Search

Background: The etiology of allergic fungal rhinosinusitis (AFRS) remains controversial. Initially thought to represent an immunoglobulin E (IgE)-mediated hypersensitivity to fungal antigens, additional data have implicated other non-IgE and cellular-mediated pathways. The aim of this study was to characterize T-helper type 1 (Th1) and Th2 immune responses of blood lymphocytes from AFRS patients by fungal antigen stimulation to help differentiate these possible pathways. Methods: Peripheral blood mononuclear cells (PBMCs) isolated from AFRS patients (n = 10) and healthy controls (HCs; n = 11) were exposed to four different fungal extracts (Alternaria, Aspergillus, Cladosporium, and Penicillium) in duplicate. After a 72-hour incubation, the supernatants were analyzed for cytokine levels of three Th1 (interferon [IFN] gamma, interleukin [IL]-2, and tumor necrosis factor alpha) and three Th2 (IL-10, IL-5, and IL-4) cytokines by cytometric bead array flow cytometry. Serum fungal-specific IgE levels were measured by ImmunoCAP (Pharmacia Diagnostics, Kalamazoo, MI). Results: Fungal extracts of Alternaria and Cladosporium stimulated higher levels of IL-5 from PBMCs in AFRS when compared with HCs (p < 0.05). IL-4 was also elevated for Alternaria in AFRS versus HCs (p < 0.05). A skewed Th2 response to fungal antigen exposure was confirmed by an elevated IL-5/IFN-gamma ratio in AFRS subjects (p < 0.05). Initial studies suggest a correlation between percent T-cell activation and IL-5 expression to IgE levels. Fungal antigens stimulated a notable but not statistically significant increase in IL-10 response in HCs. Conclusion: In AFRS patients, fungal antigens stimulated T-cell activation, inducing a predominately Th2 immune response. Healthy controls expressed an inhibitory cytokine IL-10 when exposed to these fungal antigens, possibly serving as a protective response. [ABSTRACT FROM AUTHOR]

Background: The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases. Methods: Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed. Results: The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected. Conclusions: We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs. [ABSTRACT FROM AUTHOR]

As many as 30% of AFRS patients exhibit extrasinus expansion into intracranial and orbital compartments without tissue invasion.3 AFRS patients commonly report nasal congestion, thick nasal drainage, and loss of sense of smell, but visual disturbances or facial deformity may result in severe cases.4 AFRS is a challenging CRSwNP subtype to treat given the frequently advanced presentation of disease with extensive, difficult to clear, sticky eosinophilic mucin laden with fungal hyphae. The classic diagnosis of AFRS requires strictly meeting all components of these criteria.8 However, limited reports have suggested that AFRS can progress to an invasive form of fungal sinusitis in certain clinical scenarios.9 As to whether this represents a distinct subtype of AFRS observed in immunocompromised hosts remains unclear. Six of the 32 patients with negative serum fungal-specific IgE had fungal-specific IgE levels within the mucin.13 Although the importance of local IgE reactivity in the absence of systemic IgE elevation is not clear, this phenomenon emphasizes the limits of the current diagnostic criteria for AFRS, especially because these patients would not meet current criteria. [Extracted from the article]