Case Report: Olfactory loss as the sentinel manifestation of type 2 chronic rhinosinusitis without polyps: response to IL-4Rα inhibition with stapokibart - a case series
- 1Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei , ,
- 2Department of Otorhinolaryngology, The Central Hospital of Wuhan, Huazhong University of Science and Technology , ,
Abstract
Chronic rhinosinusitis without nasal polyps (CRSsNP) is traditionally associated with type 1 inflammation, but emerging evidence reveals a subset of patients with a type 2 endotype driven by IL-4 and IL-13, often presenting with prominent olfactory dysfunction and responding poorly to conventional therapy. We report three cases of type 2 CRSsNP with comorbid allergic rhinitis (aged 29–30 years, two males, one female) who presented with debilitating olfactory loss as the sentinel symptom. All had elevated type 2 biomarkers, absence of nasal polyps, and CT evidence of sinusitis. After failure of intranasal corticosteroids, they received stapokibart (600 mg loading dose, then 300 mg every two weeks for 16 weeks). Olfactory improvement occurred within two weeks and was sustained through week 16; SNOT-22 scores decreased by approximately 90%, and Lund-Mackay scores decreased to 0 (Cases 1 and 2) and 1 (Case 3). Serum total IgE decreased in all patients; eosinophil counts decreased in two but paradoxically increased in one. No serious adverse events occurred. Type 2 CRSsNP with prominent olfactory dysfunction is a distinct, treatable phenotype. Stapokibart rapidly improves olfactory function in patients refractory to conventional therapy, supporting an endotype-driven biologic strategy for CRS.
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BibTeX
@article{cai2026case,
title = {{Case Report: Olfactory loss as the sentinel manifestation of type 2 chronic rhinosinusitis without polyps: response to IL-4Rα inhibition with stapokibart - a case series}},
author = {Hua Cai and Tao Zhou and Juan-Juan Hu and Sha-Zhou Li and Xiang-Ning Cheng and Yu-Zhe Hao and Jian-Jun Chen and Yao Hu and Liu-Qing Zhou},
journal = {Frontiers in immunology},
year = {2026},
month = sep,
doi = {10.3389/fimmu.2026.1936613},
url = {https://europepmc.org/article/PMC/PMC13661803},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Olfactory loss as the sentinel manifestation of type 2 chronic rhinosinusitis without polyps: response to IL-4Rα inhibition with stapokibart - a case series
AU - Hua Cai
AU - Tao Zhou
AU - Juan-Juan Hu
AU - Sha-Zhou Li
AU - Xiang-Ning Cheng
AU - Yu-Zhe Hao
AU - Jian-Jun Chen
AU - Yao Hu
AU - Liu-Qing Zhou
PY - 2026
DA - 2026/09/30
JO - Frontiers in immunology
DO - 10.3389/fimmu.2026.1936613
UR - https://europepmc.org/article/PMC/PMC13661803
AB - Chronic rhinosinusitis without nasal polyps (CRSsNP) is traditionally associated with type 1 inflammation, but emerging evidence reveals a subset of patients with a type 2 endotype driven by IL-4 and IL-13, often presenting with prominent olfactory dysfunction and responding poorly to conventional therapy. We report three cases of type 2 CRSsNP with comorbid allergic rhinitis (aged 29–30 years, two males, one female) who presented with debilitating olfactory loss as the sentinel symptom. All had elevated type 2 biomarkers, absence of nasal polyps, and CT evidence of sinusitis. After failure of intranasal corticosteroids, they received stapokibart (600 mg loading dose, then 300 mg every two weeks for 16 weeks). Olfactory improvement occurred within two weeks and was sustained through week 16; SNOT-22 scores decreased by approximately 90%, and Lund-Mackay scores decreased to 0 (Cases 1 and 2) and 1 (Case 3). Serum total IgE decreased in all patients; eosinophil counts decreased in two but paradoxically increased in one. No serious adverse events occurred. Type 2 CRSsNP with prominent olfactory dysfunction is a distinct, treatable phenotype. Stapokibart rapidly improves olfactory function in patients refractory to conventional therapy, supporting an endotype-driven biologic strategy for CRS.
SN - 1664-3224
ER -