Clinical and Translational Allergy · Published 2026-07-01 · DOI 10.1002/clt2.70186
Radosław Kacorzyk, Piotr Szatkowski, Agnieszka Gawlewicz‐Mroczka, Adam Ćmiel, Anna Gielicz, Adam Stępień, Patryk Hartwich, Marek Sanak, Lucyna Mastalerz
ABSTRACT Background Up to 50% of patients with nonsteroidal anti‐inflammatory drug‐exacerbated respiratory disease (N‐ERD) exhibit a noneosinophilic airway inflammatory phenotype, with paucigranulocytic asthma being the most prevalent. The aim was to identify clusters within N‐ERD and aspirin‐tolerant asthma (ATA) controls with a paucigranulocytic asthma phenotype. Methods Two separate hierarchical cluster analyses were performed using 23 variables in 36 N‐ERD patients and 19 ATA controls. Variables included demographic, clinical, treatment‐related, and hematologic parameters; sputum cytology; sinus computed tomography findings; and eicosanoid levels in induced sputum supernatant (ISS) and urine. Results Two clusters were identified in each group: 1N‐ERD, 2N‐ERD, 1ATA, and 2ATA. Cluster 1N‐ERD patients had less severe asthma and required lower doses of inhaled corticosteroids (ICS) but showed higher blood eosinophil counts, Lund‐Mackay (LM) scores, and ISS leukotriene E4 (LTE4) levels than those in cluster 2N‐ERD. Cut‐off values defining a T2‐high paucigranulocytic asthma profile in N‐ERD included LM score ≥ 18, blood eosinophils ≥ 300 cells/mm3, and ISS LTE4 ≥ 30 pg/mL, with the LM score demonstrating the highest AUC at 0.8. Among ATA controls, cluster 1ATA had more severe asthma, higher ICS doses, more severe sinonasal disease, and increased ISS leukotriene D4 and LTE4 levels compared with cluster 2ATA. Conclusion Two clusters were identified among N‐ERD patients with a paucigranulocytic asthma phenotype. Cluster 1N‐ERD was characterized by milder asthma, more severe sinonasal disease, elevated blood eosinophil counts, and elevated ISS LTE4. This T2‐high‐like cluster may represent a subgroup requiring further evaluation for anti‐T2 biologic therapy targeting chronic rhinosinusitis with nasal polyps, although further validation is required.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →
Kacorzyk, R., Szatkowski, P., Gawlewicz‐Mroczka, A., et al. (2026). Paucigranulocytic Asthma in Aspirin‐Hypersensitive Patients: Pleiotropic Regulation of Type 2 Biomarkers. Clinical and Translational Allergy. https://doi.org/10.1002/clt2.70186