SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

10/27/06

Allergic fungal sinusitis

Summary
Background – There has been considerable debate about the diagnostic criteria for allergic fungal sinusitis (AFS). Some groups have claimed that AFS represents a large majority of those with chronic hypertrophic sinusitis (CHS).

Findings – AFS and its relationship to some other respiratory disorders were discussed by Schubert of the Allergy Asthma Clinic in Phoenix, AZ. He pointed out that a histologic profile of allergic inflammation is present in a number of patients with CHS, only some of whom have definitive evidence of AFS. “Allergic mucin” containing high levels of eosinophil components are commonly seen in nasal mucus of patients diagnosed with AFS, along with fungal hyphae and, in most cases, evidence of IgE-mediated immediate hypersensitivity to certain fungi.

However, allergic mucin is found in other patients with CHS without evidence of AFS. Most of such patients have prominent nasal polyposis and some have “aspirin intolerance” syndromes. A similar mucosal pattern may also be seen in those with allergic bronchopulmonary aspergillosis.

Thus, the diagnosis of AFS often is based on careful review of nasal/sinus mucosal tissue removed at surgery.

Reference
Clin Rev Allergy Immunol 2006;30:205-16

Editor's Comments
As I have commented previously, I think that the diagnosis of AFS is made too loosely in some quarters. The presence of fungal hyphae in allergic mucin in the nasal cavity does not by itself make a diagnosis of AFS for reasons given above plus the frequent colonization by fungi in the mucus of these patients with CHS when they have been treated for long periods with anti-bacterial antibiotics.

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