In patients where the nasal polyps do not seem to respond to the above protocol (or if patient is refusing surgery), the addition of a very strong drug called Zyflo (zileuton) may be of benefit. This drug can cause liver damage (in <10% of patients) and as such, liver function bloodwork (AST/ALT) is required every month for 3 months and yearly thereafter. As long as the AST/ALT numbers do not exceed 150 (yes, it is higher than what is considered normal), it is generally considered safe to continue with this drug (though would check bloodwork weekly if that happens to ensure stability). Getting an immunologist involved in the care of such patients would also be beneficial, especially for those patients where the nasal polyps are particularly resistant to standard treatment.
Recent research has identified differences in aetiology between chronic rhinitis with polyps and chronic rhinitis without polyps [ 3 ] . Patients presenting with chronic rhinitis with polyps are found to have oedema of the nasal mucosa, low T regulatory cell activity and low levels of beta-tissue growth factor. The opposite picture is seen with patients who have chronic rhinitis without polyps. Considerable variation exists globally. Different factors may be involved, depending on factors such as geographical location, culture and differences in bacterial colonisation [ 2 ] .