Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, 55 Fruit Street, Bulfinch-422, Boston, MA 02114, USA.
Proc Am Thorac Soc. 2010 May;7(3):245-52. doi: 10.1513/pats.200909-098AL.
The intent of this article is to review the published literature addressing the role of fungi as causative agents in allergic rhinitis and rhinosinusitis. Ambient mold spores are widely distributed in nature, and an estimated 3 to 10% of the world's population is allergic to molds. There are compelling epidemiologic links between mold (fungal) allergy and illnesses such as asthma and "asthma with allergic rhinitis." Fungal allergy is more prevalent in areas of high ambient mold spore concentrations. However, epidemiologic studies have failed to demonstrate a direct relationship between fungal allergy and allergic rhinitis either via outdoor or indoor exposure. Fungal allergy is clearly linked to a subset of chronic rhinosinusitis (CRS) known as allergic fungal rhinosinusitis (AFRS). This condition represents an intense allergic response against colonizing fungi giving rise to formation of allergic (eosinophilic) mucin, mucostasis, and sinus opacification. A broader role for colonizing fungi has been postulated in CRS owing to the demonstration of fungi in mucus in the vast majority of cases of CRS, and in vitro studies demonstrating that certain fungi, particularly Alternaria, elicit a "modified" allergic response in patients with CRS that is independent of IgE.
本文旨在回顾已发表的文献，探讨真菌作为变应性鼻炎和鼻-鼻窦炎病因的作用。环境霉菌孢子广泛存在于自然界中，据估计，全世界有 3%至 10%的人对霉菌过敏。霉菌（真菌）过敏与哮喘和“伴变应性鼻炎的哮喘”等疾病之间存在着强有力的流行病学联系。在霉菌孢子浓度较高的环境中，真菌过敏更为常见。然而，流行病学研究未能证明真菌过敏与变应性鼻炎之间存在直接关系，无论是通过室外还是室内暴露。真菌过敏与已知的慢性鼻-鼻窦炎（CRS）的一个亚组（即变应性真菌性鼻-鼻窦炎，AFRS）密切相关。这种情况代表了对定植真菌的强烈过敏反应，导致形成变应性（嗜酸性粒细胞）粘蛋白、粘蛋白阻塞和窦腔不透光。由于在绝大多数 CRS 病例的粘液中都能检测到真菌，以及体外研究表明某些真菌（特别是交链孢霉）在 CRS 患者中引起一种独立于 IgE 的“改良”过敏反应，因此人们推测定植真菌在 CRS 中具有更广泛的作用。
