The Type 2 Inflammation Connection

With your skin, nose, airways and lungs as possible sites for type 2 inflammation, the list of type 2 inflammation-related conditions — including those that often occur together — is substantial. Common coexisting conditions include:

• Allergies – An allergy is a reaction of the immune system to a normally harmless substance, like certain foods or plants. People who don’t have that allergy generally won’t react to the substance.
• Asthma – Asthma is a lung condition that causes inflammation and narrowing of the lung’s airways, leading to breathing challenges that can be mild or severe.
• Chronic rhinosinusitis with nasal polyps (CRSwNP) – In this chronic inflammatory condition, benign growths called nasal polyps form in your sinuses or nose and can cause disruptive symptoms, like sinus pressure and difficulty breathing. Even after surgery to remove them, nasal polyps often grow back.
• Chronic obstructive pulmonary disease (COPD) – In this disease, airways and other parts of your lungs become damaged so that breathing becomes difficult. Smoking is the most common cause of COPD but there are also other causes, like environmental pollutants.
• Eczema – Eczema is a chronic inflammatory disease that causes dry, itchy inflamed skin. Atopic dermatitis is the most common form of eczema.
• Eosinophilic esophagitis (EoE) – This chronic condition happens as a response to triggers such as certain foods or environmental allergens. A person’s esophagus is flooded with white blood cells, causing painful swelling of the esophagus. It can become difficult to eat or swallow comfortably.
• Prurigo nodularis – This condition, which causes raised, itchy skin bumps, can occur anywhere on your body but is most common on the abdomen, arms and legs.
• Urticaria – Urticaria is the medical term for hives, which are red, itchy welts that can appear anywhere on your body, often occurring then disappearing. Over a period of weeks or even months, hives can reappear again and again, often without an obvious cause. When this happens, it’s called chronic spontaneous urticaria.

According to Gupta, when people have two or more of these conditions, HCPs should consider whether underlying type 2 inflammation could be making these conditions worse. “Environmental triggers such as allergens like pollen, pet dander, dust mites or mold, as well as pollution or infections, can trigger or worsen type 2 inflammation,” she said. “In these cases, it’s important to calm the underlying type 2 inflammation as much as possible to lessen the severity of the coexisting conditions.”

Lack of awareness of type 2 inflammation among both patients and HCPs can contribute to delayed diagnosis, especially if you have more than one condition. This lack of awareness also means the conditions can take a big toll on your quality of life and you may not understand that getting specialized care could potentially make your chronic inflammatory conditions much more manageable.

Treating underlying inflammation requires an HCP to identify inflammation that extends beyond just one condition, like asthma or EoE. One way that HCPs figure out if you have widespread inflammation is to measure the number of eosinophils in your blood.

Eosinophils are a type of white blood cell that defend your body from allergens. They can also be a marker for type 2 inflammation. When your blood contains too many eosinophils, that will help your HCP make the diagnosis of type 2 inflammation.

According to Gupta, you don’t always need to see a specialist right away if your conditions are well-controlled.“But if you ever feel your conditions are not controlled or responding to your current treatments, you should ask for a referral to a specialist.”

You may already be seeing a specialist, of course. For example, people with eczema might see a dermatologist, someone with EoE probably sees a gastroenterologist and someone with COPD probably sees a pulmonologist.

Having a multidisciplinary medical team behind you is important when dealing with complicated conditions like type 2 inflammation, so you might want to see an allergist, too. Allergists can help manage all type 2 inflammation-related conditions and should have updated knowledge of medications that can help. Gupta said, “Many of the medications used in type 2 inflammation can help with more than one condition, but they’re often biologics that require specialized knowledge and access.”

Unfortunately, there is no cure for allergic disease or type 2 inflammatory conditions. “We can manage them with medications, but it’s important to understand that if you stop your medication, your type 2 inflammation will likely come back,” Gupta said.

Without continuing to manage the underlying inflammation, flares will continue and may worsen, sometimes by a lot. “External triggers like pollution, allergens and infection can then trigger more inflammation on top of [inflammation you already have], and then your body can get into real trouble,” she said. “That's why we still see 11 deaths from asthma per day in this country — because we're not properly managing that underlying inflammation.”

On the other hand, when patients with type 2 inflammation-related conditions are able to keep their inflammation under control with the right medication regimen, and continue to have their condition monitored, their outlook is bright. “With all the good treatment options we have available, we should be able to manage type 2 inflammation-related conditions to the point where you barely even notice you have asthma or EoE or urticaria,” Gupta said. “Effective therapies and shared decision-making to choose the best regimen for you can finally get your type 2 inflammation under control.”