Allergic fungal sinusitis is a form of nasal allergy caused by the fungal elements in the environment. This results in the formation of nasal polyps and allergic mucin. This condition also leads to nasal congestion, sinus headache and nasal discharge and other chronic symptoms that are related to sinusitis.

Fungal sinusitis is a range of diseases in the sinuses and the nose that ranges from mild to severe invasion. The allergic fungal sinusitis causes sufficient morbidity bit is not an invasive condition. It is usually seen to affect the immunocompetent people or those who have a healthy immune system unlike the other fungal sinusitis. The allergic rhinitis or asthma can also be major triggering factors. There are a number of studies that have shown that people suffering from chronic sinusitis may actually be suffering from fungal sinusitis. The common fungi that cause allergic fungal sinusitis include Alternarium, Aspergillus, Bipolaris, Curvularia, and Drechslera.

Allergic fungal sinusitis progresses in a similar manner as that of aspergillosis of lungs. When you inhale the fungal elements of the environment, your body will mount to an immune or allergic response that can result in the edema of the sinus tissue. This leads to the blocking of the sinuses by the secretions within the sinus cavity. This is the basis of development of chronic sinusitis.

The symptoms of allergic fungal sinusitis include:

• Headache

• Thick nasal discharge

• Nasal obstruction

• Congestion of the nose

• Postnasal dripping

• Facial pain might occur at times

• Cough

• Sneezing and a running nose

Another major symptom is the failure to respond to the regular treatment of sinusitis. Usually, patients with allergic rhinitis are given corticosteroid nasal sprays. When affected by allergic fungal sinusitis such patients show an initial improvement, which will diminish as soon as the treatment is stopped. There are no serious complications associated with allergic fungal sinusitis but it can definitely be irritating especially when it involves the eye.

The condition of allergic fungal sinusitis is diagnosed by a CT scan or a nasal endoscopy. This is followed by a blood test, which shows raised IgE levels and eosinophilia. Immunologic tests may also have to be performed to detect the allergens that are involved.

Antifungal drugs are not used for treating the condition and the primary treatment involves a surgery. There is a small endoscopic sinus surgery performed to remove the fungal elements that trigger the reaction. The surgery also gives good aeration to the sinuses as poor ventilation conditions affect the fungal sinusitis. With this surgery, the anatomical factor that advances to chronic sinusitis can also be corrected.

The use of topical corticosteroids as nasal spray following the surgery helps reduce the inflammation. Use of nasal douches and nasal washes along with saline after the surgery can prevent crusting. There are many patients that respond well to the immunotherapy. It is important that you go for regular follow-ups, as there are chances of recurrence of allergic fungal sinusitis.

Jason Ladock

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