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Allergic fungal rhinosinusitis

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Abstract

The combination of nasal polyposis, crust formation, and sinus cultures yielding Aspergillus was first noted in 1976 by Safirstein, who observed the clinical similarity that this constellation of findings shared with allergic bronchopulmonary aspergillosis (ABPA). Eventually, this disease came to be known as allergic fungal rhinosinusitis (AFRS). As clinical evidence of AFRS accumulated, controversy regarding its etiology, pathogenesis, natural history, and appropriate treatment naturally emerged. Despite past and current efforts, many of these controversies remain incompletely resolved, but continuing clinical study has illuminated some aspects of the disease and has led to an improved understanding of AFRS and its treatment. In this article, we review current data and theories regarding the pathophysiology and clinical presentation of AFRS, as well as the roles of various surgical and nonsurgical forms of therapy.

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erences and Recommended Reading

  1. Saferstein B: Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. Chest 1976, 70:788–790.

    Google Scholar 

  2. Lamb D, Millar J, Johnston A: Allergic aspergillosis of the paranasal sinuses. J Pathol 1982, 137:56.

    Google Scholar 

  3. Katzenstein A, Greenberger P, Sale S: Allergic Aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol 1983, 72:89–93.

    Article  PubMed  CAS  Google Scholar 

  4. Gungor A, Adusmilli V, Corey JP: Fungal sinusitis: progression of disease in immunosuppression: a case report. Ear Nose Throat J 1998:77:207–215.

    PubMed  CAS  Google Scholar 

  5. Manning SC, Holman M: Further evidence for allergic pathophysiology in allergic fungal sinusitis. Laryngoscope 1998, 108:1485–1496.

    Article  PubMed  CAS  Google Scholar 

  6. Feger TA, Rupp NT, Kuhn FA, et al.: Local and systemic eosinophil activation in allergic fungal sinusitis. Ann Allergy Asthma Immunol 1997, 79:221–225.

    PubMed  CAS  Google Scholar 

  7. Marple BF: Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 2001, 111:1006–1019. prehensive review of the literature as it relates to allergic fungal rhinosinusitis.

    Article  PubMed  CAS  Google Scholar 

  8. Cody DT, Neel HB, Ferreiro JA, et al.: Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope 1994, 104:1074–1079.

    Article  PubMed  Google Scholar 

  9. Ferguson BJ, Barnes L, Bernstein JM, et al.: Geographic variation in allergic fungal rhinosinusitis. Otolaryngol Clin North Am 2000, 33:441–449.

    Article  PubMed  CAS  Google Scholar 

  10. Bent III JP, Kuhn FA: Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994, 111:580–588. This article offers the most specific set of criteria to date for establishing the diagnosis of allergic fungal rhinosinusitis.

    Article  PubMed  Google Scholar 

  11. Corey JP, Delsupehe KG, Ferguson BJ: Allergic fungal sinusitis: allergic, infectious, or both? Otolaryngol Head Neck Surg 1995, 113:110–119.

    Article  PubMed  CAS  Google Scholar 

  12. Deshpande RB, Shaukla A, Kirtane MV: Allergic fungal sinusitis: incidence and clinical and pathological features of seven cases. J Assoc Physicians India 1995, 43:98–100.

    PubMed  CAS  Google Scholar 

  13. Marple BF, Gibbs SR, Newcomer MT, et al.: Allergic fungal sinusitis-induced visual loss. Am J Rhinol 1999, 13:191–195.

    PubMed  CAS  Google Scholar 

  14. Manning S, Vuitch F, Weinberg A, et al.: Allergic aspergillosis: a newly recognized form of sinusitis in the pediatric population. Laryngoscope 1989, 99:681–685.

    Article  PubMed  CAS  Google Scholar 

  15. Manning S, Schaefer S, Close L, et al.: Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg 1991, 117:174–178.

    PubMed  CAS  Google Scholar 

  16. Marple BF: Allergic fungal sinusitis. Curr Opin Otolaryngol Head Neck Surg 1999, 7:383–387.

    Article  Google Scholar 

  17. Mukherji SK, Figueroa RE, Ginsberg LE, et al.: Allergic fungal sinusitis: CT findings. Radiology 1998, 207:417–422.

    PubMed  CAS  Google Scholar 

  18. Nussenbaum B, Marple BF, Schwade ND: Characteristics of bony erosion in allergic fungal rhinosinusitis. Otolaryngol Head Neck Surg 2001, 124:150–154.

    Article  PubMed  CAS  Google Scholar 

  19. Som PM, Curtin HD: Chronic inflammatory sinonasal disease including fungal infections: the role of imaging. Radiol Clin North Am 1993, 31:33–44.

    PubMed  CAS  Google Scholar 

  20. Manning SC, Merkel M, Kriesel K, et al.: Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope 1997, 107:170–176.

    Article  PubMed  CAS  Google Scholar 

  21. Schubert MS, Goetz DW: Evaulation and treatment of allergic fungal sinusitis, II: treatment and follow-up. J Allergy Clin Immunol 1998, 102:395–402.

    Article  PubMed  CAS  Google Scholar 

  22. Manning SC, Mabry RL, Schaefer SD, et al.: Evidence of IgEmediated hypersensitivity in allergic fungal sinusitis. Laryngoscope 1993, 103:717–721.

    Article  PubMed  CAS  Google Scholar 

  23. Mabry RL, Manning S: Radioallergosorbent microscreen and total immunoglobulin E in allergic fungal sinusitis. Otolaryngol Head Neck Surg 1995, 113:721–723.

    Article  PubMed  CAS  Google Scholar 

  24. Chrzanowski RR, Rupp NT, Kuhn FA, et al.: Allergenic fungi in allergic fungal sinusitis. Ann Allergy Asthma Immunol 1997, 79:431–435.

    Article  PubMed  CAS  Google Scholar 

  25. Corey JP: Allergic fungal sinusitis. Otolaryngol Clin North Am 1992, 25:225–230.

    PubMed  CAS  Google Scholar 

  26. Marple BF, Mabry RL: Comprehensive management of allergic fungal sinusitis. Am J Rhinol 1998, 12:263–268.

    PubMed  CAS  Google Scholar 

  27. Schanadig VJ, Rassekh CH, Gourley WK: Allergic fungal sinusitis: a report of two cases with diagnosis by intraoperative aspiration cytology. Acta Cytol 1999, 43:268–272.

    Google Scholar 

  28. Torres C, Ro JY, el-Naggar AK, et al.: Allergic fungal sinusitis: a clinicopathologic study of 16 cases. Hum Pathol 1996, 27:793–799.

    Article  PubMed  CAS  Google Scholar 

  29. Millar J, Johnston, Lamb D: Allergic bronchopulmonary aspergillosis of the maxillary sinuses (abstract). Thorax 1981, 36:710.

    Google Scholar 

  30. Berrettini S, Carabelli A, Papini M, et al.: Allergic fungal sinusitis: Is this rare disease an allergy or infection? Acta Otorhinolaryngol Ital 1996, 16:447–454.

    PubMed  CAS  Google Scholar 

  31. deShazo RD, O’Brien M, Chapin K, et al.: Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 1997, 99:4755–4785.

    Article  Google Scholar 

  32. Ferguson BJ: Immunotherapy and antifungal therapy in allergic fungal sinusitis. Presented at the 1993 Annual Meeting of the American Academy of Otolaryngic Allergy, Minneapolis, MN, Sept 29, 1993.

  33. Lydiatt WM, Sobba-Higley A, Huerter JV, et al.: Allergic fungal sinusitis with intracranial extension and frontal lobe symptoms: a case report. Ear Nose Throat J 1994, 73:402–404.

    PubMed  CAS  Google Scholar 

  34. Allphin AL, Strauss M, Abdul-Karim FW: Allergic fungal sinusitis: problems in diagnosis and treatment. Laryngoscope 1991, 101:815–820.

    Article  PubMed  CAS  Google Scholar 

  35. Loury MC, Leopold DA, Schaefer SD: Allergic Aspergillus sinusitis. Arch Otolaryngol Head Neck Surg 1993, 119:1042–1043.

    PubMed  CAS  Google Scholar 

  36. Rains BM, Mineck CW: Treatment of allergic fungal sinusitis with high dose itraconazole: a twelve year retrospective review. Abstract presented at the Combined Otolaryngology Spring Meetings, May 2001.

  37. Denning DW, Van Wye JE, Lewiston NJ: Adjunctive treatment of allergic bronchopulmonary aspergillosis with itraconazole. Chest 1991, 100:813–819.

    PubMed  CAS  Google Scholar 

  38. Marple BF, Newcomer M, Schwade N, Mabry RL: Natural history of allergic fungal rhinosinusitis: a 4- to 10-year follow-up. Otolaryngol Head Neck Surg 2002, 127:361–366.

    Article  PubMed  Google Scholar 

  39. Ponikau JU, Sherris DA, Kern EB, et al.: The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999, 74:877–884. This is a controversial, but thought-provoking, study that implicates fungus as a primary cause of chronic rhinosinusitis.

    Article  PubMed  CAS  Google Scholar 

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Luong, A., Marple, B.F. Allergic fungal rhinosinusitis. Curr Allergy Asthma Rep 4, 465–470 (2004). https://doi.org/10.1007/s11882-004-0013-5

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