New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment

Authors

Brian H Cameron
Amber U Luong

Language

English

Publication Date

3-1-2023

Journal

American Journal of Rhinology & Allergy

DOI

10.1177/19458924231152983

PMID

36848273

PMCID

PMC11898383

PubMedCentral® Posted Date

2-27-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Allergic fungal rhinosinusitis (AFRS) is an endotype of chronic rhinosinusitis (CRS) with nasal polyps characterized by eosinophilic mucin laden with fungal hyphae entrapped in expanded sinus cavities with an exaggerated hypersensitivity to fungal elements. The last decade has elucidated fungi-driven inflammatory pathways contributing to the pathophysiology of chronic inflammatory respiratory diseases. In addition, novel therapeutic biologic options have become available for CRS over the last several years.

Objective: To review the current literature examining AFRS, focusing on recent developments in our understanding of its pathophysiology and implications for treatment options.

Methods: Review article.

Results: Fungi-driven respiratory inflammation has been linked to fungal proteinases and toxin activity. In addition, AFRS patients demonstrate a local sinonasal immunodeficiency in antimicrobial peptides and hence limited antifungal activity, along with an exaggerated type 2 inflammatory response, highlighting a possible imbalanced type 1, type 2, and type 3 profile. The elucidation of these dysregulated molecular pathways has highlighted novel potential therapeutic targets. As such, the clinical management of AFRS, which once included surgery and extended courses of oral corticosteroids, is transitioning away from long courses of oral corticosteroids to incorporate novel delivery mechanisms of topical therapeutic targets and biologics for recalcitrant disease.

Conclusion: AFRS is an endotype of CRS with nasal polyps (CRSwNP) for which the molecular pathways leading to its inflammatory dysfunction are beginning to be illuminated. In addition to affecting treatment options, these understandings may shape necessary changes to diagnostic criteria and the extrapolated effects of environmental changes on AFRS. More critically, a better appreciation of fungi-driven inflammatory pathways may have implications for the understanding of broader CRS inflammation.

Keywords

Humans, Allergic Fungal Sinusitis, Nasal Polyps, Inflammation, Hypersensitivity, Paranasal Sinuses, allergic, fungal, rhinosinusitis, nasal polyps, proteinase, candidalysin, antimicrobial peptides, biologics, inflammation, IL-17, IL-4, IL-13

Published Open-Access

yes

Recommended Citation

Brian H Cameron and Amber U Luong, "New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment" (2023). Faculty, Staff and Student Publications. 1887.
https://digitalcommons.library.tmc.edu/uthmed_docs/1887