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Allergic Fungal Sinusitis: Controversy and Evolution of Understanding with Therapeutic Implications

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Allergy Frontiers: Therapy and Prevention

Part of the book series: Allergy Frontiers ((ALLERGY,volume 5))

Fungal rhinosinusitis can be categorized into distinct forms on the basis of histopathology. The invasive manifestations are fulminant or rapidly progressing, chronic or indolent, and granulomatous. The noninvasive manifestations are fungus balls and allergic fungal sinusitis (AFS). A noninvasive and controversial category introduced within the last decade resembles AFS; however, patients are not allergic and are termed nonallergic eosinophilic fungal rhinosinusitis (NA-EFRS). AFS or NA-EFRS is the subject of this chapter and will be contrasted to eosinophilic sinus disease in which fungi are absent.

Classically, AFS is defined as the histopathologic presence of eosinophilic mucin containing fungal hyphae retrieved from the nose or paranasal sinuses from patients who demonstrate IgE mediated allergy to the fungus. Patients with AFS often have asthma, peripheral eosinophilia, nasal polyps, and allergic rhinitis. The nose and sinus contents contain green, sticky or tan mucin plugs, which when examined pathologically reveal eosinophilic mucin, Charcot Leyden crystals, degenerating inflammatory cells, and sparse hyphae (Fig. 1).

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Author information

Authors and Affiliations

  1. Division of Sino-Nasal Disorders and Allergy, Department of Otolaryngology, University of Pittsburgh School of Medicine, The Eye and Ear Institute Building, 200 Lothrop Street, Suite 500, Pittsburgh, PA, 15213, USA

    Berrylin J. Ferguson

  2. Division of Sino-Nasal Disorders and Allergy, Department of Otolaryngology, University of Pittsburgh School of Medicine, The Eye and Ear Institute Building, 200 Lothrop Street, Suite 500, Pittsburgh, PA, 15213, USA

    Arpita Mehta

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  1. Berrylin J. Ferguson
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Correspondence to Berrylin J. Ferguson .

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Editors and Affiliations

  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. University of Southampton Southampton General Hospital, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. Children's Mercy Hospitals and Clinics UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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Ferguson, B.J., Mehta, A. (2009). Allergic Fungal Sinusitis: Controversy and Evolution of Understanding with Therapeutic Implications. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Therapy and Prevention. Allergy Frontiers, vol 5. Springer, Tokyo. https://doi.org/10.1007/978-4-431-99362-9_42

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  • DOI: https://doi.org/10.1007/978-4-431-99362-9_42

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