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Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens
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Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens

Published on: February 14, 2011

Medical treatment of allergic fungal sinusitis

M S Schubert1

  • 1Allergy Asthma Clinic, Phoenix, Arizona, USA.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|September 12, 2000
PubMed
Abstract

Insights

Allergic fungal sinusitis (AFS) is a distinct, under-diagnosed non-invasive sinusitis. Effective treatment requires surgery, oral corticosteroids, and aggressive allergy management, including immunotherapy, for best outcomes.

Area of Science:

  • Otolaryngology
  • Allergy and Immunology
  • Mycology

Background:

  • Allergic fungal sinusitis (AFS) is a distinct non-invasive fungal sinusitis, often under-diagnosed with variable regional incidence.
  • Dematiaceous fungi, such as Bipolaris spicifera in the southwestern US, are common causative agents.
  • AFS shares immunopathophysiology with allergic bronchopulmonary aspergillosis.

Purpose of the Study:

  • To differentiate Allergic Fungal Sinusitis (AFS) from other fungal sinusitis forms.
  • To elucidate AFS pathophysiology, clinical presentation, and diagnostic criteria.
  • To outline effective treatment and follow-up strategies, avoiding common pitfalls.

Main Methods:

  • Comprehensive literature review of MEDLINE articles (1983-present) using keywords: allergy, fungal, sinusitis, IgE, and related terms.
  • Inclusion of case reports, studies, and review articles.
  • Analysis of cross-referenced articles, published abstracts, and conference proceedings.

Main Results:

  • Patients present with nasal polyps, rhinosinusitis, and sometimes proptosis; CT scans reveal hypertrophic sinusitis and allergic mucin.
  • Histopathology shows eosinophilic-lymphocytic inflammation with fungal hyphae; patients are atopic with positive allergy skin tests and elevated total IgE.
  • Treatment involves surgery, postoperative oral corticosteroids (OCS), and aggressive allergy management including immunotherapy.

Conclusions:

  • Allergic fungal sinusitis is a recognizable allergic disorder with distinct clinical and histopathologic findings.
  • Effective management necessitates aggressive allergy control, postoperative OCS, total serum IgE monitoring, and combined medical/surgical care.
  • Cooperative medical and surgical follow-up is crucial for managing recurrence and achieving optimal patient outcomes.

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