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

  • Berrylin J. Ferguson
  • Arpita Mehta
Part of the Allergy Frontiers book series (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).


Allergy Clin Immunol Nasal Polyp Chronic Rhinosinusitis Allergic Bronchopulmonary Aspergillosis Allergic Fungal Sinusitis 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  1. 1.Division of Sino-Nasal Disorders and Allergy, Department of OtolaryngologyUniversity of Pittsburgh School of Medicine, The Eye and Ear Institute BuildingPittsburghUSA
  2. 2.Division of Sino-Nasal Disorders and Allergy, Department of OtolaryngologyUniversity of Pittsburgh School of Medicine, The Eye and Ear Institute BuildingPittsburghUSA

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