Anti-Fungus Drug Useful for Sinus Problem

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http://www.reuters.com/newsArticle.jhtml?

type=healthNews & storyID=7374133

By J. Brown, MD

NEW YORK (Reuters Health) - Treatment with a nasal spray containing

the anti-fungal drug amphotericin B reduces the swelling and

inflammation that occurs with chronic rhinosinusitis, a common cause

of stuffy nose and facial pain, new research shows.

Amphotericin B is an old drug that can cause serious side effects,

particularly to the kidneys. However, when given as a nasal spray,

the drug does not get absorbed, effectively avoiding these effects,

researchers report in the Journal of Allergy and Clinical

Immunology.

The findings, which stem from a study of 30 patients, lend weight to

the notion that fungi are involved in the development of chronic

rhinosinusitis.

In an interview with Reuters Health, lead author Dr. Jens U.

Ponikau, from the Mayo Clinic in Rochester, Minnesota, said that

fungi appear to play a key role in chronic rhinosinusitis by causing

certain immune cells to show up in the mucous layer of the nose.

Once there, the cells release toxic compounds that damage the fungi,

but also the surrounding nasal tissue.

Still, the hypothesis that fungi are involved in chronic

rhinosinusitis is controversial and it remains to be determined why

only certain people develop the condition when nasal fungi are so

common, Ponikau noted.

He and his colleagues reasoned that if the immune cells are in the

mucous membranes because of the fungi, then maybe reducing the fungi

would reduce the inflammation caused by the immune cells

and " ultimately improve the patient's symptoms. "

Compared with inactive " placebo, " 6 months of treatment with

amphotericin B nasal spray led to a significant reduction in mucous

swelling, as determined by CT scans and other tests. Moreover, such

therapy seemed to reduce the number of immune cells present.

" These findings have completely changed the way we approach

sinusitis patients at Mayo, " Ponikau noted, adding that " thousands

of chronic rhinosinusitis patients are now being treated with

antifungals. "

Larger studies will begin later this year, he said.

SOURCE: Journal of Allergy and Clinical Immunology, January 2005.