The role of ubiquitous airborne fungi in chronic rhinosinusitis.
Chronic rhinosinusitis (CRS) is a confusing disease for both allergists and otorhinolaryngologists, partially due to its poorly understood pathophysiology and partially due to its limited treatment options. Several recent reports now provide evidence for a better understanding of the etiology and the relationship of CRS to airborne fungi, especially to Alternaria. First, the development of novel methods enables detection of certain fungi in mucus from the nasal and paranasal sinus cavities. Second, a non-immunoglobulin E-mediated immunologic mechanism for reactivity of CRS patients to certain common fungi has been described. Third, these fungi are surrounded by eosinophils in vivo, suggesting that they are targeted by eosinophils. Fourth, the preliminary results of studies using antifungal agents to treat patients with CRS are promising. Overall, these recent discoveries provide a logical mechanism for the pathophysiology of CRS, and they also suggest promising avenues for treatment of CRS with antifungal agents.
Ponikau
Jens U
JU
Department of Otorhinolaryngology, University at Buffalo, The State University of New York, 3C41 Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209, USA. jponikau@buffalo.edu
Sherris
David A
DA
Kephart
Gail M
GM
Adolphson
Cheryl
C
Kita
Hirohito
H
D000391:Air Microbiology; D000528:Alternaria / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology; D000935:Antifungal Agents / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004804:Eosinophils / Q000276:immunology; D005658:Fungi / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D009297:Nasal Mucosa / Q000276:immunology / Q000382:microbiology; D010256:Paranasal Sinuses / Q000276:immunology / Q000382:microbiology; D012220:Rhinitis / Q000209:etiology* / Q000628:therapy; D012852:Sinusitis / Q000209:etiology* / Q000628:therapy
D000935:Antifungal Agents