van Staeyen E and Hellings P (2022) White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA. Front. Allergy 3:889221. doi:10.3389/falgy.2022.889221