Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

FeNO as a Non-Invasive Biomarker of Type 2 Inflammation in Chronic Rhinosinusitis with Nasal Polyps: Correlation with Serum IgE and Eosinophils

Document Type : Original

Authors
Sahar Fereydouni 1
Farahzad Jabbari Azad 1
Mehdi Bakhshaee 2
Maryam Khoshkhui 1
Yaser Yadegari 1
Mojgan Mohammadi 1
1 Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijorl.2025.88968.3979
Abstract
Introduction:
Chronic rhinosinusitis with nasal polyps is a heterogeneous inflammatory disorder often driven by type 2 inflammation. Identification of non-invasive biomarkers, such as fractional exhaled nitric oxide (FeNO), may support the assessment and personalized management.
Materials and Methods:
In this cross-sectional study, 141 patients with clinically and radiologically confirmed CRSwNP were assessed. FeNO levels, nasal eosinophilia, serum IgE, peripheral blood eosinophil counts, and skin prick test results were evaluated. Disease severity was measured using the SNOT-22 and Lund-Mackay CT scores.
Results:
FeNO showed a significant correlation with nasal eosinophilia (r = 0.53, p < 0.001), a moderate correlation with serum IgE (r = 0.40, p < 0.001), and a weak correlation with blood eosinophils (r = 0.17, p = 0.047). Serum IgE was significantly associated with both SNOT-22 and Lund-Mackay scores. FeNO did not show significant correlation with symptom severity or radiological extent, suggesting its use as a supportive marker rather than a stand-alone predictor.
 Conclusion:
FeNO may serve as a potential non-invasive marker for type 2 inflammation in CRSwNP, though it may not predict disease severity. Combining FeNO with other markers could improve clinical endotyping and management.
Keywords
Blood eosinophil
CRSwNP
Chronic rhinosinositis
FeNO
IgE
Nasal smear
Subjects
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Iranian Journal of Otorhinolaryngology
Volume 38, Issue 1
January and February 2026
Pages 1-9