Re: AAAAI - Fungi Stake a Claim in Allergic Sinusitis Pathology

[Guest guest]

" Patients with AFS are atopic, but generally their symptoms have been

unresponsive to antihistamines, intranasal corticosteroids, and prior

immunotherapy. Use of systemic corticosteroids may produce some relief

of symptoms, but relapse is typical following completion of therapy.

In contrast to patients who have invasive fungal sinusitis, patients

with AFS always are immunocompetent. "

http://www.emedicine.com/Ent/topic510.htm

This was the case with me. I strongly advice doctors to try a round

of antifungal medication such as Diflucan for a few weeks FIRST.

[Guest guest]

Wow, does this nean the tide is turning??

snk1955@... wrote: March 25, 2008

AAAAI - Fungi Stake a Claim in Allergic Sinusitis Pathology

by Neil Osterweil, Senior Associate Editor, MedPage Today

Published: February 28, 2007

Reviewed by _ Jasmer, MD_

(http://www.medpagetoday.com/reviewer.cfm?reviewerid=55) ; Associate Clinical

Professor of Medicine, University of

California, San Francisco

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 having 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. "

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

####

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800-422-7873

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000000001)

[Guest guest]

no, it means that the aaaai doesn't reconize the difference between

mycotoxin exposure effects,mycosos and allergy effects.

March

25, 2008

> AAAAI - Fungi Stake a Claim in Allergic Sinusitis Pathology

> by Neil Osterweil, Senior Associate Editor, MedPage Today

>

> Published: February 28, 2007

> Reviewed by _ Jasmer, MD_

> (http://www.medpagetoday.com/reviewer.cfm?reviewerid=55) ;

Associate Clinical Professor of Medicine, University of

> California, San Francisco

>

> 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 having 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. "

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

>

> ####

> Pure Air Control Services

> 800-422-7873

>

> **************Create a Home Theater Like the Pros. Watch the video

on AOL

> Home.

> (http://home.aol.com/diy/home-improvement-eric-stromer?video=15?

ncid=aolhom00030000000001)

>

>

[Guest guest]

what does Dr. Shoemaker say about steroid intolerance in his book?

does he say it's caused by the mycotoxin steroids? just wondering

because I tried the steroid nasal spray again not to long ago and I

ended up with haveing a major reaction/re-infection in my sinuses and

head. guess I have a allergy to steroids now too.

>

> " Patients with AFS are atopic, but generally their symptoms have been

> unresponsive to antihistamines, intranasal corticosteroids, and prior

> immunotherapy. Use of systemic corticosteroids may produce some relief

> of symptoms, but relapse is typical following completion of therapy.

> In contrast to patients who have invasive fungal sinusitis, patients

> with AFS always are immunocompetent. "

>

> http://www.emedicine.com/Ent/topic510.htm

>

> This was the case with me. I strongly advice doctors to try a round

> of antifungal medication such as Diflucan for a few weeks FIRST.

>