Ryan Matthew W, Clark Christopher M
Department of Otolaryngology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA.
Curr Allergy Asthma Rep. 2015 Dec;15(12):75. doi: 10.1007/s11882-015-0573-6.
Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS) is a form of polypoid chronic rhinosinusitis that is believed to be due to hypersensitivity to fungal antigens. The disease is characterized by type 1 hypersensitivity to fungal allergens, dramatically elevated total serum IgE, accumulation of thick eosinophil-laden mucin with non-invasive fungal hyphae within the paranasal sinuses, nasal polyposis, and sinus bony remodeling. Because of many clinicopathologic similarities to allergic bronchopulmonary aspergillosis (ABPA), these conditions can be considered analogous examples of disease in the unified airway. However, these conditions rarely occur together and their treatment differs. The treatment of AFRS relies upon surgical removal of fungal hyphae in eosinophilic mucin, while antifungal therapy is used to clear fungi from the airways in ABPA. Several uncontrolled studies suggest there may be some benefit to antifungal agents in AFRS, but randomized trials of topical and systemic antifungal therapies have not shown beneficial results in chronic rhinosinusitis (CRS). Antifungal treatment within the sinonasal cavities does not appear to be an effective approach for most chronic sinusitis, and antifungal therapy for AFRS is unproven.
变应性真菌性鼻窦炎（AFS）或变应性真菌性鼻-鼻窦炎（AFRS）是息肉样慢性鼻-鼻窦炎的一种形式，被认为是由于对真菌抗原过敏所致。该疾病的特征为对真菌变应原的1型超敏反应、血清总IgE显著升高、鼻窦内充满嗜酸性粒细胞的浓稠黏液及非侵袭性真菌菌丝的积聚、鼻息肉形成和鼻窦骨质重塑。由于在临床病理学上与变应性支气管肺曲霉病（ABPA）有许多相似之处，这些情况可被视为统一气道中疾病的类似例子。然而，这些情况很少同时发生，且其治疗方法不同。AFRS的治疗依赖于手术清除嗜酸性黏液中的真菌菌丝，而抗真菌治疗则用于清除ABPA气道中的真菌。几项非对照研究表明，抗真菌药物可能对AFRS有一定益处，但局部和全身抗真菌治疗的随机试验在慢性鼻-鼻窦炎（CRS）中并未显示出有益结果。鼻窦腔内的抗真菌治疗似乎对大多数慢性鼻窦炎不是一种有效的方法，AFRS的抗真菌治疗尚未得到证实。
