Nakayama Tsuguhisa, Inoue Natsuki, Akutsu Makoto, Tsunemi Yasuhiro, Kashiwagi Takashi, Matsuwaki Yoshinori, Yoshikawa Mamoru
Department of Otorhinolaryngology and Head & Neck Surgery, Dokkyo Medical University, Mibu, Shimotsuga, Tochigi, Japan.
Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan.
Int Forum Allergy Rhinol. 2025 Sep;15(9):944-953. doi: 10.1002/alr.23597. Epub 2025 Apr 29.
Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis driven by Types 1 and 3 allergies to fungi. In Japan, it is relatively rare and characterized by prominent eosinophilic infiltration of the sinonasal mucosa, together with eosinophilic mucin containing scattered fungi in the sinus cavity. Eosinophilic chronic rhinosinusitis (eCRS) involves similar eosinophilic infiltration and shares some clinical features with AFRS. However, the clinical differences between eCRS and AFRS remain to be fully elucidated. The aim of this study was to clarify the phenotypes of eCRS and AFRS.
This multicenter retrospective study enrolled patients with AFRS and eCRS and compared their clinical parameters. A cluster analysis was conducted to determine the phenotypes of the two diseases.
AFRS patients had a younger age of onset and exhibited milder computed tomography and nasal polyp scores than eCRS patients. Total IgE was significantly higher in AFRS patients than in eCRS patients, while mucosal eosinophil counts were similar. Olfactory disturbances were significantly less severe in AFRS patients compared with eCRS patients. The cluster analysis revealed three phenotypes for AFRS: one that was distinct and independent from eCRS, representing the more classically described AFRS patients, and more the other two that shared characteristics with eCRS.
AFRS exhibits unique clinical features compared with eCRS. Cluster analysis identified three distinct AFRS phenotypes characterized by CT findings, eosinophilic inflammation, and specific IgE levels against inhaled antigens. These findings underscore the importance of differential diagnosis and personalized treatment strategies for AFRS and eCRS.
变应性真菌性鼻-鼻窦炎（AFRS）是一种由对真菌的1型和3型变态反应驱动的慢性鼻-鼻窦炎亚型。在日本，它相对少见，其特征为鼻窦黏膜有显著的嗜酸性粒细胞浸润，同时鼻窦腔内有含散在真菌的嗜酸性黏液。嗜酸性粒细胞性慢性鼻-鼻窦炎（eCRS）涉及类似的嗜酸性粒细胞浸润，与AFRS有一些共同的临床特征。然而，eCRS和AFRS之间的临床差异仍有待充分阐明。本研究的目的是明确eCRS和AFRS的表型。
这项多中心回顾性研究纳入了AFRS和eCRS患者，并比较了他们的临床参数。进行聚类分析以确定这两种疾病的表型。
AFRS患者发病年龄较轻，计算机断层扫描和鼻息肉评分比eCRS患者轻。AFRS患者的总IgE显著高于eCRS患者，而黏膜嗜酸性粒细胞计数相似。与eCRS患者相比，AFRS患者的嗅觉障碍明显较轻。聚类分析揭示了AFRS的三种表型：一种与eCRS不同且独立，代表更典型描述的AFRS患者，另外两种与eCRS有共同特征。
与eCRS相比，AFRS表现出独特的临床特征。聚类分析确定了三种不同的AFRS表型，其特征为CT表现、嗜酸性粒细胞炎症以及针对吸入性抗原的特异性IgE水平。这些发现强调了对AFRS和eCRS进行鉴别诊断和个性化治疗策略的重要性。
