The advent of biologic therapy for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) has allowed for substantial improvement in symptom control and reduction in medical resource utilization for patients with CRSwNP. CRSwNP is characterized by chronic symptoms (>12 weeks), including nasal congestion, hyposmia or anosmia, anterior or posterior mucopurulent drainage, and, in some patients, facial pain or pressure, with patients also having objective evidence of CRSwNP on nasal endoscopy or imaging. In Western countries, CRSwNP is most frequently marked by type 2 inflammatory cells and mediators, including tissue eosinophilia, T helper type 2 cells, group 2 innate lymphoid cells, locally produced immunoglobulin E, type 2 cytokines, and mast cell activation. Both CRSwNP and aspirin-exacerbated respiratory disease (AERD), an important, severe phenotype of CRSwNP, are associated with impairments in quality of life, medical resource consumption, and recurrent CRSwNP after functional endoscopic sinus surgery (FESS), with some patients requiring revision FESS. There are now four U.S. Food and Drug Administration approved biologics for treatment of CRSwNP, including dupilumab, omalizumab, mepolizumab, and tezepelumab, and more under investigation for the treatment of CRSwNP. Biologics have been shown to decrease nasal polyp size, improve sense of smell, reduce the need for systemic corticosteroids and FESS, and improve quality of life for patients with CRSwNP. In this review, I discuss guidelines for the treatment of CRSwNP and AERD in the biologic era, efficacy of biologic medications, and emerging real-world evidence for the use of biologic therapy for CRSwNP and AERD.

Allergic Rhinitis (AR) is a highly prevalent IgE-mediated chronic inflammatory disease of the nasal mucosa worldwide. Its incidence is continuously increasing and has become one of the important chronic diseases affecting public health. Recent studies have gradually revealed that AR not only presents with local symptoms such as nasal congestion, runny nose, sneezing, and nasal itching, but is also closely related to a wide range of physical and mental health problems, especially mental and psychological disorders (such as anxiety and depression) and decreased sleep quality. There is a complex two-way or even circular interaction between these three factors. This article systematically reviews the epidemiological characteristics and pathophysiological mechanisms of AR, and focuses on exploring the association pathways and potential mechanisms between AR and mental health as well as sleep disorders, including neuroimmune regulation (such as inflammatory mediators, HPA axis function), psychological and behavioral factors, and social function impairment. Based on this, the article further summarizes the assessment tools and multimodal intervention strategies for mental and psychological problems and sleep disorders in AR patients, covering drug treatment, psychotherapy, sleep hygiene education, and comprehensive health management, etc. This article integrates current evidence and provides a theoretical framework for a comprehensive understanding of the multi-dimensional impact of AR, and offers references for comprehensive assessment and individualized intervention in clinical practice.

Rhinitis medicamentosa (RM) refers to persistent nasal congestion and related symptoms that result from prolonged use of nasal decongestants. Re-examination of the components model of addiction as applied to RM, does not support a suggestion that RM should be conceptualised as a substance-related type of behavioural addiction. Anticipation of a highly distressing nasal congestion upon the cessation of nasal decongestants might be driving their ongoing use. Instead of unnecessarily proposing yet another behavioural addiction, it might be more appropriate and useful to posit that RM represents misuse of nasal decongestants because their prolonged administration runs contrary to medical advice.

Prolonged use of topical nasal decongestants such as xylometazoline or oxymetazoline can lead to rhinitis medicamentosa (RM). This medication-induced condition is characterized by rebound congestion and compulsive reuse. A debated question is whether RM signifies physiological dependence, addiction, or simply a habit. This commentary aimed to evaluate Lakatos et al.'s (2025) work, which investigated this issue through qualitative interviews with 20 affected individuals. Using directed content analysis based on Griffiths' (2005) components model of addiction, Lakatos et al., identified all six elements (salience, mood modification, tolerance, withdrawal, conflict, and relapse) in patient histories. Lakatos et al. (2025) performed a timely and conceptually sophisticated study that connects addiction theory to a common otorhinolaryngological condition. Their qualitative approach captures the everyday lived experience of patients with RM with robust ecological validity and clinical relevance. However, the theory-driven analysis risks confirmation bias by fitting data to Griffiths' addiction model, and the small, convenience-based sample limits generalizability. Despite these constraints, the paper offers valuable insight into how negative reinforcement and conditioned anxiety sustain compulsive nasal spray use. Overall, it successfully bridges clinical observation and theoretical debate, advancing understanding of iatrogenic dependence within everyday medical practice.

Type 2 inflammatory diseases (T2D), notably severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP), represent a significant global health burden due to their high morbidity, frequent exacerbations and reliance on systemic glucocorticoids (SGCs). Targeting Interleukin-5 (IL-5), a key driver of eosinophil production and survival, has emerged as a validated therapeutic strategy. Depemokimab is a novel, first-in-class anti-IL-5 monoclonal antibody (mAb) engineered with an extended half-life via the YTE amino acid modification of its Fc region, enabling an unprecedented twice-yearly dosing interval. This review synthesizes clinical data from the Phase III SWIFT (SEA) and ANCHOR (CRSwNP) programs, demonstrating depemokimab's sustained eosinophil depletion and significant reduction in asthma exacerbation rates (annualized asthma exacerbation rate reduction of approximately 54% versus placebo). While efficacy on secondary endpoints such as lung function (FEV1) and quality of life (QoL) was mixed, the efficacy in reducing nasal polyp size (Nasal Polyp Score and Nasal Congestion) in CRSwNP was clear. The core value proposition of depemokimab is the combination of established IL-5 inhibition efficacy with patient convenience due to its dosing. We discuss its pharmacodynamic profile, safety and pivotal role in shifting the treatment paradigm towards simplified chronic disease management, positioning depemokimab as a novel, patient-centric option in the competitive landscape of T2 biologic therapies.

Introduction To evaluate the efficacy and safety of a fixed-dose combination (FDC) of levocetirizine hydrochloride 5 mg and montelukast 10 mg (L-Montus) in the treatment of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis ( PAR ) among adult patients in India. Methods This was a prospective, single-arm, multicenter clinical study conducted across three clinical sites in India. A total of 200 patients aged 18 to 64 years with moderate-to-severe SAR were enrolled. All patients received once-daily oral doses of the FDC for eight weeks, with follow-up extending to 13 weeks. Symptom severity was assessed using validated tools: total nasal symptom score (TNSS), total ocular symptom score (TOSS), and night-time symptom score (NTSS). Safety and treatment adherence were monitored throughout the study. Statistical significance was evaluated using the Friedman and Wilcoxon signed-rank tests. Results At baseline, nasal symptoms such as sneezing (100%), rhinorrhea in 194 patients (97%), and nasal congestion in 191 patients (95.5%) were highly prevalent. By week eight, TNSS decreased from 6.74±2.28 to 0.86±1.11 (p=0.005), TOSS from 5.60±2.44 to 0.61±0.87 (p=0.005), and NTSS from 4.99±2.28 to 0.37±0.59 (p=0.005), demonstrating significant symptom relief. The treatment was well-tolerated, with only 14% (28) of patients reporting mild adverse events; no serious adverse events or discontinuations were observed. Conclusions The FDC of levocetirizine and montelukast (L-Montus) demonstrated robust efficacy in reducing nasal, ocular, and nocturnal symptoms associated with SAR, with a favorable safety and adherence profile. The dual mechanism of action targeting histaminergic and leukotriene pathways likely contributed to the comprehensive symptom control. These findings support the FDC as an effective first-line therapeutic option in the Indian SAR population.

Rhinitis medicamentosa (RM), also known as ‘rebound congestion’ is inflammation of the nasal mucosa caused by the overuse of topical nasal decongestants.  It classifies as a subset of drug-induced rhinitis.  Topical decongestants are typically used in the relief of nasal congestion due to allergic rhinitis, acute or chronic rhinosinusitis, nasal polyps, or upper respiratory tract infection. The earliest nasal decongestants mainly derived from ephedrine, where there were reports of rebound congestion after prolonged use. This situation was found to develop as early as 3 days and up to 4 to 6 weeks of use.[1] However, with the emergence of modern vasoconstrictors, such as the imidazoline derivatives, the risk of developing RM is considered to be small or non-existent.

Magnolia kobus (M. kobus) has long been used to treat nasal congestion, allergic rhinitis, and sinusitis. In the current study, we demonstrate the effects and underlying mechanisms of M. kobus flower water extract (ME) and ME-derived constituent magnolin on in vitro osteoblastogenic and anti-osteoclastogenic responses. Treatment with ME or magnolin markedly enhanced the osteoblast differentiation and mineralization in MC3T3-E1 pre-osteoblasts. This osteoblastogenic activity of ME or magnolin was closely associated with upregulation of osteoblast-specific molecules, including RUNX2, DLX5, OSX, alkaline phosphatase, collagen type I, and osteopontin, as well as the activation of mitogen-activated protein kinase (MAPK) signaling pathways. Concurrently, magnolin inhibited osteoclast differentiation through inactivating MAPK pathways and downregulating NFATc1, c-Fos, tartrate-resistant acid phosphatase, and cathepsin K in RANKL-treated RAW264.7 cells. These observations suggest that ME and magnolin have pharmacological potential for the treatment and prevention of metabolic bone disorders, including osteoporosis.