Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the Department of Surgery, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Curr Opin Otolaryngol Head Neck Surg. 2021 Dec 1;29(6):510-516. doi: 10.1097/MOO.0000000000000761.
Allergic fungal rhinosinusitis (AFRS) is a debilitating condition for children. Despite there being several reviews on this topic in the adult population, there is a paucity of reviews of AFRS in the pediatric literature. This article reviews the recent evidence of pediatric AFRS with the aim to optimize outcomes of pediatric patients with this condition.
AFRS is clinically characterized by nasal polyposis, a type I hypersensitivity to fungal epitopes, very thick eosinophilic mucin, and peripheral eosinophilia. Pediatric AFRS has similar clinical characteristics to that in adults but is thought to have a more aggressive nature, with higher serum immunoglobulin E and more frequently bone erosion and malformation of facial bones. Diagnosis of pediatric AFRS is made by using the Bent and Kuhn's criteria developed for adult AFRS. The mainstay of treatment is surgery followed by postoperative corticosteroids. Adjunctive therapies, including topical/oral antifungal agents, allergen immunotherapy and biologics may improve outcomes in pediatric AFRS, but to date the current evidence is limited.
To optimize the outcome of pediatric AFRS, adequate and early diagnosis and treatment are essential. Appropriate and comprehensive endoscopic sinus surgery to open the sinuses, remove the fungal burden of disease and improve access of the sinuses to postoperative topical corticosteroid remains the standard of care.
变应性真菌性鼻鼻窦炎（AFRS）是一种令儿童虚弱的疾病。尽管成人中已有多篇关于该主题的综述，但在儿科文献中，AFRS 的综述却很少。本文综述了儿科 AFRS 的最新证据，旨在优化儿科患者的结局。
AFRS 的临床特征为鼻息肉、对真菌表位的 I 型超敏反应、非常厚的嗜酸性黏蛋白和外周嗜酸性粒细胞增多。儿科 AFRS 与成人的临床特征相似，但被认为具有更具侵袭性的性质，其血清免疫球蛋白 E 更高，且更常发生骨侵蚀和面部骨骼畸形。儿科 AFRS 的诊断采用专为成人 AFRS 制定的本特和库恩标准。治疗的主要方法是手术，然后是术后皮质类固醇。辅助治疗，包括局部/口服抗真菌药物、变应原免疫疗法和生物制剂可能改善儿科 AFRS 的结局，但迄今为止，目前的证据有限。
为了优化儿科 AFRS 的结局，充分和早期的诊断和治疗至关重要。适当和全面的内镜鼻窦手术以打开鼻窦、清除真菌病负担和改善鼻窦对术后局部皮质类固醇的吸收仍然是标准的治疗方法。
