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Allergic Fungal Rhinosinusitis and Eosinophilic Chronic Rhinosinusitis Have Different Phenotypes in Japan

Tsuguhisa Nakayama1, Natsuki Inoue2, Makoto Akutsu1

  • 1Department of Otorhinolaryngology and Head & Neck Surgery, Dokkyo Medical University, Mibu, Shimotsuga, Tochigi, Japan.

International Forum of Allergy & Rhinology
|April 29, 2025
PubMed
Abstract

Insights

Allergic fungal rhinosinusitis (AFRS) presents unique clinical features compared to eosinophilic chronic rhinosinusitis (eCRS). Cluster analysis revealed three AFRS phenotypes, aiding differential diagnosis and personalized treatment.

Area of Science:

  • Otolaryngology
  • Allergy Immunology
  • Pathology

Background:

  • Allergic fungal rhinosinusitis (AFRS) is a fungal allergy-driven subtype of chronic rhinosinusitis.
  • AFRS and eosinophilic chronic rhinosinusitis (eCRS) share features like eosinophilic infiltration but require differentiation.
  • Understanding distinct phenotypes is crucial for effective management.

Purpose of the Study:

  • To clarify the distinct clinical phenotypes of AFRS and eCRS.
  • To identify differences in clinical parameters between AFRS and eCRS patients.
  • To determine the phenotypic classifications of AFRS using cluster analysis.

Main Methods:

  • Multicenter retrospective study comparing clinical parameters of AFRS and eCRS patients.
  • Utilized cluster analysis to identify disease phenotypes.
  • Evaluated computed tomography (CT) scores, nasal polyp scores, total IgE, mucosal eosinophil counts, and olfactory disturbances.

Main Results:

  • AFRS patients showed younger age of onset and milder CT and nasal polyp scores than eCRS patients.
  • Total IgE levels were significantly higher in AFRS, while mucosal eosinophil counts were similar.
  • Cluster analysis identified three AFRS phenotypes, with one distinct from eCRS and two overlapping with eCRS characteristics.

Conclusions:

  • AFRS exhibits unique clinical features differentiating it from eCRS.
  • Three distinct AFRS phenotypes were identified based on CT findings, eosinophilic inflammation, and IgE levels.
  • Findings support differential diagnosis and personalized treatment strategies for AFRS and eCRS.
Keywords:
CTIgEcluster analysiseosinophilsnasal polyps

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