Fungus likely culprit in chronic rhinosinusitis

[Guest guest]

Medical Edge: Fungus likely culprit in chronic rhinosinusitis

http://www.newsok.com/article/1677747/

Q: I was interested to read your proposal that most chronic sinus

infections may be caused by an immune system response to fungi. I

have suffered from sinusitis for more than 20 years and have had

numerous operations on my nose and sinuses and tonsils. None of it

helped. Antibiotic treatment was also of no use. I also had no sense

of smell for more than 20 years despite using antihistamines and

steroid nasal sprays.

I am sure there is a fungal link to my sinus problems. Could you

give me an update on your research?

A: Our research findings support the idea that there is a fungal

link to the stuffy noses and persistent airway inflammation

experienced by people who have chronic rhinosinusitis.

Your body's immune system mounts different kinds of responses for

different invaders; bacteria get attacked by different cells or

systems than allergy-prompting particles, for example. Our work,

published in 2004, shows that several parts of the immune system

appear to work together when responding to inhaled airborne fungi.

This collaboration results in an abnormally increased immune system

response that causes troublesome inflammation and congestion.

The airborne fungi we studied can be found anywhere in the United

States. Certain species of airborne fungi produce spores and

byproducts called metabolites. When these fungi, spores and

metabolites are inhaled, they prompt immune responses that are

damaging in certain people. According to our research, 90 percent of

chronic rhinosinusitis patients have an enhanced immune-system

response to one fungus in particular, Alternaria. Another common

fungus, Cladosporium, can provoke a similar response. These

responses produce the distressing chronic rhinosinusitis symptoms

you know so well.

This research is important because chronic rhinosinusitis is one of

the most common chronic illnesses in the nation, with significant

costs to society, such as more than 70 million lost activity days

each year. The personal discomfort also is considerable. Symptoms

include persistent stuffy nose, thick mucus production and loss of

the sense of smell.

Although chronic rhinosinusitis causes significant discomfort and

health problems, it is not well understood. Viruses, bacteria and

allergic reactions have all been considered as potential causes of

chronic rhinosinusitis symptoms. Results of our recent investigation

support the idea that reducing fungal exposure in sensitive people

could offer new treatment options. For example, new treatments such

as taking anti-fungal medicines or nasal irrigations (flushing with

water) that include anti-fungal medications could reduce the effect

of fungi in patients with chronic rhinosinusitis.

As your question suggests, it may be time to recognize that some

patients are sensitive to airborne fungi.

Hirohito Kita, M.D, Allergic Diseases Research, Mayo Clinic,

Rochester, Minn.

Disclosure note: In accordance with the Bayh-Dole Act of 1980, Mayo

Clinic has licensed technology for the treatment of chronic

rhinosinusitis with anti-fungals to a commercial entity and will

receive royalties from that license.

Medical Edge from Mayo Clinic is an educational resource and doesn't

replace regular medical care. To send a question, go online to

www.mayoclinic.org or write to Medical Edge from Mayo Clinic, in

care of TMS, 2225 Kenmore Ave., Suite 114, Buffalo, NY 14207. For

health information, go online to www.mayoclinic.com.