Eosinophilic Mucus Chronic Rhinosinusitis: Clinical Subgroups or a Homogeneous Pathogenic Entity?

Pant, Harshita; Kette, Frank; Smith, William B.; Macardle, Peter J.; Wormald, Peter John

doi:10.1097/01.mlg.0000224547.14519.ad

Cited by 52 publications

(58 citation statements)

References 15 publications

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“…Unlike the related condition of classic allergic bronchopulmonary aspergillosis (ABPA), patients with AFRS are indistinguishable from patients with allergic rhinitis and fungal allergy in terms of total serum IgE, levels of Alternaria alternata-or Aspergillus fumigatus-specific fungal IgE, IgG or IgA levels, or in terms of the percent of fungal specific serum IgE relative to total serum IgE measurements (59). Furthermore, the prevalence of fungal allergy to Alternaria alternata or Aspergillus fumigatus in AFRS and AFRS-like patients was no different from that observed in allergic rhinitis with fungal allergy (60). This study validly points out that fungal-specific IgE measurements may be a marker of disease in AFRS without contributing importantly to the local tissue pathology.…”

Section: Pathophysiologymentioning

confidence: 45%

Allergic Fungal Rhinitis and Rhinosinusitis

Hamilos¹

2010

Proceedings of the American Thoracic Society

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The intent of this article is to review the published literature addressing the role of fungi as causative agents in allergic rhinitis and rhinosinusitis. Ambient mold spores are widely distributed in nature, and an estimated 3 to 10% of the world's population is allergic to molds. There are compelling epidemiologic links between mold (fungal) allergy and illnesses such as asthma and "asthma with allergic rhinitis." Fungal allergy is more prevalent in areas of high ambient mold spore concentrations. However, epidemiologic studies have failed to demonstrate a direct relationship between fungal allergy and allergic rhinitis either via outdoor or indoor exposure. Fungal allergy is clearly linked to a subset of chronic rhinosinusitis (CRS) known as allergic fungal rhinosinusitis (AFRS). This condition represents an intense allergic response against colonizing fungi giving rise to formation of allergic (eosinophilic) mucin, mucostasis, and sinus opacification. A broader role for colonizing fungi has been postulated in CRS owing to the demonstration of fungi in mucus in the vast majority of cases of CRS, and in vitro studies demonstrating that certain fungi, particularly Alternaria, elicit a "modified" allergic response in patients with CRS that is independent of IgE.

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Section: Pathophysiologymentioning

confidence: 45%

Allergic Fungal Rhinitis and Rhinosinusitis

Hamilos¹

2010

Proceedings of the American Thoracic Society

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“…Demographics and clinical characteristics of patient groups For permission to copy go to https://www.oceansidepubl.com/permission.htm mucus background on hematoxylin and eosin-stained mucus specimens 6,18. …”

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confidence: 99%

Accumulation of Effector Memory CD8⁺T Cells in Nasal Polyps

Pant

Hughes

Miljkovic

et al. 2013

Am J Rhinol�Allergy

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Sinus mucosa in CRS with NPs is characterized by a significant enrichment of CD8+ T cells and a relative deficiency of CD4+ T cells. The majority of NP CD8+ T cells had a terminally differentiated, mature, effector memory phenotype, which raises the question, whether these cells are pathogenic or appear as a consequence of inflammation, independent of the presence of allergy or positive microbial culture.

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“…The same group fi rst published a single-arm, open-label cohort study in 1999 (reviewed in [9]). Amphotericin B solution (100 μg/mL; 20 mL twice daily) was used for sinus irrigation by 51 patients with CRS for 3 to 17 months.…”

Section: Topical Antifungal Therapymentioning

confidence: 98%

“…However, some authors question this classifi cation and propose that all these subtypes may represent different phases of the same disease process. Allergen-specifi c IgE (to Aspergillus or Alternaria spp) presents in allergic and nonallergic forms of CRS, and "allergic" fungal disease cannot always be distinguished from "ordinary" CRS [9].…”

Section: Role Of Fungi In Chronic Rhinosinusitismentioning

confidence: 99%

Antifungal treatment and chronic rhinosinusitis

Lal

Stankiewicz

2009

Curr Allergy Asthma Rep

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Chronic rhinosinusitis (CRS) is an inflammatory disease with a multifactorial etiology. Antifungal therapy is not routinely used to treat it. However, evidence implicating fungi in some forms of CRS recently has been published. Controversy exists as to whether fungi identified in sinonasal cultures are always pathogenic. Immunologic evidence supporting the role of fungi in the pathogenesis of CRS is also debated. Topical antifungal therapy is more widely used than oral therapy, with amphotericin B irrigation being the most common. Although some studies show benefit from this irrigation, others refute the efficacy. Although oral antifungal agents are used uncommonly, itraconazole is the most commonly used drug. The efficacy of oral itraconazole in CRS has never been assessed in a clinical trial. Given the current evidence, the use of antifungals to treat CRS is controversial and has limited indications.

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Eosinophilic Mucus Chronic Rhinosinusitis: Clinical Subgroups or a Homogeneous Pathogenic Entity?

Abstract: AFS was not clinically distinct from other subgroups of EMCRS. However, eosinophilic mucus may mark a more severe and distinct form of sinus disease.

Cited by 52 publications

References 15 publications

Allergic Fungal Rhinitis and Rhinosinusitis

Allergic Fungal Rhinitis and Rhinosinusitis

Accumulation of Effector Memory CD8⁺T Cells in Nasal Polyps

Antifungal treatment and chronic rhinosinusitis

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Eosinophilic Mucus Chronic Rhinosinusitis: Clinical Subgroups or a Homogeneous Pathogenic Entity?

Abstract: AFS was not clinically distinct from other subgroups of EMCRS. However, eosinophilic mucus may mark a more severe and distinct form of sinus disease.

Cited by 52 publications

References 15 publications

Allergic Fungal Rhinitis and Rhinosinusitis

Allergic Fungal Rhinitis and Rhinosinusitis

Accumulation of Effector Memory CD8+T Cells in Nasal Polyps

Antifungal treatment and chronic rhinosinusitis

Contact Info

Product

Resources

About

Accumulation of Effector Memory CD8⁺T Cells in Nasal Polyps