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Mark S Schubert - One of the best experts on this subject based on the ideXlab platform.

  • MS: Allergic Fungal Sinusitis: pathophysiology, diagnosis and management
    2016
    Co-Authors: Mark S Schubert
    Abstract:

    Allergic Fungal Sinusitis (AFS) is a noninvasive form of Fungal rhinoSinusitis with an incidence of between 6 and 9 % of all rhinoSinusitis requiring surgery. Regional variation in incidence has been reported, with the southern and southwestern US particularly endemic. Patients with AFS commonly present with chronic rhinosinu-sitis with nasal polyps, inhalant atopy, elevated total serum immunoglobulin E (IgE), and sinus-obstructing inspissates of a characteristic extramucosal ‘peanut buttery’ visco-elastic eosinophil-rich material called ‘Allergic mucin ’ that contains sparse numbers of Fungal hyphae. Sinus CT is always abnormal, showing findings of chronic rhinoSinusitis that often include central areas of increased contrast (‘hyperattenua-tion’) within abnormal paranasal sinuses that represent the presence of Fungal-containing Allergic mucin. AFS has been found to be analogous in several ways to Allergic bronchopulmonary aspergillosis (ABPA). Both are chronic inflammatory respiratory tract disorders that are driven by hypersensitivity responses to the presence of small numbers of extramucosal fungi found growing within airway-impacting Allergic mucin. AFS Allergic mucin typically cultures positive for eithe

  • Allergic Fungal Sinusitis pathophysiology diagnosis and management
    Medical Mycology, 2009
    Co-Authors: Mark S Schubert
    Abstract:

    Allergic Fungal Sinusitis (AFS) is a noninvasive form of Fungal rhinoSinusitis with an incidence of between 6 and 9% of all rhinoSinusitis requiring surgery. Regional variation in incidence has been reported, with the southern and southwestern US particularly endemic. Patients with AFS commonly present with chronic rhinoSinusitis with nasal polyps, inhalant atopy, elevated total serum immunoglobulin E (IgE), and sinus-obstructing inspissates of a characteristic extramucosal 'peanut buttery' visco-elastic eosinophil-rich material called 'Allergic mucin' that contains sparse numbers of Fungal hyphae. Sinus CT is always abnormal, showing findings of chronic rhinoSinusitis that often include central areas of increased contrast ('hyperattenuation') within abnormal paranasal sinuses that represent the presence of Fungal-containing Allergic mucin. AFS has been found to be analogous in several ways to Allergic bronchopulmonary aspergillosis (ABPA). Both are chronic inflammatory respiratory tract disorders that are driven by hypersensitivity responses to the presence of small numbers of extramucosal fungi found growing within airway-impacting Allergic mucin. AFS Allergic mucin typically cultures positive for either dematiaceous fungi such as Bipolaris spicifera or Curvularia lunata, or Aspergillus species such as A. fumigatus, A. flavus or A. niger. As with ABPA, patients have type I immediate hypersensitivity to the etiologic mold in AFS. Further, both AFS and ABPA have been found to have association with specific class II major histocompatibility alleles. Proper diagnosis of AFS and differentiation from the other forms of both noninvasive and invasive Fungal rhinoSinusitis requires strict adherence to published diagnostic criteria. Medical treatment of AFS has been modeled to an extent after treatment approaches for ABPA that includes the use of postoperative oral corticosteroids and aggressive antiAllergic inflammation therapy. The use of follow-up measurements of total serum IgE during treatment of both AFS and ABPA patients can help to monitor disease activity. Future AFS research will lead to further insights into pathogenesis, improved treatments, and ultimately decreases in surgical recurrence rates for this highly recurrent hypertrophic rhinoSinusitis disorder.

  • Allergic Fungal Sinusitis
    Clinical Reviews in Allergy & Immunology, 2006
    Co-Authors: Mark S Schubert
    Abstract:

    Many common chronic inflammatory rhinoSinusitis conditions (hypertrophic sinus disease [HSD]) have the histopathological profile of Allergic or asthmatic inflammation. Allergic Fungal Sinusitis (AFS) is both a type of noninvasive Fungal rhinoSinusitis and a type of HSD. AFS has clinicopathological features that make it similar, but not identical, to Allergic bronchopulmonary aspergillosis (ABPA). Allergic mucin is a defined pathological entity occurring in ABPA, AFS, and in the HSD "eosinophilic mucin rhinoSinusitis (EMRS)." Diagnosis of AFS requires a careful review of surgical reports, histopathology, and culture results. Treatment includes surgery and aggressive postoperative medical management of Allergic inflammatory disease. Prognosis is good with integrated medical-surgical follow-up, but recurrence remains problematic. The association of ABPA, AFS, and HSD with class II genes of the major histocompatibility complex places the initiation of these inflammatory diseases within the context of antigen presentation and the acquired immune response. Pathological immunomanipulation of this response by local microbial superantigens may be a common mechanism for disease pathogenesis. Future research into the molecular biology of these related conditions may offer insight into the pathogenesis of other chronic inflammatory diseases.

  • Allergic Fungal Sinusitis
    Otolaryngologic Clinics of North America, 2004
    Co-Authors: Mark S Schubert
    Abstract:

    AFS is an increasingly recognized form of HSD, now reported throughout the world. It is probably the most frequently occurring Fungal rhinoSinusitis disorder. The term Fungal Sinusitis is no longer appropriate because the five categories of Fungal rhinoSinusitis can now be differentiated. Each category of Fungal rhinoSinusitis disorder carries different treatment approaches and prognosis. Diagnostic error can be minimized by adhering to strict diagnostic criteria. The analogy (but not identity) of AFS to ABPA has been supported by histopathology, immunopathology, and the clinical response to OCS treatment. AFS represents a true medical surgical disorder in which both surgery and postoperative medical treatment, if properly coordinated between medical and surgical specialists, leads to the best patient outcomes. Continued advances in the understanding of the immunogenetics and immunopathogenesis of AFS may provide fundamental insights into molecular mechanisms operant in other chronic inflammatory disorders, including other chronic eosinophilic-lymphocytic respiratory mucosal disorders such as common forms of HSD and chronic severe asthma.

  • Allergic Fungal Sinusitis pathogenesis and management strategies
    Drugs, 2004
    Co-Authors: Mark S Schubert
    Abstract:

    Allergic Fungal Sinusitis (AFS) is a noninvasive form of highly recurrent chronic Allergic hypertrophic rhinoSinusitis that can be distinguished clinically, histopathologically and prognostically from the other forms of chronic Fungal rhinoSinusitis. There are three invasive (acute necrotising, chronic invasive and granulomatous invasive) and two noninvasive (Fungal ball and Allergic Fungal) forms of Fungal rhinoSinusitis currently recognised. Confusion in differentiating between the various forms of Fungal rhinoSinusitis and between other forms of chronic hypertrophic sinus disease (HSD) can be eliminated by adhering to strict diagnostic criteria. Although there are characteristic presenting clinical history and physical examination findings, laboratory test results, including elevated total serum IgE and positive inhalant allergy skin tests, and sinus computed tomography scans showing chronic rhinoSinusitis (often with the presence of hyperattenuating sinus contents) diagnosis of AFS is essentially based on histopathology obtained from sinus surgery. Histopathology shows the presence of eosinophilic-lymphocytic sinus mucosal inflammation, extramucosal Allergic mucin (that is also seen grossly at surgery as a characteristic 'peanut-buttery' material), and scattered silver stain positive Fungal hyphae within the Allergic mucin but not in the mucosa. Treatment and follow up of AFS has been based on its immunopathological analogy to Allergic bronchopulmonary aspergillosis, a similar noninvasive Fungal hypersensitivity disorder of the lung, and its clinical and pathophysiological relationship to other forms of HSD and asthma. Treatment involves aggressive sinus surgery followed by medical management that includes allergen immunotherapy, topical and systemic corticosteroids, antihistamines and antileukotrienes. Total serum IgE levels should be followed postoperatively as they can be prognostic for recurrent disease. Close follow up and coordination of treatment by both medical and surgical physicians as a team leads to the best clinical outcomes. Ongoing studies are being directed at furthering our understanding of the pathophysiological relationships and treatment options for AFS, and other common forms of chronic hypertrophic rhinoSinusitis disorders.

Bradley F. Marple - One of the best experts on this subject based on the ideXlab platform.

  • Allergic Fungal Sinusitis induced visual loss
    American Journal of Rhinology, 1999
    Co-Authors: Bradley F. Marple, Scott R Gibbs, Mark T Newcomer, Richard L. Mabry
    Abstract:

    In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed Allergic Fungal Sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.

  • immunotherapy for Allergic Fungal Sinusitis three years experience
    Otolaryngology-Head and Neck Surgery, 1998
    Co-Authors: Richard L. Mabry, Bradley F. Marple, Randy J Folker, Cynthia S. Mabry
    Abstract:

    Since August 1994, we have treated patients with histologically proven Allergic Fungal Sinusitis with surgery followed by immunotherapy, employing Fungal and nonFungal antigens to which hypersensitivity has been demonstrated. Our results continue to be encouraging. Not only have we encountered no indication that Fungal immunotherapy has worsened these patients' condition or caused a recurrence of disease, we have confirmed dramatic improvement in these patients compared with the generally accepted course of this disease. Of 11 patients who have received immunotherapy for 1 to 3 years (mean 28 months), none has required regular or frequent treatment with a single brief course of systemic steroids, and only three are receiving topical nasal steroids. No repeat surgeries for recurrent Allergic Fungal Sinusitis have been required in the treatment group. This combination of surgery and immunotherapy has continued to prove beneficial, and we urge others to consider this approach to therapy.

  • treatment of Allergic Fungal Sinusitis a comparison trial of postoperative immunotherapy with specific Fungal antigens
    Laryngoscope, 1998
    Co-Authors: Randy J Folker, Bradley F. Marple, Richard L. Mabry, Cynthia S. Mabry
    Abstract:

    Objective: To determine the effect of immunotherapy (IT) with Fungal antigens on clinical outcome in patients with Allergic Fungal Sinusitis (AFS). Study Design: Prospective case control. Methods : In this comparison study, 22 patients meeting the diagnostic criteria of Allergic Fungal Sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent Sinusitis. Eleven patients received postoperative immunotherapy (IT) with Fungal and nonFungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy. Results: The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P <.001) and a Sinusitis-specific quality-of-life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P <.001) and topical nasal (P =.043) corticosteroid therapy to control disease. Follow-up was similar in the two groups and was not a determinant of differences in outcome (P =.7). Conclusions: Results from this study indicate that specific IT with Fungal antigens improves patient outcome in AFS.

  • comprehensive management of Allergic Fungal Sinusitis
    American Journal of Rhinology, 1998
    Co-Authors: Bradley F. Marple, Richard L. Mabry
    Abstract:

    In little more than a decade, Allergic Fungal Sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with panSinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained within the sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and Fungal stains show the presence of noninvasive hyphae. Fungal cultures may or may not be positive. We have found the following approach to Allergic Fungal Sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant Fungal and non-Fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by the patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.

  • Allergic Fungal Sinusitis: CT findings
    Radiology, 1998
    Co-Authors: Suresh K. Mukherji, Ramon Figueroa, Lawrence E. Ginsberg, Barbara A. Zeifer, Bradley F. Marple, John G. Alley, Laura L. Cooper, William R. Nemzek, David M. Yousem, Kim R. Jones
    Abstract:

    PURPOSE: To determine the computed tomographic (CT) findings in patients with Allergic Fungal Sinusitis. MATERIALS AND METHODS: The authors retrospectively reviewed CT scans and surgical and histopathologic reports in 45 patients (27 male, 18 female; age range, 8-68 years) with Allergic Fungal Sinusitis from multiple institutions. The median age (25 years) and demographics of the patients were determined. Two head and neck radiologists together evaluated the CT scans for the presence of intrasinus high-attenuation areas, extent of sinus involvement, bone expansion and thinning, bone erosion, and extension of disease into the adjacent soft tissues. RESULTS: Allergic Fungal Sinusitis was more common in male patients and in patients aged 20-30 years. All patients had increased intrasinus attenuation at non-contrast material-enhanced CT. Multiple sinus involvement occurred in 43 patients. Bilateral involvement was more common than unilateral disease. Forty-four patients had complete opacification of at least ...

Richard L. Mabry - One of the best experts on this subject based on the ideXlab platform.

  • Allergic Fungal Sinusitis induced visual loss
    American Journal of Rhinology, 1999
    Co-Authors: Bradley F. Marple, Scott R Gibbs, Mark T Newcomer, Richard L. Mabry
    Abstract:

    In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed Allergic Fungal Sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.

  • immunotherapy for Allergic Fungal Sinusitis three years experience
    Otolaryngology-Head and Neck Surgery, 1998
    Co-Authors: Richard L. Mabry, Bradley F. Marple, Randy J Folker, Cynthia S. Mabry
    Abstract:

    Since August 1994, we have treated patients with histologically proven Allergic Fungal Sinusitis with surgery followed by immunotherapy, employing Fungal and nonFungal antigens to which hypersensitivity has been demonstrated. Our results continue to be encouraging. Not only have we encountered no indication that Fungal immunotherapy has worsened these patients' condition or caused a recurrence of disease, we have confirmed dramatic improvement in these patients compared with the generally accepted course of this disease. Of 11 patients who have received immunotherapy for 1 to 3 years (mean 28 months), none has required regular or frequent treatment with a single brief course of systemic steroids, and only three are receiving topical nasal steroids. No repeat surgeries for recurrent Allergic Fungal Sinusitis have been required in the treatment group. This combination of surgery and immunotherapy has continued to prove beneficial, and we urge others to consider this approach to therapy.

  • treatment of Allergic Fungal Sinusitis a comparison trial of postoperative immunotherapy with specific Fungal antigens
    Laryngoscope, 1998
    Co-Authors: Randy J Folker, Bradley F. Marple, Richard L. Mabry, Cynthia S. Mabry
    Abstract:

    Objective: To determine the effect of immunotherapy (IT) with Fungal antigens on clinical outcome in patients with Allergic Fungal Sinusitis (AFS). Study Design: Prospective case control. Methods : In this comparison study, 22 patients meeting the diagnostic criteria of Allergic Fungal Sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent Sinusitis. Eleven patients received postoperative immunotherapy (IT) with Fungal and nonFungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy. Results: The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P <.001) and a Sinusitis-specific quality-of-life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P <.001) and topical nasal (P =.043) corticosteroid therapy to control disease. Follow-up was similar in the two groups and was not a determinant of differences in outcome (P =.7). Conclusions: Results from this study indicate that specific IT with Fungal antigens improves patient outcome in AFS.

  • comprehensive management of Allergic Fungal Sinusitis
    American Journal of Rhinology, 1998
    Co-Authors: Bradley F. Marple, Richard L. Mabry
    Abstract:

    In little more than a decade, Allergic Fungal Sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with panSinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained within the sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and Fungal stains show the presence of noninvasive hyphae. Fungal cultures may or may not be positive. We have found the following approach to Allergic Fungal Sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant Fungal and non-Fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by the patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.

  • immunotherapy for Allergic Fungal Sinusitis the second year
    Otolaryngology-Head and Neck Surgery, 1997
    Co-Authors: Richard L. Mabry, Cynthia S. Mabry
    Abstract:

    Abstract Since August 1994 we have followed a protocol of treating patients with histologically proven Allergic Fungal Sinusitis with surgical extirpation of the involved sinuses, followed by immunotherapy using both Fungal and nonFungal antigens to which hypersensitivity is demonstrated by in vitro and skin testing methods. Despite predictions to the contrary, we have encountered no evidence that these injections have worsened the condition of any patients. Rather, we have noted a marked decrease in nasal crusting in all patients, with a minimum amount of recurrent polypoid mucosa and a lessened or absent requirement for corticosteroids (systemic or topical). Two patients treated with immunotherapy required systemic corticosteroids and subsequent revision surgery for residual disease that was present before the start of immunotherapy, and they have done well since. Our experience indicates that the triad of adequate surgery, frequent follow-up and medical management, and immunotherapy with relevant Fungal and nonFungal antigens represents an effective means of treating patients with Allergic Fungal Sinusitis. Nevertheless, an even longer period of study will be necessary to provide the final answer regarding the role of immunotherapy in the treatment of Allergic Fungal Sinusitis. (Otolaryngol Head Neck Surg 1997;117:367-71.)

Peter J Macardle - One of the best experts on this subject based on the ideXlab platform.

  • Nasal Polyp Cell Populations and Fungal-Specific Peripheral Blood Lymphocyte Proliferation in Allergic Fungal Sinusitis
    'Oceanside Publications Inc.', 2010
    Co-Authors: Harshita Pant M.b.b.s., Frank Kette E. M.b.b.s., William Smith B. M.b.b.s., Peter Wormald J. M.b.b.s., Peter J Macardle
    Abstract:

    Background Allergic Fungal Sinusitis (AFS) is considered a different disease from other polypoid chronic rhinoSinusitis diseases (CRS) with eosinophilic mucus (EM) termed eosinophilic mucus chronic rhinoSinusitis (EMCRS). To substantiate this, studies on cellular responses to fungi and sinus mucosal inflammatory cell populations in AFS and other EMCRS diseases are. required. This study was designed to examine polyp inflammatory cell populations and peripheral blood Fungal-specific T-cell responses in AFS, other EMCRS subgroups (defined later), and polypoid CRS without EM. Methods A prospective study was performed. Clinical characteristics, including CRS symptoms, sinus computed tomography (CT) scans, allergy status, intraoperative endoscopy, presence of EM, and Fungal culture results were used to define patient groups. Polyps and peripheral blood were examined for populations of eosinophils, lymphocytes (CD4 + , CD8 + T cells, natural killer cells, and B cells), and neutrophils using immunohistochemistry, cytospin preparations and flow cytometry. Fungal-specific peripheral blood lymphocyte proliferation was examined in AFS patients, other EMCRS patients, CRS patients, and controls. Results There was no significant difference in the percentage of cell populations and Fungal-specific lymphocyte proliferation between AFS and other EMCRS diseases. However, AFS and other EMCRS polyps had a higher percentage of eosinophils and CD8 + T cells whereas CRS polyps had higher CD4 4 T cells. Fungal-specific lymphocyte proliferation was significantly greater in AFS and other EMCRS patients regardless of Fungal allergy, whereas in CRS and controls, higher proliferation was observed in Fungal-Allergic individuals. Conclusion These findings question the basis for differentiating AFS from, other EMCRS diseases based on Fungal allergy and fungi in EM. Fungal-specific cellular response was present in AFS and other EMCRS diseases, different from, that associated with Fungal allergy, suggesting a nonAllergic Fungal immune response. Increased CD8 + T cells in EMCRS polyps signify a different type of inflammation to CRS that may be driven by CD8 + T cells

  • ige mediated Fungal allergy in Allergic Fungal Sinusitis
    Laryngoscope, 2009
    Co-Authors: Harshita Pant, Mark Schembri, Peter J Wormald, Peter J Macardle
    Abstract:

    This review will address the current knowledge of the pathogenic mechanisms in Allergic Fungal Sinusitis (AFS) and the basis for the current classification of a subgroup of chronic rhinoSinusitis patients. Special attention is directed to the role of immunoglobulin E (IgE)-mediated Fungal allergy in the pathogenesis of AFS. Concepts relating to the mucosal inflammatory response are introduced, as a knowledge of the reactions of the sinus mucosal cells can lead to a better understanding of the mechanisms perpetuating and maintaining the chronic inflammation. Laryngoscope, 2009.

Scott C Manning - One of the best experts on this subject based on the ideXlab platform.

  • clinical presentation of Allergic Fungal Sinusitis in children
    Annual Meeting of the American Society of Pediatric Otolaryngology, 2002
    Co-Authors: John E Mcclay, Scott C Manning, Mark T Newcomer, Brad Marple, Lav Kapadia, Michael J Biavati, Brian Nussenbaum, Timothy N Booth, Nathan Schwade
    Abstract:

    Objective: To compare the differences in the clinical and radiographic presentation of Allergic Fungal Sinusitis in children and adults. Study Design: Retrospective chart and computed tomography review. Methods: The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented Allergic Fungal Sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present. Results: Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P .05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species. Conclusions: Presentation in pediatric patients with Allergic Fungal Sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.

  • further evidence for Allergic pathophysiology in Allergic Fungal Sinusitis
    Laryngoscope, 1998
    Co-Authors: Scott C Manning, Marie Holman
    Abstract:

    Controversy continues over whether Allergic Fungal Sinusitis represents a true allergy, an infection, or a point somewhere along a spectrum between allergy and infection. The present study describes two experiments that add weight to the argument that Allergic Fungal Sinusitis (AFS) is truly an immunologically mediated hypersensitivity and not a form of infection. In the first experiment, eight patients with Bipolaris culture-positive AFS were prospectively evaluated with Bipolaris antigen skin testing and with inhibition radioallergosorbent (RAST) and enzyme-linked immunosorbent assay (ELISA) for Bipolaris-specific IgE and IgG antibodies. The Bipolaris AFS cases were compared with 10 control patients with no history of AFS. All eight AFS cases demonstrated positive skin testing to Bipolaris and in addition, all tested positive by RAST and ELISA for IgE and IgG Bipolaris antibodies, respectively. In the control group one patient had a positive skin test, ELISA, and RAST and one additional patient had a positive ELISA only. Good correlation was noted between skin test, RAST, and ELISA results. In the second experiment, sinus mucosa from 14 AFS patients and 10 control patients with other forms of surgical sinus disease was analyzed by immunohistocytochemistry for the eosinophilic inflammatory mediators major basic protein (MBP) and eosinophil derived neurotoxin (EDN) and the neutrophil mediator neutrophil elastase. All AFS cases demonstrated evidence of eosinophilic mediator release, and MBP and EDN predominated over neutrophil elastase. In the control group eosinophil and neutrophil mediator release in sinus mucosa was equal. The two experiments support the concept that AFS is an antigen-triggered, IgE- and IgG-mediated hypersensitivity response with a late-phase inflammatory reaction involving release of eosinophilic mediators.

  • computed tomography and magnetic resonance diagnosis of Allergic Fungal Sinusitis
    Laryngoscope, 1997
    Co-Authors: Scott C Manning, Frank Vuitch, Marie Merkel, Kevin Kriesel, Bradley F. Marple
    Abstract:

    The objective of this study was to describe CT and MR findings in patients with Allergic Fungal Sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated Allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.

  • immunotherapy in the treatment of Allergic Fungal Sinusitis
    Otolaryngology-Head and Neck Surgery, 1997
    Co-Authors: Richard L. Mabry, Scott C Manning, Cynthia S. Mabry
    Abstract:

    Recommendations to withhold immunotherapy with Fungal antigens from patients with Allergic Fungal Sinusitis (AFS) have been based primarily on retrospectively reviewed, anecdotal case reports and theoretical considerations. A study that was approved by the investigational review board of our institution is ongoing in our department to administer immunotherapy with relevant Fungal antigens to patients with histologically proven AFS. After 1 year, no instances of worsening of symptoms as a result of this therapy have been observed. Objective measurement of improvement has been difficult, but our initial clinical impression is that this treatment regimen has resulted in significant reduction in the reaccumulation of crusts and Allergic mucin within the sinuses, has led to a reduction in the use of topical nasal steroids, and has made systemic steroid therapy unnecessary, thereby improving the quality of life of the patient. A further study of immunotherapy for patients with AFS is recommended, and suggestions for modification of the current protocol are presented. (Otolaryngol Head Neck Surg 1997;116:31-5.)

  • evidence of ige mediated hypersensitivity in Allergic Fungal Sinusitis
    Laryngoscope, 1993
    Co-Authors: Scott C Manning, Steven D Schaefer, Richard L. Mabry, Lanny G Close
    Abstract:

    Despite documentation of specific immunologic hypersensitivity in a few case reports, controversy continues as to the role of allergy versus true infection in the clinical entity of Allergic Fungal Sinusitis (AFS). Using a modified radioallergosorbent test (RAST) to multiple Fungal antigens, 16 patients meeting the histologic criteria of AFS and with positive Fungal cultures were compared to 5 control patients with similar preoperative clinical findings but without histologic or culture evidence of AFS. All patients were immunocompetent and none demonstrated histologic evidence of tissue invasion. All AFS patients were RAST-positive to at least one Fungal antigen in the family of their cultured organism with positive defined as class 2 or greater. No control patient was RAST-positive to either dematiaceous or Aspergillus Fungal antigens. Thus, modified RAST testing can aid in the routine clinical diagnosis of AFS, and it provides further serologic evidence for a type I hypersensitivity in the pathogenesis of AFS.