Interleukin-4Ra Blockade by Dupilumab Decreases Staphylococcus Colonization and Increases Microbial Diversity in CRSwNP

Inclusion Criteria: • Adults, ages 18-65 * History of CRSwNP including subjects with AERD * Sinonasal culture demonstrating staph aureus at visit 1 * History of FESS with patent sinus ostia sufficient to obtain culture and tissue samples from the middle meatus * Asthma, if present, should be well controlled * Atopic dermatitis, if present, should be well controlled * Use of nasal saline irrigation and stable dosing (\>1 month) of topical corticosteroids is permitted * Intent of the physicians caring to start dupilumab therapy as part of subject's standard of care * Subject meets FDA approved criteria for the use of dupilumab for nasal polyps Exclusion Criteria: * Concurrent serious medical problem * Uncontrolled asthma (ACT \<20 at screening visit) * Recent (within 60 days) use of oral corticosteroids * Recent (within 60 days) urgent care, ED visit, or hospitalization for asthma * Current smoker or has smoked \>10 pack-years * Biologic therapy including asthma biologic therapy in last 3 months * Recent (within 1 month) change in CRS medical treatment (topical steroids, surfactants, irrigation protocol, etc. including changes in delivery volume or delivery methodology) * Recent (within 6 weeks) upper respiratory infection * Antibiotics within 6 weeks * Pregnant or breast-feeding women * Any contraindication to the use of dupilumab including hypersensitivity on previous administration