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Immunotherapy for allergic fungal sinusitis

Hall, Ashley G.; deShazo, Richard D.

Current Opinion in Allergy and Clinical Immunology: December 2012 - Volume 12 - Issue 6 - p 629–634
doi: 10.1097/ACI.0b013e328357a233
IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush

Purpose of review Allergic fungal sinusitis (AFS) results from an immunoglobulin E (IgE)-mediated, eosinophil-predominant hypersensitivity reaction to extramucosal fungi within the paranasal sinuses. Although the pathogenesis of this noninvasive process is still not fully understood, there is new information. Recently, the use of allergen immunotherapy with fungal antigens as an adjunct in treatment of AFS has been evaluated. In this review, we summarize the experience in the published literature on the topic.

Recent findings There is evidence to suggest that allergen immunotherapy to fungal allergens may be effective in the treatment of symptoms of AFS and may decrease the rate of postoperative exacerbations and further operations. There is no evidence that this therapy induces immune complex disease. These studies pave the way for controlled trials of immunotherapy in patients with AFS.

Summary Allergen immunotherapy to fungi shows promise as a treatment to decrease the recurrence of AFS and should be considered a part of the treatment regimen. However, because the number of patients treated has been small and one study suggested that fungal immunotherapy administered before removal of fungal contents from the sinuses could worsen sinusitis, controlled studies are essential to moving forward.

Departments of Medicine and Pediatrics, Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, Jackson, Mississippi, USA

Correspondence to Richard D. deShazo, MD, Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216–4505, USA. Tel: +1 601 984 5600; fax: +1 601 984 5608; e-mail:

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