Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics

Luong, Amber U.; Chua, Andy; Alim, Bader M.; Olsson, Petter; Javer, Amin R.

doi:10.1016/j.jaip.2022.08.021

Cited by 15 publications

(13 citation statements)

References 57 publications

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“…Allergic fungal rhinosinusitis is a noninvasive form of sinus inflammation and one of the most common forms of fungal sinus disease, corresponding to 6–9% of all chronic rhinosinusitis cases. AFRS typically occurs in younger immunocompetent atopic patients (21–33 years) with sinus fungal colonization and is more common in geographic regions characterized by warm temperatures and high humidity [ 64 ]. Specific risk factors associated with AFRS are exposure to fungi, history of classic allergic rhinitis whose symptoms become progressively severe and unresponsive to antihistamines and inhaled nasal corticosteroid, in situ fungal growth, and underlying respiratory disease (rhinosinusitis or asthma) [ 65 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

“…Specific risk factors associated with AFRS are exposure to fungi, history of classic allergic rhinitis whose symptoms become progressively severe and unresponsive to antihistamines and inhaled nasal corticosteroid, in situ fungal growth, and underlying respiratory disease (rhinosinusitis or asthma) [ 65 ]. The prevalence of asthma in AFRS patients is lower than that reported in other chronic rhinosinusitis with nasal polyps (CRSwNP) subtypes, and gender predominance varies between reports [ 64 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

“…Staphylococcus aureus routinely colonizes the sinuses of patients with AFRS, and the presence of a symbiotic relationship between the fungi and S. aureus has been proposed [ 67 , 68 ]. Regarding biomarkers, patients with AFRS have very high total and specific IgE levels for fungi and relatively normal serum eosinophil levels compared with other patients with CRSwNP [ 64 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

“…Topical and oral corticosteroids are the basis of medical therapy for AFRS, used for perioperative optimization and long-term disease control postoperatively [ 73 ]. In some patients, long-term treatment with systemic corticosteroids is necessary to maintain clinical remission, with risk-benefit assessment being necessary on a case-by-case basis [ 64 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

“…It should be noted, however, that patients with AFRS were not included in pivotal Phase III studies of biologics approved for treating CRSwNP (dupilumab, omalizumab and mepolizumab) [ 78 , 79 , 80 ]. Despite this, case reports and smaller prospective studies suggest the effectiveness of dupilumab, omalizumab, and mepolizumab in AFRS patients, positioning these biologics as an add-on therapy for refractory or steroid-dependent cases [ 64 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

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Clinical Manifestations of Human Exposure to Fungi

Oliveira

Lisboa

et al. 2023

JoF

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Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.

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Section: Allergic Fungal Diseasesmentioning

confidence: 99%

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

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Clinical Manifestations of Human Exposure to Fungi

Oliveira

Lisboa

et al. 2023

JoF

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Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis

Bentan,

Pingree,

Lee

et al. 2024

The Laryngoscope

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ObjectiveTo compare the efficacy of th2‐targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).MethodsThe TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non‐mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.ResultsAll mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%–13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%–19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%–15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%–10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%–7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%–4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%–11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%–22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%–19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%–12.17%, p = 0.005).ConclusionAlthough all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.Level of EvidenceNA Laryngoscope, 2024

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New Innovations and Treatments for Chronic Rhinosinusitis

Fokkens,

Reitsma

2023

Contemporary Rhinology: Science and Practice

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Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics

Cited by 15 publications

References 57 publications

Clinical Manifestations of Human Exposure to Fungi

Clinical Manifestations of Human Exposure to Fungi

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis

New Innovations and Treatments for Chronic Rhinosinusitis

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