Allergic Fungal Rhinosinusitis and the Unified Airway

the Role of Antifungal Therapy in AFRS

Matthew W. Ryan, Christopher M. Clark

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS) is a form of polypoid chronic rhinosinusitis that is believed to be due to hypersensitivity to fungal antigens. The disease is characterized by type 1 hypersensitivity to fungal allergens, dramatically elevated total serum IgE, accumulation of thick eosinophil-laden mucin with non-invasive fungal hyphae within the paranasal sinuses, nasal polyposis, and sinus bony remodeling. Because of many clinicopathologic similarities to allergic bronchopulmonary aspergillosis (ABPA), these conditions can be considered analogous examples of disease in the unified airway. However, these conditions rarely occur together and their treatment differs. The treatment of AFRS relies upon surgical removal of fungal hyphae in eosinophilic mucin, while antifungal therapy is used to clear fungi from the airways in ABPA. Several uncontrolled studies suggest there may be some benefit to antifungal agents in AFRS, but randomized trials of topical and systemic antifungal therapies have not shown beneficial results in chronic rhinosinusitis (CRS). Antifungal treatment within the sinonasal cavities does not appear to be an effective approach for most chronic sinusitis, and antifungal therapy for AFRS is unproven.

Original languageEnglish (US)
Article number75
JournalCurrent Allergy and Asthma Reports
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Allergic Bronchopulmonary Aspergillosis
Hyphae
Paranasal Sinuses
Sinusitis
Mucins
Fungal Antigens
Immediate Hypersensitivity
Antifungal Agents
Eosinophils
Allergens
Immunoglobulin E
Hypersensitivity
Fungi
Therapeutics
Serum

Keywords

  • Allergic bronchopulmonary aspergillosis
  • Allergic fungal rhinosinusitis
  • Antifungal
  • Chronic rhinosinusitis
  • Fungal sinusitis
  • Unified airway

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Allergic Fungal Rhinosinusitis and the Unified Airway : the Role of Antifungal Therapy in AFRS. / Ryan, Matthew W.; Clark, Christopher M.

In: Current Allergy and Asthma Reports, Vol. 15, No. 12, 75, 01.12.2015.

Research output: Contribution to journalArticle

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