ROLE OF IMMUNOTHERAPY IN LONG TERM MANAGEMENT OF    ALLERGIC FUNGAL RHINOSINUSITIS, AN INSTITUTIONAL STUDY

OBJECTIVE: To measure alterations in SPA1, A2, and D gene expression in various forms of inflammatory chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: Sinus mucosal biopsies were performed in patients with allergic fungal rhinosinusitis (AFS), CRS with nasal polyposis, cystic fibrosis (CF), and controls. SP mRNA was measured with quantitative polymerase chain reaction. RESULTS: Patients with CF (n = 4) showed significantly increased SPA1 (82-fold), SPA2 (100-fold), and SPD (47-fold) mRNA ( P < 0.05) when compared with controls (n = 5). Patients with CRS with nasal polyposis (n = 5) also demonstrated elevated SPA1 (27-fold), SPA2 (13-fold), and SPD (13-fold). Patients with AFS (n = 7) had increased SPA1 (5-fold), SPA2 (9-fold), and SPD (17-fold), but were not statistically significant. CONCLUSION: SPA1, A2, and D are upregulated in various forms of CRS, but are significantly elevated in cystic fibrosis CRS. SIGNIFICANCE: Understanding the role of SPs in CRS will help develop novel treatment approaches for sinonasal pathoses.

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Evaluation of the Role of Immunotherapy in Allergic Fungal Rhinosinusitis

10.51429/ejmm30315 ◽

2021 ◽

Vol 30 (3) ◽

pp. 111-117

Author(s):

Ghada A. Mokhtar ◽

Sylvia W. Roman ◽

Aya M. Elgendy ◽

Marian A. Gerges ◽

Alsayed Abdulmageed ◽

...

Keyword(s):

Endoscopic Examination ◽

Type I ◽

Fungal Culture ◽

Total Ige ◽

Prick Test ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Fungal Allergens ◽

Type I Hypersensitivity

Background: Allergic fungal rhinosinusitis (AFRS) is a distinct form of chronic rhinosinusitis. Type I hypersensitivity to inhaled fungal allergens has been implicated as key pathogenesis. Immunotherapy as one of the therapeutic options is still controversial. Objective: to evaluate the role of immunotherapy in the management of AFRS patients not responding to medical treatment 3 months following endoscopic surgery. Methodology: A total of 35 patients diagnosed as resistant AFRS were included in this prospective study. Patients were diagnosed following clinical, radiological, and endoscopic examination of nose and paranasal sinuses. Specimens were collected during endoscopy and subjected to microscopic examination and fungal culture. Skin prick test and assessment of total IgE level were performed for all patients. Sublingual immunotherapy (SLIT) was initiated for all patients for 6 months. Clinical efficacy of SLIT was assessed using the 20-item sino-nasal outcome test (SNOT-20) score. Results: Aspergillus spp. was the most frequent fungus isolated (74.3%) from patients. All patients were sensitized to mixed fungi. Elevated total IgE (> 100 IU/mL) was found in all patients with 40% of them had peripheral eosinophilia. A significant improvement (p < 0.001) was recorded in the SNOT-20 score of examined patients recording a mean of 1.2 ± 0.3, 6 months after SLIT compared to 1.93 ± 0.44 before immunotherapy initiation. Conclusion: Immunotherapy appears to be a good adjunctive therapy for the management of resistant cases of AFRS.

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The role of clay, organic carbon and long-term management on mouldboard plough draught measured on the Broadbalk wheat experiment at Rothamsted

Soil Use and Management ◽

10.1111/j.1475-2743.2006.00054.x ◽

2006 ◽

Vol 22 (4) ◽

pp. 334-341 ◽

Cited By ~ 47

Author(s):

C. W. Watts ◽

L. J. Clark ◽

P. R. Poulton ◽

D. S. Powlson ◽

A. P. Whitmore

Keyword(s):

Organic Carbon ◽

Mouldboard Plough ◽

Term Management

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*Poster 123: Long-Term Management of Health and Social Participation in Rehabilitation Population: Role of a Nurse Case Manager

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2010.07.152 ◽

2010 ◽

Vol 91 (10) ◽

pp. e42

Author(s):

Cynthia Gagnon ◽

Maud-Christine Chouinard ◽

Francois Champagne ◽

Melissa Lavoie

Keyword(s):

Social Participation ◽

Case Manager ◽

Nurse Case Manager ◽

Term Management

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Allergic Fungal Rhinosinusitis Involving Frontal Sinus: A Prospective Study comparing Surgical Modalities

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1141 ◽

2013 ◽

Vol 6 (1) ◽

pp. 10-15

Author(s):

AK Gupta ◽

Rijuneeta LNU ◽

H Verma ◽

A Chakrabarti

Keyword(s):

Prospective Study ◽

Frontal Sinus ◽

Long Term Results ◽

Distinct Advantage ◽

Postoperative Results ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Group I ◽

A Prospective Study

ABSTRACT Allergic fungal rhinosinusitis (AFRS) represents a hypersensitivity response to extramucosal fungi within the sinus cavity without evidence of tissue invasion. AFRS is characterized by fungal element with allergic mucin, Charcot-Leyden crystals, type I hypersensitivity, bony erosion with sinus infection on computed tomographic (CT) scan. Surgery remains the treatment of choice for AFRS followed by prolonged steroid therapy. Surgical approaches for frontal sinus disease can be either endonasal endoscopic or external. This is a nonrandomized prospective study, where the postoperative results of endoscopic frontal sinusotomy were compared with external frontoethmoidectomy approach. This is a nonrandomized prospective study, where the postoperative results of endoscopic frontal sinusotomy were compared with external frontoethmoidectomy approach. The comparison between external frontoethmoidectomy and endoscopic approach was done by using Chi-square test. There was no statistical significant difference found, when postoperatively clinical symptoms, radiology and investigations in patients of both the groups were compared. The success rate was 95.5% in group I and 91.1% after 6 months of follow-up. The world literature lacks prospective studies where attempts are made to compare the long-term results of both the surgical modalities for AFRS patients. Endoscopic endonasal approach has a distinct advantage over the external frontoethmoidectomy approach as it minimizes external scars over the face with almost equal or better long-term results. How to cite this article Verma H, Rijuneeta, Gupta AK, Chakrabarti A. Allergic Fungal Rhinosinusitis Involving Frontal Sinus: A Prospective Study comparing Surgical Modalities. Clin Rhinol An Int J 2013;6(1):10-15.

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