AAAAI: Fungi Stake a Claim in Allergic Sinusitis Pathology

[Guest guest]

MedPage Today - Little Falls,NJ

http://www.medpagetoday.com/MeetingCoverage/AAAAIMeeting/tb/5135

SAN DIEGO, Feb. 28 -- Allergic fungal sinusitis deserves a place of

its own at the table of nasty chronic rhinosinusitis infections,

researchers asserted here.

It may account for up to 10% of chronic rhinosinusitis, said

S. Hutcheson, of Saint Louis University Medical School, at

a briefing during the American Academy of Allergy, Asthma, &

Immunology meeting here. Action Points

Explain to patients who ask that some researchers suspect fungi as

the source of a large proportion of chronic sinus infections. This

study suggests that allergic fungal sinusitis may be an entity

distinct from chronic rhinosinusitis.

This study was published as an abstract and presented as a poster

and orally in a briefing at a conference. These data and conclusions

should be considered to be preliminary as they have not yet been

reviewed and published in a peer-reviewed publication.

" Allergic fungal sinusitis appears to be a separate and distinct

form of chronic rhinosinusitis, " she said.

Clinically, patients with allergic fungal sinusitis look pretty much

the same as those with chronic rhinosinusitis of non-fungal origin,

but the serology tells a different story, said G. Slavin,

M.D., director of the division of allergy & immunology, at Saint

Louis University, who headed the research team.

The question is, however, what can be done about it?

" With allergic fungal sinusitis, certainly the most successful

treatment has been long term prednisone, " Dr. Slavin said. " There is

great controversy about antifungal treatment of chronic

rhinosinusitis, and as a matter of fact there is now an ongoing

multicenter double-blind placebo study on intranasal amphotericin B,

and there's also one in the offing on oral itraconazole [sporanox]

for chronic rhinosinusitis, following the Mayo Clinic proposition

that the vast majority are due to fungi. "

In a study of 84 patients with chronic rhinosinusitis and nasal

polyps who underwent nasosinus surgery, the authors found that the

patients with fungal infection had total immunglobulin E (IgE),

specific immunoglobulin G (IgG) anti-Alternaria mold antibody, and

specific IgE against seven different fungi were significantly

elevated compared with patients with chronic rhinosinusitis. Also

IgE appears to play an important role in the pathogenesis of the

fungal infections.

The investigators came to their conclusions after recovering

exudates from the patients, culturing them and examining them by

histology for the presence of eosinophils, Charcot-Leyden crystals

(breakdown products of eosinophils), and for fungal elements, such

as hyphae.

They also looked for serum total IgE and IgG anti-Alternaria

antibodies, and looked for evidence of six additional fungal species

including Aspergillus, Bipolaris, Curvularia, Epicoccum, Fusarium

and Phoma.

They found that the exudates from 66 patients had high numbers of

eosinophils, visible fungal hyphae, or were culture positive, and

these patients were designated as have allergic fungal sinustitis.

An additional 18 patients were labeled as having standard (non-

fungal) chronic rhinosinusitis.

Both the serum total IgE and specific IgG anti-Alternaria were

statistically significantly elevated in the allergic fungal compared

to the chronic rhinosinusitis group. The total mean IgE was 1,080

IU/ml (range, 28-12,230 IU/ml) for patients with fungal infections,

compared with 324 IU/ml (range 8.8-1081 IU/ml) for those without

evidence of fungal infection.

The mean specific IgG-anti-Alternaria 40.6 mg/l (range 0-182 mg/l)

for those with allergic fungal sinusitis, and 8.2 mg/l (range 2-37.7

mg/l) for those with chronic sinusitis.

Among the 15 patients who were tested for the presence of all seven

fungi, immunoblotting tests for IgE anti-fungi showed multiple bands

to all fungi in nine of 10 patients with allergic fungal infections,

compared with none of five patients with chronic rhinosinusitis. The

number of positive bands for each fungus was significantly higher

among patients with allergic fungal sinusitis compared with those

with chronic rhinosinusitis.

" A significant and distinct immune response was observed in allergic

fungal sinusitis subjects that was different from that seen in

chronic rhinosinusitis subjects, " Hutcheson said. " The antibody

responses reflect our view that IgE antibodies do indeed play an

important role in the differences seen in allergic fungal sinusitis

subjects, and this distinguishes them from chronic rhinosinusitis

subjects. "

" IgG is also increased in these subjects, probably due to a

heightened general inflammatory resposnse, " she

continued. " Interestingly, the one chronic rhinosinusitis patient in

whom IgE reactivity was seen against all seven fungi had twice the

specific IgG-anti-Alternatira level of any other chronic

rhinosinusitis subject. "

The study was funded by the O'Donnell Research Fund. The

authors had no financial disclosures.

Primary source: American Academy of Allergy, Asthma & Immunology

Source reference:

Hutcheson PS et al . " Is Allergic Fungal Sinusitis A Distinct Form Of

Chronic Rhinosinusitis? " Abstract 639 presented Feb. 25.

[Guest guest]

well, according to this, I have " allergic " fungal sinusitis. and yes

the high amounts of alterneria at my second home caused it. tottally

seperate from the effects to my sinuses from breathing stachy myco's

up my nose in the first home. he he, maybe mcs is a severe allergic

reaction of the brain. oh, that dont work because some poeple dont

show allergies to molds.

>

> MedPage Today - Little Falls,NJ

>

> http://www.medpagetoday.com/MeetingCoverage/AAAAIMeeting/tb/5135

>

> SAN DIEGO, Feb. 28 -- Allergic fungal sinusitis deserves a place of

> its own at the table of nasty chronic rhinosinusitis infections,

> researchers asserted here.

>

> It may account for up to 10% of chronic rhinosinusitis, said

> S. Hutcheson, of Saint Louis University Medical School, at

> a briefing during the American Academy of Allergy, Asthma, &

> Immunology meeting here. Action Points

>

> Explain to patients who ask that some researchers suspect fungi as

> the source of a large proportion of chronic sinus infections. This

> study suggests that allergic fungal sinusitis may be an entity

> distinct from chronic rhinosinusitis.

>

>

> This study was published as an abstract and presented as a poster

> and orally in a briefing at a conference. These data and

conclusions

> should be considered to be preliminary as they have not yet been

> reviewed and published in a peer-reviewed publication.

> " Allergic fungal sinusitis appears to be a separate and distinct

> form of chronic rhinosinusitis, " she said.

>

>

> Clinically, patients with allergic fungal sinusitis look pretty

much

> the same as those with chronic rhinosinusitis of non-fungal origin,

> but the serology tells a different story, said G. Slavin,

> M.D., director of the division of allergy & immunology, at Saint

> Louis University, who headed the research team.

>

>

> The question is, however, what can be done about it?

>

>

> " With allergic fungal sinusitis, certainly the most successful

> treatment has been long term prednisone, " Dr. Slavin said. " There

is

> great controversy about antifungal treatment of chronic

> rhinosinusitis, and as a matter of fact there is now an ongoing

> multicenter double-blind placebo study on intranasal amphotericin

B,

> and there's also one in the offing on oral itraconazole [sporanox]

> for chronic rhinosinusitis, following the Mayo Clinic proposition

> that the vast majority are due to fungi. "

>

>

> In a study of 84 patients with chronic rhinosinusitis and nasal

> polyps who underwent nasosinus surgery, the authors found that the

> patients with fungal infection had total immunglobulin E (IgE),

> specific immunoglobulin G (IgG) anti-Alternaria mold antibody, and

> specific IgE against seven different fungi were significantly

> elevated compared with patients with chronic rhinosinusitis. Also

> IgE appears to play an important role in the pathogenesis of the

> fungal infections.

>

>

> The investigators came to their conclusions after recovering

> exudates from the patients, culturing them and examining them by

> histology for the presence of eosinophils, Charcot-Leyden crystals

> (breakdown products of eosinophils), and for fungal elements, such

> as hyphae.

>

>

> They also looked for serum total IgE and IgG anti-Alternaria

> antibodies, and looked for evidence of six additional fungal

species

> including Aspergillus, Bipolaris, Curvularia, Epicoccum, Fusarium

> and Phoma.

>

>

> They found that the exudates from 66 patients had high numbers of

> eosinophils, visible fungal hyphae, or were culture positive, and

> these patients were designated as have allergic fungal sinustitis.

> An additional 18 patients were labeled as having standard (non-

> fungal) chronic rhinosinusitis.

>

>

> Both the serum total IgE and specific IgG anti-Alternaria were

> statistically significantly elevated in the allergic fungal

compared

> to the chronic rhinosinusitis group. The total mean IgE was 1,080

> IU/ml (range, 28-12,230 IU/ml) for patients with fungal infections,

> compared with 324 IU/ml (range 8.8-1081 IU/ml) for those without

> evidence of fungal infection.

>

>

> The mean specific IgG-anti-Alternaria 40.6 mg/l (range 0-182 mg/l)

> for those with allergic fungal sinusitis, and 8.2 mg/l (range 2-

37.7

> mg/l) for those with chronic sinusitis.

>

>

> Among the 15 patients who were tested for the presence of all seven

> fungi, immunoblotting tests for IgE anti-fungi showed multiple

bands

> to all fungi in nine of 10 patients with allergic fungal

infections,

> compared with none of five patients with chronic rhinosinusitis.

The

> number of positive bands for each fungus was significantly higher

> among patients with allergic fungal sinusitis compared with those

> with chronic rhinosinusitis.

>

>

> " A significant and distinct immune response was observed in

allergic

> fungal sinusitis subjects that was different from that seen in

> chronic rhinosinusitis subjects, " Hutcheson said. " The antibody

> responses reflect our view that IgE antibodies do indeed play an

> important role in the differences seen in allergic fungal sinusitis

> subjects, and this distinguishes them from chronic rhinosinusitis

> subjects. "

>

>

> " IgG is also increased in these subjects, probably due to a

> heightened general inflammatory resposnse, " she

> continued. " Interestingly, the one chronic rhinosinusitis patient

in

> whom IgE reactivity was seen against all seven fungi had twice the

> specific IgG-anti-Alternatira level of any other chronic

> rhinosinusitis subject. "

>

>

> The study was funded by the O'Donnell Research Fund. The

> authors had no financial disclosures.

>

>

> Primary source: American Academy of Allergy, Asthma & Immunology

> Source reference:

> Hutcheson PS et al . " Is Allergic Fungal Sinusitis A Distinct Form

Of

> Chronic Rhinosinusitis? " Abstract 639 presented Feb. 25.

>