Screening Questionnaire Developed for Type 2 Inflammation Diseases

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Dysregulation of type 2 (T2) immune responses can cause abnormal inflammation, leading to various diseases affecting different organs, including skin. This can result in multiple coexisting disorders in a single patient, but mild cases might not be immediately recognized, especially when different specialists are involved. This lack of coordination and communication can delay diagnosis and lead to suboptimal care.^1-2

To address this, dermatologists joined a multidisciplinary group of specialists from fields such as pneumology, immunology, allergology, and otorhinolaryngology worked to identify key symptoms of T2-related diseases like asthma, chronic rhinosinusitis, and atopic dermatitis. They proposed a simple, patient-friendly questionnaire to screen for these coexisting T2 conditions and facilitatetimely referral to the appropriate specialist, aiming to improve early detection and interdisciplinary collaboration.³

Methods and Research

A search was conducted on MEDLINE, a primary part of PubMed, and Scopus for articles on symptoms of 8 common diseases linked to T2 inflammation: asthma, chronic rhinosinusitis, allergic rhinitis, allergic conjunctivitis, IgE-mediated food allergy, atopic dermatitis, eosinophilic oesophagitis, and NSAID-exacerbated respiratory disease (NERD). Researchers reviewed the findings and discussed them in meetings with clinical experts, who identified these key symptoms identified for each condition:

• IgE-Mediated Food Allergy: Symptoms appear within an hour of ingestion and can affect various systems, including skin (urticaria), gastrointestinal tract, and respiratory system. Oral allergy syndrome is a common manifestation.
• Atopic Dermatitis (AD): Features include pruritic, erythematous lesions, which may be smooth, crusted, or scaly. Chronic lesions and intense itching are significant signs.

Considerations from other specialties:

• Asthma: Common symptoms include shortness of breath, dry cough, wheezing, and chest tightness. Persistent dry cough is a notable sign, especially in children.
• Chronic Rhinosinusitis: Characterized by nasal obstruction, rhinorrhoea, and hyposmia/anosmia, with symptoms lasting more than 12 weeks. Nasal obstruction and loss of smell are key indicators.
• Allergic Rhinitis: Symptoms include nasal congestion, rhinorrhoea, itching, and sneezing, often occurring seasonally or year-round. Sneezing and nasal itching are commonly reported.
• Allergic Conjunctivitis: Symptoms include pruritus, tearing, and conjunctival hyperaemia. It can be seasonal or perennial and is often associated with allergic rhinitis.
• Eosinophilic Oesophagitis: Symptoms in children include abdominal pain and feeding issues, while adults typically experience dysphagia and food impaction.
• NSAID-Exacerbated Respiratory Disease (NERD): This condition involves asthma, eosinophilic chronic rhinosinusitis, and acute respiratory symptoms following NSAID use. Severe asthma and recurrent nasal polyposis are common, with symptoms like nasal congestion and wheezing after NSAID ingestion.

Based on this literature review and expert consensus, the resulting 15-piece questionnaire developed uses patient-friendly language to capture key symptoms of T2-related conditions. It is designed to be quick and easy to use during consultations, with particular benefits in primary care settings.

Conclusion and Moving Forward

T2 inflammation often underlies various diseases, but researchers stated issues like poor interdisciplinary coordination, a focus on severe cases, and lack of screening tools can delay diagnosis and treatment, leading to lower care quality. During a recent European study, patients identified the lack of a multidisciplinary approach as a major gap in managing these diseases.² To address this gap, researchers developed a screening questionnaire to help primary care doctors and specialists quickly identify and manage T2 inflammatory diseases.

Researchers stated the next steps involve validating the questionnaire with patients and physicians, including testing various versions and assessing its effectiveness in clinical practice. They hope the final validated tool will help improve the early detection and management of T2 inflammation-related diseases, potentially influencing referral processes and overall patient care.

References

1. McCormick JP, Lee JT. Insights into the implications of coexisting type 2 inflammatory diseases. J Inflamm Res. 2021;14:4259-4266.2021 Aug 30. doi:10.2147/JIR.S311640
2. De Prins L, Raap U, Mueller T, et al. White paper on European patient needs and suggestions on chronic type 2 inflammation of airways and skin by EUFOREA [published correction appears in Front Allergy. 2022 Sep 09;3:1001078. doi: 10.3389/falgy.2022.1001078]. Front Allergy. 2022;3:889221. 2022 Jun 2. doi:10.3389/falgy.2022.889221
3. Palomares O, Cisneros C, Ortiz de Frutos FJ, et al. Multidisciplinary management of type 2 inflammation diseases using a screening tool. Front Allergy. 2024;5:1427279. 2024 Jul 18. doi:10.3389/falgy.2024.1427279