How does Dupixent help to reduce nasal polyps?

Question

Hello doctor,

I had chronic nasal polyps for years and had surgery twice, but they keep coming back. My ENT (ear, nose, and throat doctor) says now to try taking a biologic like Dupixent.

I wonder how long that takes to work and if it shrinks the polyps fully or controls symptoms. Also, can polyps cause pressure on the eyes or headaches?
I am also allergic to NSAIDs (non-steroidal anti-inflammatory drugs). Does it make my case worse or harder to treat?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Thanks for the briefing regarding the problem. Firstly, you need to understand that nasal polyps are a consequence of chronic allergy. Allergy is a hyperactive response to allergens coming in contact with your respiratory tract, causing an inflammatory cascade beginning with mere watering of the nose, recurrent sinusitis, causing headaches, nasal obstruction, and so on. Nasal polyps are the end stage when the inflammatory process has not reached a standstill.

Recurrence of polyps despite surgery indicates recurrent exposure to the allergen in question, which you can specifically detect by getting a comprehensive allergy panel and blood testing done. The results will reveal which allergen you need to avoid for life.

I would suggest you go for an oral steroid therapy that includes 60 mg of Prednisolone for five days in the morning after food, followed by 30 mg for the next five days, followed by 20 mg for the next five days, and 10 mg for the next five days. This should certainly shrink the polyps. Once this is done, you can shift to biologics like Dupixent, which is Dupilumab, a monoclonal antibody acting against specific inflammatory markers like interleukin 4 and 13, which are the mediatory pathways for allergy and nasal polyps.

Since you have made a clear mention that you are allergic to Aspirin, you could also have Aspirin sensitivity with nasal polyps, with possible asthma, and this is called samters triad, which you read and understand well online. Yes, this does make things harder to treat, and yes, we have a solution for it, which we call immunotherapy. Dupixent is not going to shrink the polyp; it is the steroid that is going to do so. Once the polyps have shrunk with oral steroids, you can use Dupixent as a maintenance therapy to keep things in control. Avoiding allergens will be the key factor to prevent persistent recurrence.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.