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Spanish consensus on the management of chronic rhinosinusitis with nasal polyps (POLIposis NAsal / POLINA 2.0)

Alobid I1,2,3,4, Colás C5, Castillo JA3,6, Arismendi E3,4,7, del Cuvillo A8, Gómez-Outes A9, Sastre J4,7,10, Mullol J3,4,11, On behalf of POLINA group

1Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
2Unidad Alergo Rino, Centro Médico Teknon, Barcelona, Spain
3Clinical and Experimental Respiratory Immunoallergy, Institute of Biomedical Research “August Pi i Sunyer” (IDIBAPS), Spain
4Network of Biomedical Research in Respiratory Diseases (CIBERES); Health Institute Carlos III, Spain.
5Allergy Department, Hospital Clínico Universitario “Lozano Blesa”, Instituto de Investigación Sanitaria de Aragón, Facultad de Medicina, Universidad de Zaragoza, Spain
6Pneumology Department, Hospital Universitari Dexeus, Barcelona, Spain
7Pulmonology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
8Rhinology and Asthma Unit, Department of Otorhinolaryngology, Jerez University Hospital, Jerez, Spain
9Division of Pharmacology and Clinical Drug Evaluation. Medicines for Human Use. Agencia Española de Medicamentos y Productos Sanitarios, Spain
10Allergy department, Fundación Jiménez Diaz, Universidad Autónoma de Madrid, Spain
11Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain

J Investig Allergol Clin Immunol 2023; Vol. 33(5)
doi: 10.18176/jiaci.0910

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a high prevalent and burdensome disease for individuals and health systems which management involves many specialties: otorhinolaryngology, allergology, pulmonology, primary care, pharmacy, and paediatrics. A multidisciplinary approach and the participation of the patient in decision making are essential, both for the diagnosis and for the therapeutic strategy. The authors of the consensus aim to translate the current knowledge into an easy-to-read practical guide and emphasize those aspects in which there is still discussion or unmet needs due to the lack of proper scientific evidence. An iterative approach for the development of an evidence-based systematic review with recommendations was used, using a standard quality assessment scheme (Scottish Intercollegiate Guidelines Network -SIGN- and National Institute for Health and Care Excellence -NICE-), and a critical evaluation of the guideline has been carried out through the instrument Appraisal of Guidelines for Research and Evaluation (AGREE II) and Recommendation Excellence (AGREE REX). Based on the foregoing, the POLINA has been considered a guideline of good quality by an independent agency.
The POLINA consensus contributes with new schemes for the definition of control, therapeutic management including severity evaluation and surgery, and indications for biologic use and response. Finally, this guideline focuses on the research unmet needs in CRSwNP. 

Key words: Asthma, Biologics, Chronic rhinosinusitis, Corticosteroids, CRSwNP, Endoscopic sinus surgery, Guideline, Nasal polyps, N-ERD, Type 2 inflammation