Allergic fungal rhinosinusitis

Dykewicz, Mark S.; Rodrigues, J.; Slavin, Raymond G.

doi:10.1016/j.jaci.2018.06.023

Cited by 63 publications

(68 citation statements)

References 93 publications

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“…AFO is an uncommon ear condition [4,5], whose pathogenesis is quite similar with AFRS and ABPA as it could be type 1 and type 3 hypersensitivity to multiple fungi [2] with elevated serum IgE and IgG against specific fungal antigens. As skin tests, biological and mycological results suggested in that case, Aspergillus species were involved as usually reported in AFRS [1,2], but also in AFO [3,5], when fungal elements can be identified. Firstly described by Chen et al [3] in 2013, this diagnosis is supported by seeing a sticky and sandy peanutbutter-like mucus coming out from a tympanic perforation which may have been present for several years with multiple failed surgical closure attempts [3,5].…”

Section: Discussionsupporting

confidence: 59%

“…Firstly described by Chen et al [3] in 2013, this diagnosis is supported by seeing a sticky and sandy peanutbutter-like mucus coming out from a tympanic perforation which may have been present for several years with multiple failed surgical closure attempts [3,5]. HTCT ( Figure 1) and specifically MRI ( Figure 2) suggested cholesteatomatous chronic otitis, except dark heterogeneous T2-weighted images, as it can be seen in AFRS because of ferromagnetic elements inside the fungal mucus [1]. The first histological report was consistent with an early stage epidermal invasion, but underlying presence of hypersensitivity cells suggested the intertwining of both pathologies in the form of squamous cell epithelial metaplasia.…”

Section: Discussionmentioning

confidence: 90%

“…Allergic fungal rhinosinusitis (AFRS), first described in 1976 by Safirstein et al [1,2], is a distinct phenotype of chronic rhinosinusitis with nasal polyps. It is suggested by the presence of a specific mucus in one or more sinuses impaired with mucociliary clearance, similar to that found in the bronchi of patients with allergic bronchopulmonary aspergillosis (ABPA).…”

Section: Introductionmentioning

confidence: 99%

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A Concomitant Allergic Fungal Otomastoiditis with an Allergic Fungal Rhinosinusitis

Vandersteen¹,

Pradelli²,

D’andrea³

et al. 2020

ACR

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Background: Allergic fungal otomastoiditis is a rare ear condition characterized by the presence of a specific middle ear mucus usually found in allergic bronchopulmonary aspergillosis. Methods: We report a case of concomitant allergic fungal otomastoiditis and rhinosinusitis in an immunocompetent 27-year-old man complaining of right otorrhea and nasal discharge for 6 months resistant to any medical treatment. Examination revealed a sticky mucus arising from a polypoid middle ear associated with a right middle meatus purulent discharge. Surgical treatment revealed no cholesteatoma but thick yellowish mucus and a fungal ball, as targeted by imaging, both of which containing Aspergillus species. Result: The patient received short postoperative systemic corticotherapy and showed no recurrence 6 months after. Discussion: Allergic fungal otomastoidis should be considered in the face of a sticky mucus arising from perforated chronic otitis, especially when associated with allergic fungal rhinosinusitis. Complete surgical debridement is essential.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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A Concomitant Allergic Fungal Otomastoiditis with an Allergic Fungal Rhinosinusitis

Vandersteen¹,

Pradelli²,

D’andrea³

et al. 2020

ACR

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“…Noninvasive fungal rhinosinusitis represents a complex and overlapping group of diseases in which the sinonasal mucosa exhibits an inflammatory response to fungal elements. The literature on its pathogenesis is confounded by controversy over inclusion criteria defining each of the disease entities . Historically, studies have focused on the involvement of immune cell hypersensitivity and pro‐inflammatory cytokines in AFRS, whereas literature on mycetoma has focused on ciliary dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Fungal extracts stimulate solitary chemosensory cell expansion in noninvasive fungal rhinosinusitis

Patel

Triantafillou

Maina

et al. 2019

Int Forum Allergy Rhinol

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Background: Solitary chemosensory cells (SCCs) are rare epithelial cells enriched in nasal polyps and are the primary source of interleukin-25 (IL-25), an innate cytokine eliciting T-helper 2 (Th2) immune response. Although it is proposed that SCCs are stimulated by antigens released by upper airway pathogens, the exogenous triggers of human SCCs remain elusive. We studied patients with noninvasive fungal rhinosinusitis to determine whether extracts of Aspergillus fumigatus and Alternaria alternata stimulate SCC proliferation as an early event in type 2 inflammation. Methods:Multicolor flow cytometry, immunofluorescence, and enzyme-linked immunoassay were used to interrogate mucosa from patients with mycetomas and allergic fungal rhinosinusitis (AFRS) for SCCs and IL-25. Primary sinonasal epithelial cells from AFRS patients and noninflamed inferior turbinates were stimulated with fungal extracts for 72 hours, and SCC population frequency as well as mitotic activity were quantified using flow cytometry.Results: SCCs producing IL-25 are enriched in inflamed mucosa compared with intrapatient noninflamed control tissue (38.6% vs 6.5%, p = 0.029). In cultured sinonasal epithelial cells from AFRS nasal polyps, Aspergillus fumigatus and Alternaria alternata stimulated higher SCC frequency compared with controls (27.4% vs 10.6%, p = 0.002; 18.1% vs 10.6%, p = 0.046), which led to increased IL-25 secretion in culture media (75.5 vs 3.3 pg/mL, p < 0.001; 32.3 vs 3.3 pg/mL, p = 0.007). Ki-67 expression was higher in SCCs grown in fungal stimulation conditions compared with controls. Conclusion:Although fungal antigens are known to potentiate immune response through innate cytokines, including IL-25, the early expansion of SCCs in the presence of fungus has not been described. This early event in the pathogenesis of noninvasive fungal rhinosinusitis may represent a target for intervention. C 2019 ARS-AAOA, LLC.

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“…AFRS is prevalent in western countries but is relatively rare in Asia. Patients with AFRS have type I hypersensitivity, nasal polyposis with allergic mucin within the sinus cavity, and present with thick mucus, nasal obstruction and anosmia . The presentation of AFRS could vary by geographic, genetic or ethnic factors.…”

Section: Discussionmentioning

confidence: 99%

Validate the classification of fungal rhinosinusitis: A retrospective analysis of 162 patients at a single institution

Hua

Jiang

et al. 2019

Clinical Otolaryngology

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Allergic fungal rhinosinusitis

Cited by 63 publications

References 93 publications

A Concomitant Allergic Fungal Otomastoiditis with an Allergic Fungal Rhinosinusitis

A Concomitant Allergic Fungal Otomastoiditis with an Allergic Fungal Rhinosinusitis

Fungal extracts stimulate solitary chemosensory cell expansion in noninvasive fungal rhinosinusitis

Validate the classification of fungal rhinosinusitis: A retrospective analysis of 162 patients at a single institution

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