Allergic Fungal Rhinosinusitis: Recent Findings on Immunotherapy - Essay Sample

Purpose of Review

Allergic fungal Rhinosinusitis is a disease with no definitive form of treatment. It is a fungal sinus infection, and the fungi are present around the environment. Recent findingsImmunotherapy shows good progress in treating the symptoms of Allergic fungal Rhinosinusitis. The symptoms include the following. It blocks the infected sinus, causes sticky mucus, and is characterized by thick fungal debris. It causes asthma, nasal polyps, or other forms of allergies, and it leads to chronic sinusitis. When a patient has this condition, their sense of smell is interrupted, and worse cases cause a lack of vision and displace the eyeball. Surgery is more effective than most forms of treatment of the disease and is less likely to recur.

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Summary

Immunotherapy has been used extensively, but there is a concern of systematic hypersensitivity after the use of a high dose in a patient with allergic fungal Rhinosinusitis. It is important to use immunotherapy effectively to prevent any concerns of further reaction or recurrence of the disease. The objective of this paper is to show the effectiveness of immunotherapy on Allergic fungal Rhinosinusitis.

Effectiveness of Immunotherapy in Allergic fungal RhinosinusitisIntroduction

The best treatment for Allergic Fungal Rhinosinusitis does not exist as there are several ways, and patients react differently. Allergic Fungal Rhinosinusitis may cause hypersensitivity, and its pathophysiology is still up for debate. Allergic Fungal Rhinosinusitis is everchanging, and it is classified into threes granulomatous invasive, chronic invasive and acute necrotizing. The non-invasive classification is allergic, fungal and mycetoma. Allergic Fungal Rhinosinusitis is unique from other sinusitis prognostically, histopathologically and clinically, yet it has a high probability of recurrence, and it is mostly non-invasive. Allergic Fungal Rhinosinusitis is diagnosed in a five-stage process. First, the paranasal tissues are opacified. Next, the specific sinus is eroded and expanded. Unenhanced CT scans are then performed to scatter areas that are highly attenuated with thickening if the mucosal. Culture is performed to determine the hypersensitivity on nasal polyposis and also on non-tissue mucus.

Discussion

Effectiveness of Immunotherapy in Allergic fungal RhinosinusitisDifferent types of allergies cause different degrees of reaction in people. Immunotherapy is a useful treatment method to treat different forms of allergies. Immunotherapy works by increasing the content of allergens that the individual is allergic to gradually (1). This method makes the immune system of the individual to be less reactive to the allergens as their bodies produce a type of antibody blocks the reactions (2). It consequently minimizes the degree of allergic reaction that the individual suffers in the future and the inflammation that can be present as asthma or rhinitis.

As a patient considers immunotherapy, it is crucial to identify the specific allergens causing the reaction. It is done by performing skin or blood tests to identify the antibodies present as a result of the allergens. Immunotherapy is best if the condition of reaction is severe, or they are only reactive to specific allergens (3). For Allergic Fungal Rhinosinusitis, the first trial of immunotherapy is done for six months to determine where the immune reaction is from the administered fungal antigens and whether they are positive or negative. After six months after determining whether the antigens that the patient is allergic to are fungal or non-fungal, the specific ones are used for treatment (4). It is essential to administer both fungal and non-fungal antigens separately during the first six months to determine the cause of the reaction. When the allergic reactions can be maintained, both fungal and non-fungal antigens can then be combined (5).

There is a misconception that only the identified type of fungi from culturing the allergic fungal mucin can only be the only one used for treatment. Not all patients get a positive culture, and it depends mostly on the state of the laboratories where it was done (6). The diagnosis of Allergic Fungal Rhinosinusitis does not also depend on the presence of fungi from the culturing process. It is best if different typed of molds are utilized during testing, and the best ones are chosen depending on the common Allergic Fungal Rhinosinusitis cases in the area and the experience of the doctor performing the tests (7). During the treatment, they should involve positive reactors.

Types of immunotherapy can include allergy shots; allergy drops and allergy tablets. Allergy shots are the most common ones, and it has a huge impact in changing the immune system making it possible to prevent other allergies (8). Allergy tablets are used for specific types of allergies and are different from allergy shots as they help the body develop resistance to allergens, consequently reducing symptoms. Allergy tablets, however, do not prevent other types of allergies or the development of asthma (9). Allergy drops are forms of allergy tablets, but they are rarely used, especially in the United States, as it requires approval.

Pathogenesis of Allergic Fungal Rhinosinusitis mainly utilizes fungal hypersensitivity, but it is controversial. It is because its pathogenesis uses techniques of eosinophilic mucin Chronic Rhinosinusitis. Culturing Allergic Fungal Rhinosinusitis fungus has a success rate starting from 50%. It is, however, difficult to determine whether they represent either the causative agents or the nonpathogenic flora (10). It is less risky to identify pathogens in the nose than commensurate organisms with the application of old techniques. It is believed that Allergic Fungal Rhinosinusitis originates from certain smaller categories of fungi, yet they are not easily cultured. It makes it difficult to determine the effectiveness of implementing immunotherapy to treat Allergic Fungal Rhinosinusitis (11). Previous research shows that there is an incomplete eosinophilic sinusitis spectrum and is dependent on the criteria by Bent and Kuhn of nasal polyposis with chronic bacterial Rhinosinusitis. They all stimulate the response of Th2 and may increase eosinophilic inflammation (12).

Apart from the culturing methods, there are no antigens to detect the organisms that are suspected of causing Allergic Fungal Rhinosinusitis, and it complicates the determination of the effectiveness of immunotherapy on Allergic Fungal Rhinosinusitis (13). Mold extracts are found commercially, but they all lack sufficient allergen. Allergen extracts are produced from materials of primary cultures, and they are stored to maintain the integrity of the product. The manufacturers can choose their way of choosing fungi stains (14). Manufacturers have exceptions as some fungi are difficult to stage.

Most knowledge on the effectiveness of immunotherapy to treat Allergic Fungal Rhinosinusitis is dependent on its success on allergic broncho-pulmonary aspergillosis or ABPA. It is present in the allergic bronchial mucin, and it is more in fungal serum specific immunoglobin E and immunoglobin G. Allergic Fungal Rhinosinusitis is found in the same areas of the sinus-allergic mucin and is high in fungal specific serum immunoglobin G in the majority of patients with hypertrophic sinus disease (15). Previous analysis of immunohistology shows that there is an increase in an allergic response in patients that have strong immunity and is associated with the toxicity of the neutrophil elastase, which is a basic protein of the eosinophilic granule. A previous study shows that Allergic Fungal Rhinosinusitis patients have fungal antigens that stimulate their peripheral blood mononuclear cells secreting Th2-type cytokines (16). It shows that Allergic Fungal Rhinosinusitis affects humoral immune factors. Bipolaris skin test results show high levels of allergen-specific immunoglobin E serum more than any fungal antigens. It shows that immunotherapy is important to control the inflammatory response in a patient with Allergic Fungal Rhinosinusitis (17). Apart from the response of the immunoglobin E, there is other fungal sinusitis with the same hypersensitivity. The use of immunotherapy for Allergic Fungal Rhinosinusitis is, however, controversial because it may trigger a Gell and Coombs type III reaction due to the presence of allergen-specific immunoglobin G. It is evident as patients with Allergic Fungal Rhinosinusitis get anxiety in the early stages of application of immunotherapy (18). Allergic Fungal Rhinosinusitis required desensitization of allergens before clinical safety was determined. Immunotherapy may not be as efficient because it may worsen symptoms, especially if the patient has not been through surgery (19).

Experience with allergen immunotherapy for Fungal sinusitisA previous study on immunotherapy on nine patients with Allergic Fungal Rhinosinusitis for 12 months over four years shows the effectiveness of immunotherapy (20). The patients' experience decreased allergic mucin, polyp recurrence and nasal crusting. No patient shows any reactions related to the immune complex. The antigen used for immunotherapy of Allergic Fungal Rhinosinusitis was Bi-Polaris, which is the most suitable one available commercially. After two years, immunotherapy included non-fungal antigens (22). Two patients suffer a recurrence of the disease, and they are administered with systemic steroids, and they have to undergo surgery. Immunotherapy continues fine throughout, and the administration of systemic steroids is reduced over time (23). After three years before seven months of the conclusion of immunotherapy, three patients are used as controls, and they are discontinued from the treatment. Out of all the patients, only two required further administration of systemic steroids (24). The patients used as controls suffered worsening conditions, and they needed administration of oral steroids (25). They show changes in allergen-specific immunoglobin E, which increases and decreasing and inconsistent immunoglobin G. After 17 months of discontinuation; the patients did not show signs of fungal casts, allergic mucin or recurring polyps. The above study is the famous one by Mabry.

Patients Duration

The patients' experience decreased allergic mucin, polyp recurrence and nasal crusting. No patient shows any reactions related to the immune complex.22 yearsRecurrence of the disease, and they are administered with systemic steroids, and they have to undergo surgery. Immunotherapy continues fine throughout, and the administration of systemic steroids is reduced over time33 yearsthree patients are used as controls, and they are discontinued from the treatment. Out of all the patients, only two required further administration of systemic steroids. The patients used as controls suffered worsening conditions, and they needed administration of oral steroids. They show changes in allergen-specific immunoglobin E, which increases and decreasing and inconsistent immunoglobin G. After 17 months of discontinuation; the patients did not show signs of fungal casts, allergic mucin or recurring polyps.After the 1990s, there has been a noticeable gap in studies about the treatment of Allergic Fungal Rhinosinusitis by immunotherapy. It is mainly because Mabry's study does not show the major benefits of using immunotherapy as a form of treatment but only shows the result of its effectiveness. It does not also cover long term effectiveness of immunotherapy as the study only lasts four years. The study by Mabry also utilizes the immunotherapy techniques that only use end-point titration. Currently, the practice of immunotherapy uses more potent allergens than before (26). However, it has scared off researchers who f...