Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis☆,☆☆,★,★★,♢
Section snippets
METHODS
Patients with AFS were either referred perioperatively by various otolaryngologic surgeons or were diagnosed during the course of medical management for allergic respiratory disease. All patients suspected of having AFS therefore had undergone the study—entering sinus surgery just before or early during the course of our initial evaluation. The diagnosis of AFS was made in 67 consecutive patients over 8 years from 1 Allergy and Immunology practice (M.S.S.), and each had been subsequently
RESULTS
Sixty-seven patients with AFS initially were seen, as described in the Methods section. Four histopathologic criteria for the diagnosis of AFS are described in Table I; all criteria had to be met for the diagnosis of AFS. First, allergic mucin from the sinus surgery specimen was present either microscopically on the H&E stain, on gross inspection at surgery, or both. Second, either a positive silver stain for fungal hyphae was manifested in the allergic mucin and/or the surgical fungal culture
DISCUSSION
AFS is increasingly being recognized as a complicating feature of hypertrophic rhinosinusitis. Although other cases of fungal sinusitis have been reported, consistent differentiation of AFS from all other forms of fungal sinusitis has only recently been scrutinized.
Our large database of 67 consecutive patients has allowed a more thorough demographic and diagnostic analysis of AFS than has previously been published. Several conclusions can be drawn from the current clinical series. Patients with
Acknowledgements
We wish to acknowledge the assistance and laboratory skills of Bonnie Whisman, MS, and Mary Fust, LPN. We thank Peter Nutley, MD, Joseph Spataro, MD, Michael Reid, MD, and Edward Chu, MD, for helpful discussions and the staff of the Allergy Asthma Clinic.
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From athe Allergy Asthma Clinic, Phoenix; and bthe Department of Allergy-Immunology, Wilford Hall Medical Center, Lackland AFB.
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Supported in part by the US Air Force.
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The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the US Government.
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Reprint requests: Mark S. Schubert, MD, PhD, Allergy Asthma Clinic, 31 W Camelback Road, Phoenix, AZ 85013.
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