Int Forum Allergy Rhinol. 2025 Nov 29. doi: 10.1002/alr.70076. Online ahead of print.
ABSTRACT
BACKGROUND: Eosinophil peroxidase (EPX) in nasal mucus correlates with markers of type 2 inflammation and tissue eosinophilia in chronic rhinosinusitis (CRS). This study evaluated EPX as a dynamic biomarker across treatment modalities and its potential prognostic value in eosinophilic CRS.
METHODS: Patients with bilateral CRS undergoing treatment with endoscopic sinus surgery (ESS) or dupilumab injections, as well as non-CRS controls undergoing endoscopic endonasal pituitary surgery were prospectively enrolled. Nasal cytology brushings from the middle meatus were collected pre-and post-treatment, except in the dupilumab group (sampled once after stabilization on medication). EPX was quantified via ELISA and correlated with clinical data.
RESULTS: Twenty-nine CRS patients and 7 non-CRS controls were included. EPX levels decreased post-treatment in both treatment groups. Median paired change was -233.5 ng/µl (CRS ESS group, p = 0.015) and 0 ng/µl (non-CRS control group, p = 0.57). The difference of medians (non-paired) in the dupilumab-treated CRS group as compared to the pre-treatment CRS group was -460.9 ng/µl (p = 0.027). A strong negative correlation was observed between pre-treatment EPX concentration and ΔSNOT-22 score (Spearman's p = 0.70, p = 0.038), indicating that higher pre-treatment EPX levels were associated with greater improvements in SNOT-22 scores.
CONCLUSION: EPX levels are elevated in CRS and decline with treatment. Higher baseline EPX may predict greater post-treatment symptom improvement, supporting EPX as a marker of disease activity and treatment response in CRS.
SUMMARY: Eosinophil peroxidase (EPX) correlates with local type 2 inflammation and may serve as a noninvasive biomarker of eosinophilic chronic rhinosinusitis. EPX declines after surgery and dupilumab, highlighting its potential to track treatment response. High baseline EPX predicts patients likely to achieve a clinically meaningful Sinonasal Outcome Test-22 change.
PMID:41317131 | DOI:10.1002/alr.70076