Allergic Fungal Sinusitis

Vol. 10 No. 1, January-March 2008 5 Introduction Allergic fungal sinusitis is a benign noninvasive sinus disease, believed to be an allergic reaction to aerosolized environmental fungi. It has been almost three decades when in 1976 Safirstein noted that the combination of polyposis, crust formation and sinus cultures yielding aspergillus was similar to the constellation of findings observed in allergic bronchopulmonary aspergillosis(1). Subsequently allergic fungal sinusitis was initially described by Millar in 1981(2). Over the past two decades allergic fungal sinusitis has been increasingly identified. It is probably the most frequently occurring fungal rhinosinusitis disorder(3). Continuing research has high lightened some aspects of the disease and has led to an improved understanding of allergic fungal sinusitis and its treatment. In this article, we review current data regarding the etiology, pathophysiology, clinical presentation, diagnosis and roles of various surgical and nonsurgical therapies in the treatment of allergic fungal sinusitis. Incidence The incidence of allergic fungal sinusitis in cases of chronic rhinosinusitis treated surgically has been approximately 6 to 7%.(4) The incidence of aspirin sensitivity has been demonstrated to be 27% in patients with allergic fungal sinusitis(4). Asthma has been associated in 65% of the patients.(5) Incidence of allergic fungal sinusitis is high in temperate regions with relatively high humidity. Mean age according to large series is 23 42 years(4,6). Etiology and Pathophysiology Allergic fungal sinusitis is thought to be an allergic reaction to fungi. The causative fungi usually are dematiaceous. Among these Bipolaris spicifera has been Allergic Fungal Sinusitis