EVALUATION AND TREATMENT OF ALLERGIC FUNGAL SINUSITIS - I - DEMOGRAPHICS AND DIAGNOSIS

Background: Pew eases of allergic fungal sinusitis have been systemati cally evaluated to conclusively confirm working clinical, histopatholo gic, and serologic diagnostic criteria. Objectives: The objective of t his study was to describe 67 consecutive cases of allergic fungal sinu sitis, the largest number of cases Set published. Methods: Cases from 1 practice over 8 years were evaluated with a consistent protocol, inc luding skin testing, serum chemistries and serologies, and surgical sp ecimen analysis. Results: All patients were atopic (100%) and had nasa l polyposis (100%). They tended to be young (33.3 +/- 13.1 years, mean +/- SEM), immunocompetent (92%; remaining 8% with low quantitative im munoglobulin but normal function), have slight female preponderance (5 8%), have a history of hypertrophic rhinosinusitis (100%), report nasa l cast production (75%), and have developed their disease in the south western United States. Bipolaris spicifera was the most prevalent fung us involved (67%). Total serum IgE (mean 668 IU/mL) and fungal-specifi c Ige were generally elevated, whereas fungal-specific precipitins and specific IgE were generally negative despite positive fungal-specific immediate hypersensitivity skin tests. Conclusions: Patients with all ergic fungal sinusitis tend to have elevated total serum IgE and funga l-specific IgG at diagnosis but not fungal-specific IgE or precipitins , Histopathologic criteria for allergic fungal sinusitis diagnosis are discussed. The southwestern United States appears to be a ''hot spot' ' for the disease, particularly caused by B spicifera.