Consensus statement Consensus status* Respondents
For the purposes of simplification, the underlying immunopathology of type 2 inflammation can be considered as Th2 cell and/or ILC2 activation, with expression of type 2 inflammation cytokines, including interleukin (IL)‐4, IL‐5 and IL‐13, and can often be characterised by the elevation of certain biomarkers, including (but not limited to) allergen-specific immunoglobulin (Ig)Es, elevated levels of blood and/or tissue eosinophils, and, in asthma, elevated fractional exhaled nitric oxide (FeNO).
Consensus (Second Delphi questionnaire)
All experts
Type 2 inflammation may be considered as an underlying immunopathological driver of some phenotypes of asthma.
Consensus (First Delphi questionnaire)
Respiratory subgroup
Type 2 inflammation may be considered as an underlying immunopathological driver of some types of chronic rhinitis.
Consensus (Second Delphi questionnaire)
Respiratory subgroup
Type 2 inflammation may be considered as an underlying immunopathological driver of chronic rhinosinusitis with nasal polyps.
Consensus (First Delphi questionnaire)
Respiratory subgroup
Type 2 inflammation may be considered as an underlying immunopathological driver of atopic dermatitis.
Consensus (First Delphi questionnaire)
Dermatology subgroup
Type 2 inflammation may be considered as an underlying immunopathological driver of eosinophilic esophagitis.
Consensus (Third Delphi questionnaire circulated after the virtual meeting)
All experts
Epidemiological evidence suggests that, in ADULTS, there is an overlap in the occurrence of asthma, chronic rhinitis with or without nasal polyps, atopic dermatitis and eosinophilic esophagitis.
Consensus (First Delphi questionnaire)
All experts
However, most of the epidemiological studies are too heterogeneous to draw accurate conclusions about the exact extent of the overlap. Therefore, more evidence is required.
Consensus (First Delphi questionnaire)
All experts
Epidemiological evidence suggests that, in CHILDREN, there is an overlap in the occurrence of asthma, chronic rhinitis, atopic dermatitis and eosinophilic esophagitis.
Consensus (First Delphi questionnaire)
All experts
However, most of the epidemiological studies are too heterogeneous to draw accurate conclusions about the exact extent of the overlap. Therefore, more evidence is required.
Consensus (First Delphi questionnaire)
All experts
Atopic dermatitis and asthma can coexist in adults and children.
Consensus (First Delphi questionnaire)
All experts
Asthma and chronic rhinitis can coexist in some patients.
Consensus (First Delphi questionnaire)
All experts
Asthma and chronic rhinosinusitis with nasal polyps can coexist in some adult patients.
Consensus (First Delphi questionnaire)
All experts
Adult-onset asthma with chronic rhinosinusitis with nasal polyps is a distinct subset of asthma and presents clinically with a disease that is more difficult to control compared with other subsets of asthma
Consensus (First Delphi questionnaire)
Respiratory subgroup
In my clinical experience, the presence of more than one atopic condition such as asthma, chronic rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis and eosinophilic esophagitis may often predispose patients, especially adult patients, to more severe disease compared with having only a single atopic condition.
Consensus (Second Delphi questionnaire)
All experts
In my clinical experience, type 2 inflammation may drive mild, moderate and severe forms of asthma, chronic rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis and eosinophilic esophagitis.
Consensus (First Delphi questionnaire)
All experts
In my clinical experience, some overlapping types of asthma, chronic rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis and eosinophilic esophagitis may be considered as a set of related multimorbid conditions driven by underlying type 2 inflammation.
Consensus (Second Delphi questionnaire)
All experts
Patients presenting with a primary type 2 inflammatory condition should be asked about symptoms related to other type 2 inflammatory comorbid conditions.
Consensus (First Delphi questionnaire)
All experts
Biomarkers, such as eosinophils, IgE and FeNO for asthma, should be used in the clinic to assess the status of type 2 inflammation.
Consensus (First Delphi questionnaire)
Respiratory subgroup
It would be useful to have validated biomarkers of type 2 inflammation relevant to atopic dermatitis.
Consensus (Second Delphi questionnaire)
Dermatology subgroup
Where clinical settings allow for this, specialists should work together across functions when managing patients with severe signs and symptoms of multiple concurrent type 2 inflammatory conditions.
Consensus (Second Delphi questionnaire)
All experts
Patients with a severe refractory type 2 inflammatory condition and additional type 2 inflammatory conditions will benefit from having their cases discussed at cross-functional multidisciplinary team conferences.
Consensus (First Delphi questionnaire)
All experts
The pattern of overlap in asthma, rhinitis, chronic rhinosinusitis with nasal polyps, atopic dermatitis and eosinophilic esophagitis, captured in previous statements, is reflective of my clinical experience.
Near consensus (Experts could abstain from voting)
All experts
The pattern of overlap in asthma, rhinitis, chronic rhinosinusitis with nasal polyps and atopic dermatitis captured in previous statements, is reflective of my clinical experience. No consensus All experts
The combined symptoms related to multiple moderate type 2 inflammatory conditions may be more burdensome for a patient compared with the symptoms of a single severe type 2 inflammatory condition. No consensus All experts
While the most serious cases should take priority in cross-functional multidisciplinary team conferences, some patients with multiple concurrent refractory moderate type 2 inflammatory conditions may benefit from having their cases discussed in this setting. No consensus All experts