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Evangelos Frigas - One of the best experts on this subject based on the ideXlab platform.
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allergic Fungal Sinusitis secondary to dermatiaceous fungi curvularia lunata and alternaria
Otolaryngology-Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:: Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
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Allergic Fungal Sinusitis Secondary to Dermatiaceous Fungi—Curvularia Lunata and Alternaria:
Otolaryngology–Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
Frederick A. Kuhn - One of the best experts on this subject based on the ideXlab platform.
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Allergic Fungal Sinusitis: diagnosis and treatment.
Current Opinion in Otolaryngology & Head and Neck Surgery, 2003Co-Authors: Frederick A. Kuhn, Ron SwainAbstract:Since allergic Fungal Sinusitis was initially described by Millar et al. in 1981, many have tried to define and explain the disorder. It has been labeled as the sinonasal equivalent of allergic bronchopulmonary aspergillosis; however, allergic Fungal Sinusitis cannot be categorized so easily. Accord
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Allergenic fungi in allergic Fungal Sinusitis
Annals of Allergy Asthma & Immunology, 1997Co-Authors: Robert R Chrzanowski, Frederick A. Kuhn, Ned T. Rupp, Amy E. Phillips, William K. DolenAbstract:Background Patients with allergic Fungal Sinusitis demonstrate skin test reactivity to many Fungal extracts. Various fungi have been isolated from the characteristic allergic mucin. Objective This study was designed to identify allergens in allergic mucin and to compare them to those found in commercial Fungal extracts. Methods Allergic mucin was collected during functional endoscopic sinus surgery from 11 patients meeting strict diagnostic criteria for allergic Fungal Sinusitis and from three allergic rhinitis patients with chronic Sinusitis. A portion was solubilized in saline and centrifuged. To identify allergens, proteins in allergic mucin and Fungal extracts were separated by SDS-polyacrylamide gel electrophoresis, transferred to nitrocellulose and immunostained using patient sera and enzyme-labeled anti-human IgE. Results All patient sera recognized numerous bands ranging from 18 to 90 kD. In mucin, bands were consistently found in the 35 to 50 kD range. Corresponding bands in Fungal extracts were found in only 1/11 patients with allergic Fungal Sinusitis. Sera from 4/11 patients detected an 18-kD protein in allergic mucin, but sera from all patients with allergic Fungal Sinusitis recognized an 18-kD protein in commercial Fungal extracts. Sera from selected patients with allergic Fungal Sinusitis detected human epithelial proteins in the 35 to 50 kD range. Conclusions Fungal allergens were not detected in allergic mucin of all patients with allergic Fungal Sinusitis. The 18-kD allergen appears to be shared by many fungi, and may be a Fungal panallergen. The source of the apparent allergens in the 35 to 50-kD range warrants further study.
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Prognosis for allergic Fungal Sinusitis
Otolaryngology - Head and Neck Surgery, 1997Co-Authors: Stephen B. Kupferberg, John P. Bent, Frederick A. KuhnAbstract:Allergic Fungal Sinusitis is a recently described clinical entity that has gained increased attention as a cause of chronic Sinusitis. The diagnosis can be established by demonstrating (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic CT scan; (4) eosinophilic mucus without Fungal invasion into sinus tissue; and (5) positive Fungal stain of sinus contents removed intraoperatively or during office endoscopy. The exact pathogenesis of allergic Fungal Sinusitis remains controversial, and no treatment modality has proved to be consistently effective. Several reports during the last decade have suggested that allergic Fungal Sinusitis recurs more frequently than chronic bacterial Sinusitis, but no studies have specifically addressed the prognosis of allergic Fungal Sinusitis. During the past two and a half years, we have treated 26 patients with allergic Fungal Sinusitis. The treatment always included functional endoscopic sinus surgery, topical nasal steroids, postoperative nasal saline irrigations, and endoscopic cleaning in the office. Adjuvant medical therapy included systemic steroids, oral antiFungals, a combination of systemic steroids and oral antiFungals, or in some cases, no additional treatment. Outcome was graded subjectively as improved, unchanged, or worse. Mean follow-up was 14.5 months. Twenty-two of 26 patients were improved. In reviewing postoperative outcomes, we observed endoscopic recurrent disease that generally preceded patient symptoms. Consequently, we developed an endoscopic staging system to record postoperative clinical status. Use of this staging system allowed evaluation of various treatments and enabled classification of patient outcome. Nineteen of 24 patients examined with extensive follow-up had objective signs of recurrent disease. It appears that this is a chronic disease characterized by physical signs that appear before the return of subjective clinical symptoms. (Otolaryngol Head Neck Surg 1997;117:35-41.)
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Allergic Fungal Sinusitis/polyposis.
Allergy and Asthma Proceedings, 1996Co-Authors: John P. Bent, Frederick A. KuhnAbstract:In the last decade, the medical community has recognized allergic Fungal Sinusitis as an unique clinical entity strongly associated with nasal polyps. We will review the differential diagnosis, clinical features, diagnosis, treatment, and prognosis. Appropriate management requires distinguishing allergic Fungal Sinusitis from other forms of chronic Fungal and bacterial Sinusitis. Surgical treatment initially results in dramatic improvement, and oral steroids help maintain postoperative success. However, recurrent disease eventually prevails, leaving a glaring need for improved medical treatment.
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allergic Fungal Sinusitis polyposis
Allergy and Asthma Proceedings, 1996Co-Authors: John P. Bent, Frederick A. KuhnAbstract:In the last decade, the medical community has recognized allergic Fungal Sinusitis as an unique clinical entity strongly associated with nasal polyps. We will review the differential diagnosis, clinical features, diagnosis, treatment, and prognosis. Appropriate management requires distinguishing allergic Fungal Sinusitis from other forms of chronic Fungal and bacterial Sinusitis. Surgical treatment initially results in dramatic improvement, and oral steroids help maintain postoperative success. However, recurrent disease eventually prevails, leaving a glaring need for improved medical treatment.
Jeffrey M Bartynski - One of the best experts on this subject based on the ideXlab platform.
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allergic Fungal Sinusitis secondary to dermatiaceous fungi curvularia lunata and alternaria
Otolaryngology-Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:: Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
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Allergic Fungal Sinusitis Secondary to Dermatiaceous Fungi—Curvularia Lunata and Alternaria:
Otolaryngology–Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
Thomas V Mccaffrey - One of the best experts on this subject based on the ideXlab platform.
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allergic Fungal Sinusitis secondary to dermatiaceous fungi curvularia lunata and alternaria
Otolaryngology-Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:: Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
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Allergic Fungal Sinusitis Secondary to Dermatiaceous Fungi—Curvularia Lunata and Alternaria:
Otolaryngology–Head and Neck Surgery, 1990Co-Authors: Jeffrey M Bartynski, Thomas V Mccaffrey, Evangelos FrigasAbstract:Allergic Fungal Sinusitis is a newly recognized entity consisting of a panSinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinoSinusitis. Pathophysiologically the disease is a combination of both IgE-mediated and antibody-antigen reactions to the specific Fungal antigens. Here we present two cases of allergic Fungal Sinusitis--one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic Fungal Sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic Fungal Sinusitis have appeared in the literature. Diagnostic criteria for allergic Fungal Sinusitis include radiologic evidence of panSinusitis in an atopic individual; findings at surgery of allergic mucin; positive Fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic Fungal Sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, Fungal infections--and especially phaeohyphomycosis--are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.
John P. Bent - One of the best experts on this subject based on the ideXlab platform.
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Prognosis for allergic Fungal Sinusitis
Otolaryngology - Head and Neck Surgery, 1997Co-Authors: Stephen B. Kupferberg, John P. Bent, Frederick A. KuhnAbstract:Allergic Fungal Sinusitis is a recently described clinical entity that has gained increased attention as a cause of chronic Sinusitis. The diagnosis can be established by demonstrating (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic CT scan; (4) eosinophilic mucus without Fungal invasion into sinus tissue; and (5) positive Fungal stain of sinus contents removed intraoperatively or during office endoscopy. The exact pathogenesis of allergic Fungal Sinusitis remains controversial, and no treatment modality has proved to be consistently effective. Several reports during the last decade have suggested that allergic Fungal Sinusitis recurs more frequently than chronic bacterial Sinusitis, but no studies have specifically addressed the prognosis of allergic Fungal Sinusitis. During the past two and a half years, we have treated 26 patients with allergic Fungal Sinusitis. The treatment always included functional endoscopic sinus surgery, topical nasal steroids, postoperative nasal saline irrigations, and endoscopic cleaning in the office. Adjuvant medical therapy included systemic steroids, oral antiFungals, a combination of systemic steroids and oral antiFungals, or in some cases, no additional treatment. Outcome was graded subjectively as improved, unchanged, or worse. Mean follow-up was 14.5 months. Twenty-two of 26 patients were improved. In reviewing postoperative outcomes, we observed endoscopic recurrent disease that generally preceded patient symptoms. Consequently, we developed an endoscopic staging system to record postoperative clinical status. Use of this staging system allowed evaluation of various treatments and enabled classification of patient outcome. Nineteen of 24 patients examined with extensive follow-up had objective signs of recurrent disease. It appears that this is a chronic disease characterized by physical signs that appear before the return of subjective clinical symptoms. (Otolaryngol Head Neck Surg 1997;117:35-41.)
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Allergic Fungal Sinusitis/polyposis.
Allergy and Asthma Proceedings, 1996Co-Authors: John P. Bent, Frederick A. KuhnAbstract:In the last decade, the medical community has recognized allergic Fungal Sinusitis as an unique clinical entity strongly associated with nasal polyps. We will review the differential diagnosis, clinical features, diagnosis, treatment, and prognosis. Appropriate management requires distinguishing allergic Fungal Sinusitis from other forms of chronic Fungal and bacterial Sinusitis. Surgical treatment initially results in dramatic improvement, and oral steroids help maintain postoperative success. However, recurrent disease eventually prevails, leaving a glaring need for improved medical treatment.
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allergic Fungal Sinusitis polyposis
Allergy and Asthma Proceedings, 1996Co-Authors: John P. Bent, Frederick A. KuhnAbstract:In the last decade, the medical community has recognized allergic Fungal Sinusitis as an unique clinical entity strongly associated with nasal polyps. We will review the differential diagnosis, clinical features, diagnosis, treatment, and prognosis. Appropriate management requires distinguishing allergic Fungal Sinusitis from other forms of chronic Fungal and bacterial Sinusitis. Surgical treatment initially results in dramatic improvement, and oral steroids help maintain postoperative success. However, recurrent disease eventually prevails, leaving a glaring need for improved medical treatment.
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Fungal Sinusitis: an update.
Annals of Allergy Asthma & Immunology, 1996Co-Authors: James F. Morpeth, John P. Bent, Frederick A. Kuhn, Ned T. Rupp, William K. DolenAbstract:Objective To review the classification of Fungal Sinusitis as well as discuss current approaches to diagnosis and management. Data sources A MEDLINE literature search was performed using the index terms sinus infection, Fungal, diagnosis, radiology, microbiology, and treatment. The search was restricted to the English language and human subjects. With one exception the references were restricted to the last 10 years. Clinical data from studies performed at our institution were also included. Results Fungal Sinusitis can be divided into four primary categories: (1) acute/fulminant (invasive), (2) chronic/indolent (invasive), (3) fungus ball, and (4) allergic Fungal Sinusitis. Each subtype has unique immunologic, pathologic, and clinical features. Allergic Fungal Sinusitis is the most recently described and most common form. The treatment and prognosis of Fungal Sinusitis varies significantly among the four different categories. Conclusion Recent advances in endoscopy and computed tomography have enhanced the understanding of Fungal Sinusitis; however, they remain diseases surrounded by controversy. New insights into the etiology and pathogenesis of these diseases along with advances in diagnosis and treatment will lead to improved medical therapy.
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Diagnosis of Allergic Fungal Sinusitis
Otolaryngology - Head and Neck Surgery, 1994Co-Authors: John P. Bent, Frederick A. KuhnAbstract:Allergic Fungal Sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic Sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic Fungal Sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic Fungal Sinusitis and differentiate it from chronic bacterial Sinusitis and other forms of Fungal Sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic Fungal Sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a posi...
