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Allergic Aspergillus Rhinosinusitis
Arunaloke Chakrabarti1, Harsimran Kaur2
1Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. arunaloke@hotmail.com.
Abstract:
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
Insights
Allergic fungal rhinosinusitis (AFRS) is a complex sinus disease affecting many globally. This review explores its definition, pathogenesis, diagnosis, and management, highlighting ongoing controversies and recent advancements.
Area of Science:
- Otolaryngology
- Allergology
- Mycology
Background:
- Allergic fungal rhinosinusitis (AFRS) is a distinct form of chronic rhinosinusitis, prevalent in atopic individuals.
- It is characterized by eosinophilic mucin and fungal elements within paranasal sinuses, without mucosal invasion.
- AFRS presents global incidence variations and ongoing debates regarding its definition and cause.
Purpose of the Study:
- To review current understanding of AFRS, addressing controversies in its definition and etiopathogenesis.
- To summarize recent advancements in the diagnosis and management of AFRS.
- To provide a comprehensive overview for clinicians and researchers.
Main Methods:
- Literature review of existing studies on AFRS.
- Analysis of diagnostic approaches including imaging, histopathology, mycology, and immunology.
- Evaluation of current and potential management strategies.
Main Results:
- Controversies persist regarding AFRS definition, with terms like EFRS and EMRS adding complexity.
- Multiple hypotheses exist for AFRS pathogenesis, with recent research offering deeper insights.
- Diagnosis requires a multidisciplinary approach; management often involves surgery and steroids, but optimal protocols are debated.
Conclusions:
- AFRS remains a disease with unresolved questions regarding its etiology and precise definition.
- Multidisciplinary diagnostic strategies are crucial for accurate identification.
- While current management includes surgery and steroids, the efficacy of antifungals and immunomodulators requires further investigation.
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