Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

Suri, Neeraj; Bhavya, B M

doi:10.18203/issn.2454-5929.ijohns20181853

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Kaur R et al in their study showed a male to female ratio of 1.18:1. 19 While a study conducted by Suri N et al 5 showed female preponderance which contradicts to our study.…”

Section: Discussioncontrasting

confidence: 99%

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Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

et al. 2020

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Objective: To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS. Methods: Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined. Results: Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%. Conclusion: Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients. doi: https://doi.org/10.12669/pjms.36.3.1661 How to cite this:Awan NU, Cheema KM, Naumeri F, Qamar S. Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1661 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Kaur R et al in their study showed a male to female ratio of 1.18:1. 19 While a study conducted by Suri N et al 5 showed female preponderance which contradicts to our study.…”

Section: Discussioncontrasting

confidence: 99%

“…4 AFRS is considered to be a hypersensitivity reaction to fungal antigens. 5 Gold standard for diagnosis of AFRS in CRS patients is debatable as different forms of CRS may have similar clinical presentation and radiological findings. Most commonly used criteria for diagnosis of AFRS is Bent and Kuhn.…”

Section: Introductionmentioning

confidence: 99%

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

et al. 2020

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Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis

Mostafa

Fadel

Mohammed

et al. 2019

Eur Arch Otorhinolaryngol

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Role of Systemic Omalizumab in Management of Allergic Fungal Rhinosinusitis

Mostafa

Hassan

Hamdi

et al. 2019

Ain Shams Medical Journal

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Background: Allergic fungal rhinosinusitis (AFRS) is due to the continuous exposure of fungal antigens to an atopic individual. It is caused by type I, IgE mediated (and possibly type III) hypersensitivity reaction to an extramucosal fungal antigen. Medical treatment following the surgery is the standard protocol of management. Steroids (systemic/topical) have been considered as the standard medical treatment for control of the disease despite high recurrence rate and their serious side effects. Instead, omalizumab, a humanized monoclonal anti-IgE antibody, can be tried as a new treatment modality with less side effects to control symptoms and decrease the recurrence rate in AFRS patients. It acts by aborting the immunological reaction to sinonasal fungi through preventing the release of inflammatory mediators that cause allergic signs and symptoms. Aim: To evaluate the role of omalizumab for postoperative management of AFRS patients in comparison to topical steroids as regarding symptom free interval and side effects. Patients and methods: A total of 20 patients with AFRS were included in the study. Patients were divided randomly into two equal groups: group A used local steroid and group B used single dose of subcutaneous omalizumab. Clinical parameters were compared at 4,8,12 and 24 weeks. Results: Although there was no statistical significant difference between both groups as regards endoscopic nasal examination posttreatment, patients of group B were statistically better as regards clinical and subjective parameters. Conclusion: We suggest that omalizumab has more superior effect than local steroids in controlling nasal symptoms in AFRS patients despite the same endoscopic scores post-treatment. More well-designed large prospective randomized controlled trials to determine the effects and optimal dosage and duration of omalizumab therapy in patients with AFRS will be necessary.

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Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

Cited by 3 publications

References 23 publications

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis

Omalizumab versus intranasal steroids in the post-operative management of patients with allergic fungal rhinosinusitis

Role of Systemic Omalizumab in Management of Allergic Fungal Rhinosinusitis

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