The Role of Race and Ethnicity in Chronic Rhinosinusitis With Nasal Polyps: A Scoping Review

Abstract

Background

Race or ethnicity may influence chronic rhinosinusitis (CRS) endotype. Asian patients with CRS with nasal polyps (CRSwNP) may have increased Th1/Th17/mixed endotypes. However, there is a paucity of research concerning the endotype of non-Caucasian and non-Asian patients.

Objective

This review seeks to summarize literature as it pertains to associations between race or ethnicity and endotype with the goal highlighting knowledge gaps to guide future inquiry.

Methods

Systematic scoping review methodology was used to summarize the current literature in accordance with PRISMA guidelines.

Results

Of the 8877 articles identified, 261 articles pertaining to race or ethnicity and endotype in CRSwNP were included. 163 studies with race or ethnicity-specific data involved Asian patients and demonstrated increased presence of Th1, Th17, and mixed endotypes, but also increasing prevalence of Th2 endotypes in multiple countries across Asia. There were 56 studies involving Caucasian patients demonstrating a predominance of Th2 endotypes though several recent studies also demonstrated that mixed inflammation may contribute to disease. There was a relative lack of literature involving other races and ethnicities, specifically: South Asian (n = 2), Middle Eastern (n = 9), African/African-American (n = 16), and Latino/Hispanic-American (n = 9). Allergic fungal rhinosinusitis appeared relatively prevalent in South Asian, Middle Eastern and African/African-American patients, though, relatively low numbers of studies and patients preclude definitive conclusions.

Conclusion

This scoping review demonstrates that both race and ethnicity appear to play a role in affecting CRSwNP endotype. Additional research is necessary to investigate these factors, particularly in non-Caucasian and non-Asian patients.