Summary of Recommendations

Video

Document Overview

Design and created by Guideline Central in participation with the American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology.

Medical Management of Chronic Rhinosinusitis with Nasal Polyposis

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

Publication Date: Nov 8, 2022

Page Last Updated: May 5, 2026

Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations

Implications for:	Strong Recommendation (S)	Conditional Recommendation (C)
Patients	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	The majority of individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
Policy	The recommendation can be adopted as policy in most situations.	Policymaking will require substantial debate and involvement of various stakeholders.

Certainty in the Evidence
High	H	Low	L
Moderate	M	Very Low	VL

Source: Grading of Recommendations Assessment, Development and Evaluation Working Group (Schunemann HJ et al. Am J Respir Crit Care Med. 2006;174:605-14. Guyatt GH et al. BMJ 2008;336:924-6).

Document Overview

Document Title: Medical Management of Chronic Rhinosinusitis with Nasal Polyposis

Authoring Societies

American College of Allergy, Asthma, and Immunology

American Academy of Allergy, Asthma & Immunology

Document Publication Date: Nov 8, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.jacionline.org/article/S0091-6749(22)01484-1/fulltext

Source Citation: Rank MA, Chu DK, Bognanni A, Oykhman P, Bernstein JA, Ellis AK, Golden DBK, Greenhawt M, Horner CC, Ledford DK, Lieberman J, Luong AU, Orlandi RR, Samant SA, Shaker MS, Soler ZM, Stevens WW, Stukus DR, Wang J, Peters AT, The Joint Task Force on Practice Parameters GRADE Guidelines for the Medical Management of Chronic Rhinosinusitis with Nasal Polyposis, Journal of Allergy and Clinical Immunology (2022), doi: https://doi.org/10.1016/j.jaci.2022.10.026.

Bognanni A, Chu DK, Rank MA, Bernstein J, Ellis AK, Golden D, Greenhawt M, Hagan JB, Horner CC, Ledford DK, Lieberman J, Luong AU, Marks LA, Orlandi RR, Samant SA, Shaker M, Soler ZM, Stevens WW, Stukus DR, Wang J, Peters AT. Topical corticosteroids for chronic rhinosinusitis with nasal polyposis: GRADE systematic review and network meta-analysis. J Allergy Clin Immunol. 2022 Dec;150(6):1447-1459.

Oykhman P, Paramo FA, Bousquet J, Kennedy DW, Brignardello-Petersen R, Chu DK. Comparative efficacy and safety of monoclonal antibodies and aspirin desensitization for chronic rhinosinusitis with nasal polyposis: A systematic review and network meta-analysis. J Allergy Clin Immunol. 2022 Apr;149(4):1286-1295.

Chu DK, Lee DS, Lee KM, Schunemann HJ, Szczeklik W, Lee JM. Benefits and harms of aspirin desensitization for aspirin exacerbated respiratory disease: a systematic review and meta-analysis. Int Forum Allergy Rhin. 2019;9:1409-19.

Supplemental Implementation Resources

Podcast

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of this document is to evaluate the current evidence and provide guidance on the use of INCS and biologics for CRSwNP and ATAD for AERD.

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D012852 - Sinusitis

D009298 - Nasal Polyps

D012852 - Sinusitis

D009298 - Nasal Polyps

Keywords: chronic rhinosinusitis, crs, crswnp, nasal polyps, rhinosinusitis

Target Patient Population: people with Chronic rhinosinusitis with nasal polyposis (CRSwNP) aged 18 years and older

Target Provider Population: specialists in allergy-immunology, otorhinolaryngologists, pulmonologists, general practitioners, and allied health practitioners

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Should intranasal corticosteroids rather than no intranasal corticosteroids be used in Chronic rhinosinusitis with nasal polyposis?
Should biologics rather than no biologics be used Chronic rhinosinusitis with nasal polyposis?
Should aspirin therapy after desensitization (ATAD) rather than no ATAD, be used in people with Aspirin-exacerbated respiratory disease (AERD)?

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 122

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes