PMID- 19330659
OWN - NLM
STAT- MEDLINE
DCOM- 20090727
LR  - 20220311
IS  - 1460-2709 (Electronic)
IS  - 1369-3786 (Linking)
VI  - 47 Suppl 1
DP  - 2009
TI  - Allergic fungal sinusitis: pathophysiology, diagnosis and management.
PG  - S324-30
LID - 10.1080/13693780802314809 [doi]
AB  - Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis 
      with an incidence of between 6 and 9% of all rhinosinusitis requiring surgery. 
      Regional variation in incidence has been reported, with the southern and 
      southwestern US particularly endemic. Patients with AFS commonly present with 
      chronic rhinosinusitis with nasal polyps, inhalant atopy, elevated total serum 
      immunoglobulin E (IgE), and sinus-obstructing inspissates of a characteristic 
      extramucosal 'peanut buttery' visco-elastic eosinophil-rich material called 
      'allergic mucin' that contains sparse numbers of fungal hyphae. Sinus CT is 
      always abnormal, showing findings of chronic rhinosinusitis that often include 
      central areas of increased contrast ('hyperattenuation') within abnormal 
      paranasal sinuses that represent the presence of fungal-containing allergic 
      mucin. AFS has been found to be analogous in several ways to allergic 
      bronchopulmonary aspergillosis (ABPA). Both are chronic inflammatory respiratory 
      tract disorders that are driven by hypersensitivity responses to the presence of 
      small numbers of extramucosal fungi found growing within airway-impacting 
      allergic mucin. AFS allergic mucin typically cultures positive for either 
      dematiaceous fungi such as Bipolaris spicifera or Curvularia lunata, or 
      Aspergillus species such as A. fumigatus, A. flavus or A. niger. As with ABPA, 
      patients have type I immediate hypersensitivity to the etiologic mold in AFS. 
      Further, both AFS and ABPA have been found to have association with specific 
      class II major histocompatibility alleles. Proper diagnosis of AFS and 
      differentiation from the other forms of both noninvasive and invasive fungal 
      rhinosinusitis requires strict adherence to published diagnostic criteria. 
      Medical treatment of AFS has been modeled to an extent after treatment approaches 
      for ABPA that includes the use of postoperative oral corticosteroids and 
      aggressive antiallergic inflammation therapy. The use of follow-up measurements 
      of total serum IgE during treatment of both AFS and ABPA patients can help to 
      monitor disease activity. Future AFS research will lead to further insights into 
      pathogenesis, improved treatments, and ultimately decreases in surgical 
      recurrence rates for this highly recurrent hypertrophic rhinosinusitis disorder.
FAU - Schubert, Mark S
AU  - Schubert MS
AD  - Allergy Asthma Clinic, Ltd, Phoenix, Arizona 85013, USA. marks10295@aol.com
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20090327
PL  - England
TA  - Med Mycol
JT  - Medical mycology
JID - 9815835
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - *Case Management
MH  - Fungi/immunology/isolation & purification
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Incidence
MH  - Mycoses/*diagnosis/*drug therapy/epidemiology/physiopathology
MH  - Paranasal Sinuses/*microbiology/*pathology
MH  - Sinusitis/*diagnosis/*drug therapy/epidemiology/physiopathology
MH  - United States/epidemiology
RF  - 59
EDAT- 2009/03/31 09:00
MHDA- 2009/07/28 09:00
CRDT- 2009/03/31 09:00
PHST- 2009/03/31 09:00 [entrez]
PHST- 2009/03/31 09:00 [pubmed]
PHST- 2009/07/28 09:00 [medline]
AID - 909962359 [pii]
AID - 10.1080/13693780802314809 [doi]
PST - ppublish
SO  - Med Mycol. 2009;47 Suppl 1:S324-30. doi: 10.1080/13693780802314809. Epub 2009 Mar 
      27.