Allergic Fungal Rhinosinusitis

The humidity plus many of the urban environments that Atlanta provides is ripe for producing allergic fungal rhinosinusitis (AFRS).  In fact the southeast United States has the highest rate of fungal sinus conditions in the world.
Allergic fungal sinusitis is type of sinusitis caused by an abnormal response to otherwise “normal” fungi in the environment.  Each day we breathe in hundreds of thousands of fungal spores.  Our nose’s function is try and trap most of these before entering the lungs.  Occasionally, due to reasons we don’t fully understand, some of these fungi are allowed to set up shop and grow in the sinuses much like a vine grows on a tree.  The body’s vigorous response to the fungus often causes more problem than the fungus itself, leading to bone remodeling and production of thick mucous secretions.  Sometimes bone thinning can be so great that the bone of the skull base or eye socket disappears, allowing for the sinusitis to begin to spread into the brain and eyes.
While surgery is usually needed up front to control the most severe disease, long term management of the excessive inflammation is mandatory to limit recurrences.  Usually this involves frequent steroid rinses or sprays, occasional systemic steroids, and often allergy immunotherapy to limit the body’s response to the fungus.  Sometimes anti-fungal medications are used as well, but again usually the problem is more the fault of the immune system’s hypersensitivity than the fungus itself.
Of course environment plays a big role too.  In an upcoming post we’ll discuss the various environment controls we have found most helpful.