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Allergic fungal sinusitis: allergic, infectious, or both?
J P Corey1, K G Delsupehe, B J Ferguson
1University of Chicago, Pritzker School of Medicine, IL 60647, USA.
Summary
Allergic fungal sinusitis, an immune response to fungi, often affects atopic patients with nasal polyps. Complete surgical removal of allergic mucin and long-term nasal steroid use are recommended therapies.
Area of Science:
- Otolaryngology
- Allergy Immunology
- Mycology
Background:
- Allergic fungal sinusitis (AFS) is a noninvasive sinus disease.
- It results from a hypersensitivity reaction to fungal antigens, frequently involving Dematiaceae family fungi.
- AFS should be suspected in atopic individuals with persistent nasal polyps.
Purpose of the Study:
- To outline the diagnostic criteria and therapeutic strategies for allergic fungal sinusitis.
- To emphasize the importance of early diagnosis and complete management to prevent recurrence.
Main Methods:
- Diagnosis relies on characteristic histopathologic findings of allergic mucin and hyphae.
- Imaging (CT, MRI) can suggest AFS but is not diagnostic.
- Surgical findings of thick, tenacious mucin in atopic patients with polyps are indicative.
Main Results:
- Histopathology confirms AFS by identifying allergic mucin and hyphae via special stains or culture.
- Complete surgical exenteration of allergic mucin, often endoscopically, is the primary treatment.
- Adjunctive short-term systemic steroids and long-term nasal steroid sprays are commonly used.
Conclusions:
- Recurrence of AFS is common, especially with incomplete mucin removal or re-exposure to fungal antigens.
- Long-term clinical, endoscopic, and radiographic follow-up is crucial for managing AFS.
- Complete eradication of allergic mucin is key to successful treatment and preventing symptom recurrence.