Related Experiment Videos
Fungus-specific IgG and IgE in allergic fungal rhinosinusitis
Alexander E Stewart1, Darrell H Hunsaker
1Department of Otolaryngology, Naval Medical Center, San Diego, CA 92134-1005, USA. aestewart@pol.net
Objective:
Our study goal was to study fungus-specific immunoglobulins G (sIgG) and E (sIgE) in polypoid rhinosinusitis with and without evidence of allergic fungal rhinosinusitis (AFS).
Study Design And Setting:
A prospective analysis was conducted of fungal sIgG and sIgE using a 9-mold RAST panel in 13 AFS, 11 AFS-like, and 27 non-AFS polypoid rhinosinusitis patients. Nonpolyp controls included 17 volunteers with allergic rhinitis and 11 with no atopic history.
Results:
All groups had elevated fungal sIgG levels. Polyps, increasing polyp severity, and AFS were associated with elevated fungal sIgG to a greater number of molds. The AFS group had sIgE elevations (>or=class II) to an average of 5 molds versus only 0.1 in the non-AFS polyp group. Total IgE was 971 U/mL versus 64 U/mL, respectively.
Conclusions:
Multiple elevations of fungal sIgE are adequate diagnostic evidence of these fungi when fungal cultures and histologic examinations are negative in diagnosing AFS. The significance of increased fungal sIgG remains unclear.
Significance:
Early recognition of AFS may be facilitated by screening polypoid rhinosinusitis patients with total serum IgE and RAST testing.
Insights
Elevated fungal-specific immunoglobulin E (sIgE) is key for diagnosing allergic fungal rhinosinusitis (AFS), even with negative tests. Screening polypoid rhinosinusitis patients with total IgE and RAST testing aids early AFS recognition.
Area of Science:
- Immunology
- Allergy
- Otolaryngology
Background:
- Polypoid rhinosinusitis (PRS) is a chronic inflammatory condition.
- Allergic fungal rhinosinusitis (AFS) is a specific subtype requiring accurate diagnosis.
- Distinguishing AFS from non-AFS PRS is clinically important.
Purpose of the Study:
- To investigate fungus-specific immunoglobulins G (sIgG) and E (sIgE) in patients with PRS.
- To compare sIgG and sIgE levels in AFS, AFS-like, and non-AFS PRS.
- To evaluate the diagnostic utility of sIgE for AFS.
Main Methods:
- Prospective analysis of fungal sIgG and sIgE using a 9-mold RAST panel.
- Study included 13 AFS, 11 AFS-like, and 27 non-AFS PRS patients.
- Control groups included volunteers with allergic rhinitis and healthy individuals.
Main Results:
- All groups exhibited elevated fungal sIgG levels.
- Higher polyp severity and AFS correlated with increased fungal sIgG to more molds.
- The AFS group showed significantly higher fungal sIgE elevations (average 5 molds) compared to the non-AFS polyp group (average 0.1 molds).
- Total IgE levels were markedly higher in the AFS group (971 U/mL) versus the non-AFS polyp group (64 U/mL).
Conclusions:
- Multiple fungal sIgE elevations are sufficient for diagnosing AFS when cultures and histology are negative.
- The clinical significance of elevated fungal sIgG in PRS requires further investigation.
- Screening PRS patients with total serum IgE and RAST testing can facilitate early AFS detection.