The diagnosis and incidence of allergic fungal sinusitis

Objective: To reevaluate the current criteria for diagnosing allergic funga l sinusitis (AFS) and determine the incidence of AFS in patients with chron ic rhinosinusitis (CRS), Methods: This prospective study evaluated the incidence of AFS in 210 conse cutive patients with CRS with or without polyposis, of whom 101 were treate d surgically. Collecting and culturing fungi from nasal mucus require speci al handling, and novel methods are described. Surgical specimen handling em phasizes histologic examination to visualize fungi and eosinophils in the m ucin, The value of allergy testing in the diagnosis of AFS is examined. Results: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 c onsecutive surgical cases of CRS, Allergic fungal sinusitis was diagnosed i n 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathol ogic findings and culture results. Immunoglobulin E-mediated hypersensitivi ty to fungal allergens was not evident in the majority of AFS patients. Conclusion: The data presented indicate that the diagnostic criteria for AF S are present in the majority of patients with CRS with or without polyposi s. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.