scholarly journals Immunotherapy in Allergic Fungal Sinusitis: The Controversy Continues. A Recent Review of Literature

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0045 ◽  
Author(s):  
Mary S. Doellman ◽  
Gregory R. Dion ◽  
Erik Kent Weitzel ◽  
Erika Gonzalez Reyes
Keyword(s):  
Treatment Strategies ◽  
Serum Levels ◽  
Specific Ige ◽  
High Serum ◽  
Type I ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Type Iii ◽  
Delayed Reactions ◽  
Local Reactions

Allergic fungal sinusitis (AFS), also referred to as allergic fungal rhinosinusitis (AFRS), is a noninvasive, eosinophilic form of recurrent chronic allergic hypertrophic rhinosinusitis. AFS has distinct clinical, histopathological, and prognostic findings that differentiate it from other forms of sinusitis. The core pathogenesis and optimum treatment strategies remain debated. Concerns surround the use of immunotherapy for AFS because allergen-specific immunoglobulin G (IgG) induced by immunotherapy could theoretically incite a Gell and Coombs type III (complex mediated) reaction. Type I hypersensitivity is established by high serum levels of allergen-specific IgE to various fungal antigens and positive Bipolaris skin test results. Type III hypersensitivity is established by an IgG-mediated process defined by the presence of allergen-specific IgG that forms complexes with fungal antigen inducing an immunologic inflammatory response. These reveal the multiple immunologic pathways through which AFS can impact host responses. Recent literature establishing benefits of fungal immunotherapy and no evidence of type III-mediated reactions, severe local reactions, or delayed reactions, indicate that application of AFS desensitization is a reasonable therapeutic strategy for this difficult to manage entity. Our review should encourage further clinical acceptance of AFS desensitization because the existing literature on this subject shows benefits of fungal immunotherapy and no evidence of type III-mediated reactions, severe local reactions, or delayed reactions.

Diagnosis of Allergic Fungal Sinusitis

1994 ◽  
Vol 111 (5) ◽  
pp. 580-588 ◽  
Author(s):  
John P. Bent ◽  
Frederick A. Kuhn
Keyword(s):  
Nasal Polyposis ◽  
Bone Erosion ◽  
Skin Tests ◽  
Type I ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
High Attenuation ◽  
Fungal Invasion ◽  
History Of

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilic were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive. Therefore, for the diagnosis of allergic fungal sinusitis to be established, the following criteria should be met: (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic computed tomography signs; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed during surgery. Radiographic bone erosion does not necessarily imply invasive disease, and a positive fungal culture, although desirable, is not necessary to confirm the diagnosis. Unilateral predominance of disease, a history of asthma, Charcot-Leyden crystals, and peripheral eosinophilla corroborate the diagnosis but are not always present. Perhaps because of the novelty of the disease, much misunderstanding surrounds allergic fungal sinusitis. Misdiagnosis is common, recurrence rates are high, and proper treatment remains elusive. Before proceeding with other advances, a common understanding of the diagnosis of allergic fungal sinusitis is mandatory.

scholarly journals Fungal sinusitis diagnostic management and classification

2009 ◽  
Vol 56 (3) ◽  
pp. 145-148
Author(s):  
I. Pendjer ◽  
I. Boricic ◽  
V. Arsic ◽  
Z. Dudvarski ◽  
J. Dotlic ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Diagnostic Procedures ◽  
Specific Ige ◽  
Topical Steroids ◽  
Positive Staining ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Non Invasive ◽  
Invasive Fungal Sinusitis

The aim of this paper is to present the current classification of fungal sinusitis and share our experiences in diagnostic procedures and treatment outcomes. The study includes 31 patients operated since 2000-2009. in whome some form of fungal infection had been diagnosed. There were 10 patients with mycetoma, and 16 patients with chronic non-invasive fungal sinusitis, while in five patients allergic fungal sinusitis was proven. All patients were treated postoperatively with topical steroids and irrigation with saline solution, without use of fungicides. Characteristics of chronic non-invasive funga sinusitis and mycetoma are CT with specific opacification and calcification with involement of maxillary sinus unilaterally or bilateral together with pathohistological finding of positive staining by Grocott with the identification of fungi from secret or tissue. Allergic fungal sinusitis is characterized by eosinophilia, positive skin test to fungal allergens, elevated serum level of both specific IgE antibodies to causal fungus and total IgE, as well as, pathohistological finding of allergic mucus which include non-invasive hifa. Fungal sinusitis in immunocompetent patients is classified into the following categories: mycetoma, chronic non-invasive fungal sinusitis, chronic indolent sinusitis (which does not occur in our population) and allergic fungal sinusitis.

A Review and Proposed Classification System for the No-Option Patient With Chronic Limb-Threatening Ischemia

2020 ◽  
pp. 152660282096391
Author(s):  
Tanner I. Kim ◽  
Shant S. Vartanian ◽  
Peter A. Schneider
Keyword(s):  
Treatment Strategies ◽  
Major Amputation ◽  
Occlusive Disease ◽  
Tissue Loss ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Type Iv ◽  
Foot Anatomy ◽  
Type V

A growing, but poorly defined subset of patients with chronic limb-threatening ischemia (CLTI) have “no option” for revascularization. One notable subgroup includes patients with severe ischemia and advanced pedal artery occlusive disease, termed “desert foot,” who are at high risk for major amputation due to a lack of conventional revascularization options. Although new therapies are being developed for no-option patients with desert foot anatomy, this subgroup and the broader group of no-option patients are not well defined, limiting the ability to evaluate outcomes. Based on a systematic review, a classification of the no-option CLTI patient was constructed for use in clinical practice and studies. Several no-option conditions were identified, including type I—severe and pedal occlusive disease (desert foot anatomy) for which there is no accepted method of repair; type II—lack of suitable venous conduit for bypass in the setting of an acceptable target for bypass; type III—extensive tissue loss with exposure of vital structures that renders salvage impossible; type IV—advanced medical comorbidities for which available revascularization options would pose a prohibitive risk; and type V—presence of a nonfunctional limb. While type I and type II patients may have no option for revascularization, type III and type V patients have wounds, infection, comorbidities, or functional status that may leave them with few options for revascularization. As treatment strategies continue to evolve and novel methods of revascularization are developed, the ability to identify no-option patients in a standardized fashion will aid in treatment selection and assessment of outcomes.

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

2007 ◽  
Vol 21 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Jean Jacques Braun ◽  
Gabrielle Pauli ◽  
Philippe Schultz ◽  
André Gentine ◽  
David Ebbo ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Skin Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Oral Corticosteroids ◽  
Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

Increased serum concentrations of type I procollagen C-terminal propeptide and osteocalcin during a short course of calcitriol administration to adult male volunteers

1991 ◽  
Vol 125 (6) ◽  
pp. 609-613 ◽  
Author(s):  
Jeppe Gram ◽  
Jens Bollerslev ◽  
Henning K. Nielsen ◽  
Peter Junker
Keyword(s):  
Serum Concentration ◽  
Serum Levels ◽  
Bone Collagen ◽  
Type I ◽  
Type Iii ◽  
Procollagen Type ◽  
Short Course ◽  
Procollagen Type I ◽  
Serum Hyaluronan ◽  
Healthy Males

Abstract. To investigate bone collagen metabolism during vitamin D treatment, 15 healthy males (aged 28-45 years, median 34) were treated orally with calcitriol, 2 μg daily for 7 days and followed for a total of 2 weeks. The serum concentration of calcitriol rose markedly (median difference and 95% confidence limits: 49% (5-82), p<0.005) during treatment, whereas serum levels of calcidiol, and calcium remained unchanged. The serum level of procollagen type I C-terminal propeptide rose 15% (7-33, p<0.003), whereas no alterations were observed concerning serum procollagen type III N-terminal propeptide, and serum hyaluronan. The serum concentration of osteocalcin rose concomitantly (26% (12-45), p<0.003). All values returned to baseline levels within seven days after the treatment week. The serum levels of osteocalcin and procollagen type I C-terminal propeptide were positively correlated (rs=0.71, p<0.004) during the study. Serum procollagen type I C-terminal propeptide and serum osteocalcin did not correlate with serum procollagen type III N-terminal propeptide or serum hyaluronan either at baseline or after treatment. It is concluded that a short course of calcitriol administration to healthy males stimulates the biosynthesis of bone-related matrix proteins. By contrast, connective tissue components of predominantly extraosseous origin are not affected.

High Levels of Growth Differentiation Factor 15 in Patients with Congenital Dyserythtopoietic Anemia Type I

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3456-3456
Author(s):  
Hannah Tamary ◽  
Hanna Shalev ◽  
Galit Avraham ◽  
Meira Zoldan ◽  
Itai Levi ◽  
...  
Keyword(s):  
Transferrin Receptor ◽  
Elevated Serum ◽  
Serum Levels ◽  
High Serum ◽  
Type I ◽  
Soluble Transferrin Receptor ◽  
Ineffective Erythropoiesis ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
A Minor

Abstract Growth differentiation factor 15 (GDF15) is a member of the TGF-beta superfamily of cytokines previously found to suppress hepcidin in primary human hepatocytes. GDF15 is secreted from human erythroblasts, and extremely high serum levels are present in β-thalassemia patients (Tanno et al., Nat. Med. 2007, 13, 1096–1101). To determine if elevated GDF15 levels are unique for thalassemia or more generally associated with iron-loading related to ineffective erythropoiesis, we determined the GDF15 levels, as well as, serum hepcidin (Swinkels DW et al, PLoS ONE PLoS ONE. 2008;3:e2706), ferritin, erythropoietin (EPO) and soluble transferrin receptor (sTfR) in patients with the congenital dyserythropoietic anemia type I (CDA I). Seventeen Israeli Bedouins with CDA I were studied, all homozygous for the founder R1040W mutation in the CDAN1 gene. All of the patients studied were young adults with a mean age of 29 years. Two patients previously underwent splenectomy, and one patient is currently transfusion-dependent. For comparison, ten healthy volunteers (HV) were studied. The mean level of GDF15 in CDA I patients was significantly elevated [10,239 ± 3,049 pg/ml (range 5,530–17,008) compared to 269 ± 238 pg/ml in healthy controls; p = 1.5×10−10]. Consistent with a previous study of dyserythropoietic anemia patients, significantly higher levels of soluble transferrin receptor were detected among the CDA I population (sTfR; CDA I, 86.4 ± 14.0 nmol/L; HV, 21.4 ± 6.2 nmol/L, p = 7.4×10−15). Serum EPO levels were also elevated (EPO; CDA I, 118 ± 59 IU/dL; HV, 2.0 ± 1.5 IU/dL, p = 2.3×10−7). For iron analyses, three patients with extensive transfusion histories were excluded. Among the remaining 14 patients, iron overload was demonstrated by elevated serum ferritin (CDA I, 916 ± 507 ng/ml; HV, 72 ± 60 ng/ml, p = 1.4×10−5). Despite the significant elevation in iron stores, significantly elevated levels of hepcidin 25 (Hep25) were not detected in the CDA I patients. Instead, a minor decrease in serum Hep25 levels were detected (Hep25; CDA I, 3.3 ± 2.8 nM; HV, 4.1 ± 3.0 nM, p = 0.27). Correlation analyses were performed between the iron parameters (Ferritin and Hep25) and GDF15, sTfR, or EPO levels. Only GDF15 demonstrated a significant positive correlation with ferritin and significant inverse correlations with Hep25 and the Hep25/Ferritin ratio. Weaker correlations with EPO were identified. Unexpectedly, the correlation trends for sTfR were opposite those of GDF15 in this group. These results demonstrate that GDF15 is immensely over-expressed in CDA I, and further suggest this cytokine contributes to hepcidin dysregulation and secondary hemochromatosis in humans with ineffective erythropoiesis.

scholarly journals Hepatitis C Virus (HCV)-Related Cryoglobulinemia: Cryoglobulin Type and Anti-HCV Profile

2013 ◽  
Vol 20 (5) ◽  
pp. 698-703 ◽  
Author(s):  
Martha Minopetrou ◽  
Emilia Hadziyannis ◽  
Melanie Deutsch ◽  
Maria Tampaki ◽  
Asimina Georgiadou ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Laboratory Data ◽  
High Serum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Serum Igg ◽  
Serum Igg Levels

ABSTRACTCryoglobulin characteristics in chronic hepatitis C (CHC) might be of importance for knowing more about the pathogenesis and treatment of the disease. We aimed to investigate the relationship between cryoglobulin types and their specificity against hepatitis C virus (HCV) antigenic epitopes in CHC patients. We analyzed samples from 43 patients with HCV-associated cryoglobulinemia, of whom 4 had concomitant lymphoma. Cryoglobulins were measured, purified, typed by immunofixation electrophoresis, and tested for IgG and IgM anti-HCV antibodies by immunoblot analysis and an enzyme-linked immunosorbent assay (ELISA). Clinical and other laboratory data were recorded. The median cryocrit level of the tested samples was 6%. Type I cryoglobulins were detected in 9.3% (4/43) of the cryoprecipitates, and type II cryoglobulins were detected in 48.8% (21/43) of the cryoprecipitates. IgM monoclonal protein, mainly IgM(κ), was found in 92% (23/25) of type I and II cryoprecipitates. Type III cryoglobulins were identified in 41.9% (18/43) of the patients and were associated with high blood serum IgG levels. In 81.3% (13/16) of type II and 92.3% (12/13) of type III cryoglobulins, there was IgG reactivity against the viral core region. Ninety-two percent and 32% of IgG anti-HCV core-positive cryoprecipitates had additional specificities against the NS3 and NS4 regions, respectively. Also, IgM anti-HCV antibodies were detected in 31% of the cryoprecipitates. In conclusion, all types of cryoglobulins were found in patients with HCV-associated cryoglobulinemia, with type II being the most frequently identified. Type III cryoglobulins were common and were associated with high serum IgG levels. HCV-related cryoglobulins demonstrated IgM, and particularly IgG, anti-HCV specificities, mainly against the core and NS3 epitopes.

scholarly journals The Relationship between Calcaneal Spur Type and Plantar Fasciitis in Chinese Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Lei Zhang ◽  
Han-wen Cheng ◽  
Lu-jing Xiong ◽  
Zhang-rong Xia ◽  
Meng-yao Zhang ◽  
...  
Keyword(s):  
Chinese Population ◽  
Plantar Fasciitis ◽  
Treatment Strategies ◽  
Common Disease ◽  
Type I ◽  
X Rays ◽  
Type Ii ◽  
Type Iii ◽  
Vas Scores ◽  
The Relationship

Plantar heel pain is a common disease with a high incidence in different races. It significantly reduced the quality of life of patients. However, the cause of PHP is still controversial and there were varieties of physiological factors associated with PHP. The most common pathological factor in the population was plantar fasciitis. Some existing research studies had found a correlation between calcaneal spurs and plantar fasciitis, and this study had found the correlation in Chinese population. It is invaluable not only to understand the relationship between different types of plantar calcaneal spurs and plantar fasciitis but also to identify the most appropriate treatment strategies. A total of 71 patients with calcaneal spurs were chosen from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. All 71 patients had completed X-rays and MRI scans; then, surgeons had removed their plantar calcaneal spurs. After surgery, all patients were followed up for 12 months; their prognosis was tested by the VAS and AOFAS scores. Type II (29, 40.8%) had the highest incidence in Chinese population, followed with type I (24, 33.8%) and type III (18, 25.4%). Preoperative VAS scores showed that type II (7.72±1.10) was significantly higher than the other two types (P<0.001). Postoperative VAS scores of type II were higher than those of type I and type III (P<0.001). Postoperative AOFAS scores of type II were the lowest (P<0.001). Researchers had proved that type II was more likely to cause PF.

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