What treatment approach do you suggests for a patient with nasal polyp disease and asthma who was improved on dupilumab, but over last 2 years has begun to have increased nasal symptoms and rising eosinophil counts?

Dr. @Dr. First Last's comments are quite valuable. It might be more expedient to consider simpler options first, then progress to the less common diagnoses as needed. I very much agree that unless we know what is meant by "increased nasal symptoms", it is difficult to provide precise alternative the...

It is important to better define "nasal symptoms". If the patient has symptoms of allergic sensitization (sneezing, itching), an aggressive nasal steroid-based therapy is desirable. If they are already on such therapy (commonly done with CRS wNP patients, even after starting dupilumab and the worsen...

The answer depends somewhat on the nature of the symptoms. The rising serum eosinophils could be reactive due to infection or inflammation, secondary to side effects of the dupilumab, or due to another underlying cause such as EGPA (Eosinophilic granulomatosis with polyangitis).

First and foremost, ...