Local and Systemic Eosinophil Activation in Allergic Fungal Sinusitis

The development of chronic sinusitis is a complex multifactorial process characterized by inflammation of nasal and sinus mucosa. Many studies have shown that the composition of the inflammatory substrate in chronic sinusitis is similar to that seen in allergic rhinitis and in the late-phase response to antigen challenge. Mononuclear cells, consisting of T and B lymphocytes and activated eosinophils, are prominent in the sinus mucosa of patients with chronic sinusitis, especially in atopic patients. Cellular recruitment and activation of the inflammatory infiltrate have been largely attributed to the effects of T(H)2 cytokines (namely interleukin -4, IL-5, IL-13, and granulocyte-macrophage colony-stimulating factor). Current treatment of allergic chronic sinusitis consists of nasal corticosteroids and immunotherapy. A subgroup of steroid-insensitive patients demonstrates an overexpression of a variant of the glucocorticoid receptor (GR). Despite these advances, the management and treatment of chronic sinusitis is often fraught with failures and remains a frustrating task for both physician and patient.

Section: Fungal Infectionmentioning

confidence: 99%

Molecular immunology and immunotherapy for chronic sinusitis

Nguyen

Fakhri

Frenkiel

et al. 2003

“…Although some CRS patients produce specific immunoglobulin E (IgE) against fungi [23,24], there is no evidence that this IgE production directly results in the disease state of CRS. Furthermore, CRS develops in patients who have IgE antibodies to fungi or other common aeroallergens and in those who do not.…”

Section: Why Do Eosinophils Exist? the Immune Response To Fungimentioning

confidence: 99%

The role of ubiquitous airborne fungi in chronic rhinosinusitis

Ponikau

Sherris

Kephart

et al. 2005

Chronic rhinosinusitis (CRS) is a confusing disease for both allergists and otorhinolaryngologists, partially due to its poorly understood pathophysiology and partially due to its limited treatment options. Several recent reports now provide evidence for a better understanding of the etiology and the relationship of CRS to airborne fungi, especially to Alternaria. First, the development of novel methods enables detection of certain fungi in mucus from the nasal and paranasal sinus cavities. Second, a non-immunoglobulin E-mediated immunologic mechanism for reactivity of CRS patients to certain common fungi has been described. Third, these fungi are surrounded by eosinophils in vivo, suggesting that they are targeted by eosinophils. Fourth, the preliminary results of studies using antifungal agents to treat patients with CRS are promising. Overall, these recent discoveries provide a logical mechanism for the pathophysiology of CRS, and they also suggest promising avenues for treatment of CRS with antifungal agents.

“…Based on similar IgE behavior associated with recurrence of AFRS, total IgE levels have been proposed as useful indicators of AFRS clinical activity. Total IgE values are generally elevated in AFRS, often to more than 1000 U/L [6,21,22].…”

Section: Immunologic Testingmentioning

confidence: 99%

“…The concept of eosinophilic activation associated with AFRS was further supported by Feger et al [6], who studied eosinophilic cationic protein levels (ECP) in the serum and mucin of patients with AFRS. No differences in serum ECP were detected between patients with AFRS and controls, but ECP levels were significantly higher in mucin recovered from patients with AFRS compared with controls (P < 0.01).…”

Section: Introductionmentioning

confidence: 95%

“…Studies such as those by Manning and Holman [5] and Feger et al [6] offer strong immunologic and histologic data to support the argument that AFRS represents an immunologically mediated disorder rather than a point on the spectrum of infectious fungal disease. Furthermore, these observations have lead to speculation regarding the pathophysiology of AFRS.…”

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Allergic fungal rhinosinusitis

Luong

Marple²

2004

The combination of nasal polyposis, crust formation, and sinus cultures yielding Aspergillus was first noted in 1976 by Safirstein, who observed the clinical similarity that this constellation of findings shared with allergic bronchopulmonary aspergillosis (ABPA). Eventually, this disease came to be known as allergic fungal rhinosinusitis (AFRS). As clinical evidence of AFRS accumulated, controversy regarding its etiology, pathogenesis, natural history, and appropriate treatment naturally emerged. Despite past and current efforts, many of these controversies remain incompletely resolved, but continuing clinical study has illuminated some aspects of the disease and has led to an improved understanding of AFRS and its treatment. In this article, we review current data and theories regarding the pathophysiology and clinical presentation of AFRS, as well as the roles of various surgical and nonsurgical forms of therapy.