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Ear, Nose and Throat

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Recurrent Respiratory Papillomatosis

Recurrent Respiratory Papillomatosis (RRP) is a condition where multiple warts grow within the airway and breathing passages. These warts are called papillomata and when they grow inside the voice-box (larynx) they result in hoarseness and an altered voice but more importantly can restrict breathing.

What is the cause?

RRP is caused by a viral infection. Human Papillomavirus (HPV) types 6 and 11 are the responsible viruses. The HPV virus is very common and about 25% of the population have this virus inside their bodies albeit without any sign of disease, though the proportion does vary with age.

The importance of HPVWithin the HPV virus family other members (types) can also cause cancer. The HPV types that cause cervical cancer in adults are HPV 16 and 18. The types that cause cancer are called high-risk. There are also low-risk HPV virus types which cause benign conditions such as skin warts and RRP, though the types that cause skin warts are different to RRP types. Skin warts do not cause RRP.

What is the cure?Unfortunately, RRP has no cure. The management of the condition requires repeated removal of the papillomatous lesion under general anaesthetic and this may be necessary every 4-6 weeks initially. Numerous additional (adjuvant) therapies have been used in the UK and abroad however these have not been found to be curative. Mr Donne has performed laboratory research into the adjuvant therapies and has been awarded a PhD for his work. He actively continues to do research into RRP.

HPV vaccine
There is now a vaccine available against HPV 6 and 11. It might prevent RRP developing but it is not known to have an effect on the RRP condition once it is established. The effects of the vaccine on RRP prevalence is not yet known.

Research
Mr Adam Donne at Alder Hey is actively performing research to improve our understanding of RRP. His current research is looking into possible prognostic and therapeutic biomarkers for RRP. He is also the Chief Investigator for the UK arm of a major international study based in the USA looking at the genetics of RRP. It is thought that subtle genetic differences may affect the way different people fight HPV infection hence those that develop disease versus those that simple have the virus in their bodies with no ill effects.

Contact Details
Mr Adam Donne
Alder Hey Children’s NHS Foundation Trust
Eaton Road
Liverpool
L12 2AP
0151 228 4811

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