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Fungi in chronic hyperplastic eosinophilic sinusitis: reasonable doubt.
Larry Borish1, Lanny Rosenwasser, John W Steinke
1Asthma and Allergic Disease Center, Beirne Carter Center for Immunology Research, University of Virginia Health System, Charlottesville, VA, USA. lb4m@virginia.edu
Clinical Reviews in Allergy & Immunology
|June 21, 2006
Summary
Chronic hyperplastic eosinophilic sinusitis (CHES) is an eosinophil-rich inflammatory disease. Identifying the specific antigen triggering CHES is crucial for developing effective treatments and potentially a cure.
Area of Science:
- Immunology
- Otolaryngology
- Allergy and Immunology
Background:
- Chronic hyperplastic eosinophilic sinusitis (CHES) is a T-helper 2 (Th2)-like inflammatory condition.
- The disease is characterized by lymphocyte initiation and eosinophil-rich infiltration.
- Immune responses in CHES involve antigen presentation by dendritic cells to T-helper lymphocytes.
Purpose of the Study:
- To review potential models for CHES pathophysiology.
- To identify and discuss potential antigens responsible for initiating CHES.
- To explore the hypothesis of fungal antigens as a cause of CHES.
Main Methods:
- Review of existing literature on CHES.
- Discussion of various proposed etiological models.
- Speculation on antigen-independent disease phases.
Main Results:
- Multiple factors may contribute to CHES, including allergens, bacteria, bacterial superantigens, and fungal antigens.
- A hypothesis suggests fungal antigens may play a role, but current evidence is circumstantial.
- The development of an antigen-independent phase post-initiation is plausible.
Conclusions:
- Identifying the specific antigen is key to curing CHES.
- Fungal antigens are an intriguing but unproven hypothesis for CHES.
- Definitive proof requires demonstrating T-cell response to fungal antigens and disease amelioration upon their removal.