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Kokoszka M, Stryjewska-Makuch G, Kantczak A, Górny D, Glück J. Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience. Int Arch Allergy Immunol 2023; 184:856-865. [PMID: 37536291 DOI: 10.1159/000531017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/27/2023] [Indexed: 08/05/2023] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is primary, Th2-mediated, chronic rhinosinusitis, which is diagnosed when the criteria defined by Bent and Khun are met. The disease is most common in countries located in the subtropical and tropical regions characterized by high temperatures and high levels of humidity, which favour the wider occurrence of fungi in the environment. The presence of specific IgE antibodies directed against fungal allergens, which is one of the diagnostic criteria, proves the systemic nature of the disease and allows one to distinguish AFRS from eosinophilic fungal rhinosinusitis. There is no unified treatment method for AFRS described in the literature, and relapses are common. Sinus surgery remains the treatment of choice. Oral and topical steroid therapy plays an important role in the treatment process. The effectiveness of antifungal treatment and immunotherapy is unclear. Biological treatment, the results of which are promising, has raised great hopes. The aim of this study was to reveal how often AFRS occurs in European countries, what environmental factors influence its development, and how important it is to specify its diagnostic criteria and treatment methods. We present an overview of the available literature. In addition, we share our own experience and describe two cases of AFRS diagnosed and treated at our centre.
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Affiliation(s)
- Magdalena Kokoszka
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Grażyna Stryjewska-Makuch
- Department of Laryngology and Laryngological Oncology, Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Ada Kantczak
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Dorota Górny
- Department of Paediatric Otolaryngology, Head and Neck Surgery, Department of Paediatric Surgery, Upper Silesian Child Health Centre, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joanna Glück
- Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology in Katowice, Medical University of Silesia, Katowice, Poland
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Xu T, Guo XT, Zhou YC, Zhou Q, Wang YF. Consideration of the Clinical Diagnosis of Allergic Fungal Sinusitis: A Single-Center Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231167247. [PMID: 37019648 DOI: 10.1177/01455613231167247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Allergic fungal rhinosinusitis (AFRS) is characterized by refractory and high recurrence rate. Improper treatment may lead to repeated recurrence and even serious complications, including vision loss, blindness, and intracranial complications. However, AFRS is easy to be misdiagnosed clinically. OBJECTIVE To ensure early diagnosis, the clinical presentations of patients with AFRS were studied. METHODS Data from patients with sinusitis hospitalized in the First Affiliated Hospital of the University of Science and Technology of China (USTC) from January 2015 to October 2022 were collected. The patients were divided into three groups; group A patients with AFRS, group B patients suspected of AFRS, and group C patients with fungus ball sinusitis (FBS).We retrospectively analyzed the data using IBM SPSS 19.0 to perform the chi-square test and one-way ANOVA test. RESULTS In total, 35 cases of AFRS, 91 cases of suspected AFRS, and 661 cases of FBS were rediagnosed. Compared with FBS patients, AFRS patients were younger, the total IgE, the percentage of eosinophils and basophils in peripheral blood were higher, and the proportion of patients with allergic rhinitis, asthma or hypo olfactory was higher. It had a higher recurrence rate. These results were also observed in the comparison between suspected AFRS patients and FBS patients, but no significant difference was found in the comparison between suspected AFRS patients and suspected AFRS patients. CONCLUSIONS AND SIGNIFICANCE AFRS may be misdiagnosed due to the low detection of fungi. To ensure early diagnosis, we recommend that patients with clinical, radiological, and laboratory features similar to those of AFRS but without evidence of fungal staining be treated according to the treatment criteria of AFRS.
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Affiliation(s)
- Tao Xu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiao-Tao Guo
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yi-Cui Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Qian Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yin-Feng Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Mehta MP, Wise SK. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:65-81. [DOI: 10.1016/j.otc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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AlQahtani A, Alim B, Almudhaibery F, Mulafikh D, Almutairi S, Almohanna S, Alfawwaz F. The Impact of Climatic, Socioeconomic, and Geographic Factors on the Prevalence of Allergic Fungal Rhinosinusitis: A Worldwide Ecological Study. Am J Rhinol Allergy 2022; 36:423-431. [PMID: 35187957 DOI: 10.1177/19458924211069226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The prevalence of allergic fungal rhinosinusitis (AFRS) and its associated risk factors have been an issue of debate. Some epidemiological factors have been correlated to the disease prevalence. OBJECTIVES To observe the prevalence pattern of AFRS worldwide and to investigate the effect of specific epidemiological factors on the disease prevalence. METHODS A systematic review was derived from 1983 to December 2018. Data on the prevalence of AFRS were collected from the selected studies. Relevant factors assessing each city's climate, socioeconomics and geography were used to study the association with AFRS prevalence. RESULTS 35 cities across 5 continents were investigated. The worldwide average rate of AFRS in CRS cases is 7.8% (0.2%-26.7%) in which more than half of the investigated cities (57%) had low AFRS prevalence, while the remaining cities had intermediate (11%) and high (32%) prevalence. Cities with higher temperatures were associated with a higher prevalence of AFRS (p-value 0.002), whereas cities with humid continental climate were significantly associated with a low prevalence of AFRS (p-value 0.032). Humidity and wind speed were lower in the cities with higher AFRS prevalence (p-value 0.018 and 0.008, respectively). There were no significant correlations between AFRS prevalence and economic levels, presence of water bodies, rainfall amounts, altitude, and presence of forests. CONCLUSION AFRS has a worldwide distribution pattern with varying prevalence. In this ecological study, we observed a correlation between AFRS prevalence and climatic factors (climate classification, humidity, temperature, and wind speed). Socioeconomic factors should be analyzed on an individual basis for better assessment of the relationship with disease prevalence.
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Affiliation(s)
| | - Bader Alim
- King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Saad Almohanna
- Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Suzuki M, Connell J, Psaltis AJ. Pediatric allergic fungal rhinosinusitis: optimizing outcomes. Curr Opin Otolaryngol Head Neck Surg 2021; 29:510-516. [PMID: 34545860 DOI: 10.1097/moo.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition. RECENT FINDINGS AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited. SUMMARY To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care.
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Affiliation(s)
- Masanobu Suzuki
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - James Connell
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Alkis James Psaltis
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Brescia G, Franz L, Alessandrini L, Parrino D, Barion U, Marioni G. Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS). Am J Otolaryngol 2020; 41:102301. [PMID: 31732306 DOI: 10.1016/j.amjoto.2019.102301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. MATERIALS AND METHODS A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. RESULTS Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. CONCLUSIONS Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
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Oretti G, Castellana G, Manuguerra R, Silini EM, Ferri T. Isolated fronto-ethmoidal allergic fungal rhinosinusitis: case report and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:563-567. [PMID: 31910185 PMCID: PMC7233786 DOI: 10.23750/abm.v90i4.7832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Fungal rhinosinusitis (FRS) is a clinical entity characterized by the presence of fungi within sino-nasal cavities that may occur in patients with normal or defective immunity. Allergic fungal rhinosinusitis (AFRS) is a form of non-invasive FRS that affects patients with an abnormal immuno-mediated response to fungal antigens. This article describes a case of isolated fronto-ethmoidal AFRS. Methods: A 20-year old male patient presented with a history of a left nasal respiratory obstruction and allergic oculorhinitis. CT scans showed a polypoid mass in the left nasal cavity and opacification of the left ethmoid sinus, frontal recess and frontal sinus with hyperdense component. The patient underwent functional endonasal sinus surgery (FESS) with removal of nasal polyps from the left nasal cavity and of cheesy-like material and dense mucus from the left ethmoid and frontal sinus. Histological examination showed presence of fungal hyphae within the allergic mucus; a diagnosis of AFRS was made. Results: Follow up at 14 months showed no signs of recurrence. Conclusions: The AFRS case reported herein is characterized by isolated unilateral fronto-ethmoid involvement, a rare presentation. Endoscopic nasal treatment was effective with complete patient recovery. (www.actabiomedica.it)
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Affiliation(s)
- Gabriele Oretti
- Azienda Ospedaliero Universitaria Parma - Departement of Otolaryngology.
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Abstract
Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.
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Affiliation(s)
- Virendra Singh
- Department of Oral and maxillofacial Surgery, PGIDS, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana 124001 India
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Barac A, Ong DSY, Jovancevic L, Peric A, Surda P, Tomic Spiric V, Rubino S. Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity. Front Microbiol 2018; 9:583. [PMID: 29666610 PMCID: PMC5891636 DOI: 10.3389/fmicb.2018.00583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction:Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity. Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group). Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples. Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from “normal flora” into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.
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Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - David S Y Ong
- Department of Medical Microbiology and Infection Prevention, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands.,Department of Epidemiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ljiljana Jovancevic
- Department of Otorhinolaryngology, Clinical Centre of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Pavol Surda
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, United Kingdom
| | - Vesna Tomic Spiric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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