Severe Asthma, Allergen Sensitization, and Chronic Rhinosinusitis: A 10-Year Real-Life Cohort Study

Background: Severe asthma frequently coexists with allergen sensitization and chronic rhinosinusitis (CRS), both of which contribute to disease burden. Real-life data describing sensitization patterns and CRS characteristics in severe asthma remain limited.Objective: To evaluate allergen sensitization profiles, clinical and CT-confirmed CRS, and nasal polyp characteristics in a real-life cohort of patients with severe asthma.Methods: This retrospective study included adult patients with severe asthma followed over a 10-year period. Demographic characteristics, asthma-related features, sensitization patterns, sinonasal assessments, nasal polyp scores, and laboratory parameters were analyzed. Results: A total of 160 patients were included. Atopy was present in 71.9% of cases and was significantly less frequent in patients treated with benralizumab compared with other biologic therapies (p < 0.001). Clinical CRS was detected in 60.1%, while CT-confirmed CRS was present in 70.7%. Monosensitized patients had significantly lower rates of both clinical and CT-confirmed CRS (p = 0.048 and p = 0.002, respectively). Nasal polyps were identified in 19.3% of patients, with a recurrence rate of 30.9%. Dermatophagoides farinae and Dermatophagoides pteronyssinus were the most common sensitizations.Conclusion: Allergen sensitization and CRS/CRSwNP are highly prevalent in severe asthma and shape the clinical phenotype of the disease. Comprehensive evaluation of upper-airway involvement and sensitization is essential in the management of severe asthma.