Allergic Fungal Sinusitis : Causes, Symptoms, Treatment, Prognosis, Prevention

Fungus is a plant-like organism that is ubiquitous. It is present everywhere, even in the air that we breathe. Though plant-like, it is not completely a plant, as it does not have any chlorophyll. Hence, it cannot make its own food and thereby, has to depend on other dead organic matters to get its food. However, in some cases, fungus can eat living organisms.

As we breathe in air, fungus present in the air gets into the body. Usually, it cannot affect the human beings, as the natural and healthy immunity system of the body prevents them from reacting. However, if the immune system is not healthy, it can cause inflammation of the sinus and nose. The reason behind this is that they enter the body through the nostrils and as they reach the dark and damp sinus and nasal cavity, they find a natural home. Consequently, fungal sinusitis occurs. Among the various types, allergic fungal sinusitis is more common.

Fungal sinusitis can be of different types. One such type that has become quite common over the last two decades is Allergic Fungal Sinusitis or AFS. This type of fungal sinusitis occurs to those, who are allergic to certain types of fungi. The fungi belonging to the Dematiaceous family are most commonly involved in Allergic Fungal Sinusitis or AFS. Some of the particular species of fungi are –

• Bipolaris
• Alternaria
• Curvularia.

What characterizes the allergic fungal sinusitis is a thick fungal debris and mucin, which is a carbohydrate-rich glycoprotein secretion. These are developed in the sinus cavities.

As already mentioned, the major cause of Allergic Fungal Sinusitis or AFS is a family of fungi with a few species specifically more responsible. When these fungi enter the body through natural nasal respiration, the body, due to its natural immune system, tries to prevent them. This causes an allergic reaction as well as swelling of the sinus. Swelling blocks the sinus and the blocked sinus is an ideal place for these fungi to grow.

For those, who have a healthy immune system, Allergic Fungal Sinusitis is but a mild disease. They usually only get a runny nose or a blocked nose as a symptom of Allergic Fungal Sinusitis or AFS. However, those, who have a weak immune system and a serious allergic reaction to these fungi, develop certain symptoms such as –

• Facial pain
• Headaches
• Cough
• Swelling.

Apart from these symptoms of Allergic Fungal Sinusitis or AFS, which are quite obvious for any kind of sinusitis, there are certain other symptoms as well. These include –

• A solid nasal discharge in brown or green colour
• Hearing difficulties with blocked ear canals
• Sensitivity to sound
• Bad breathe due to fungal growth
• Lung problems caused by sliding of mucus in lungs.

In very rare cases, nose bone and sinuses are found to be expanded due to the disease. As a result, the eyes push forward, increasing the distance between eyes.

The common complications associated with Allergic Fungal Sinusitis are –

• Development of nasal polyps
• Obstruction of the airways in the nostrils
• Infection of the lungs caused by the post-nasal drip
• Difficulty in smelling.

Allergic fungal sinusitis is not uncommon. About 5 to 10% of all chronic rhinosinusitis patients are found to be suffering from allergic fungal sinusitis. Young immune-competent patients, who belong to the age group of 23 to 42, are seen to acquire this disease more than others. Research studies have shown that the geographical regions that are located in the high temperate zone and have relatively higher humidity are more impacted. Allergic Fungal Sinusitis or AFS is most common in young adults and adolescents.

The ratio of occurrence in male to female is 2:1 and in adults, it is 1:1.4. The mean age of diagnosis of Allergic Fungal Sinusitis or AFS is 21.9 years.

Diagnosis of allergic fungal sinusitis is very important. The doctor will start with a clinical history of the patient. Usually, the patient will have a history of Bacterial Rhinosinusitis. The patient would have gone through several antibiotic courses and topical nasal preparations. Further diagnostic tests that the doctor will perform are –

• Blood Test to Diagnose Allergic Fungal Sinusitis: To check if there is an increased level of antibody or not.
• X-ray and CT scan to Detect Allergic Fungal Sinusitis: To check for the presence of fungus and mucus in the sinus.
• Skin Test for Diagnosing Allergic Fungal Sinusitis: To check if the patient is allergic to certain fungi.
• Surgery for Allergic Fungal Sinusitis: Surgery is done to reveal the mucus in the sinus. During this, the sample of the mucus is collected to test under a microscope for the presence of any fungi.

These tests help the General Physician to determine if the condition owes to allergic fungal sinusitis or not. If it is diagnosed as allergic fungal sinusitis, the doctor will recommend a specialist for treatment.

The main focus and treatment objective is to remove the mucus as well as the fungi that have caused the allergic reaction and mucus build-up. Along with the removal, the prevention of the fungi from coming back or recurrence must also be ensured. These are done through surgeries as well as through medicines.

• Surgery to Treat Allergic Fungal Sinusitis: To remove the mucus layer and the fungi, the surgeon will use an endoscope or tube-like equipment that is connected with a camera. The tube is inserted through the nostrils and thus the mucus and fungi are pulled out. Even if the patient has polyps, this surgery can be performed.
• Medicines for Treating Allergic Fungal Sinusitis: There are a number of medicines that need to be prescribed for the patient. These are –
  • Steroid tablets to reduce the inflammation.
  • Antifungal and corticosteroid tablets that can prevent the fungus from growing.
  • Liquid antifungals should be taken through syringe to wash off the fungal growth in the nose.
  • Antibiotics are given to treat bacterial infection.
  • Steam inhalation for blockage release and saline rinse for more serious blockage.

Apart from these, recently more advanced treatment methods are being practiced in which the doctors are injecting a very little amount of dead fungi into the body of the patient. This works as an immunotherapy by building a natural resistance of the body against these fungi.

Allergic fungal sinusitis usually responds well to the treatment. Unfortunately, recurrence is not uncommon; however, with steroid therapy, usually there is a high chance that the relapse or recurrence is significantly reduced.

Immunotherapy is the best prevention method for Allergic Fungal Sinusitis. As the body builds up antibody in advance, when the actual attack occurs, there is less chance that the disease will take place.

If runny nose and breathing difficulty persists for long and usual medicines for cough and cold doesn’t seem to be of much help, it is a must that you see a doctor. The doctor will be able to diagnose the condition and refer to the best treatment option.

References:

Also Read:

• 6 Alternative Ways to Treat Sinusitis or Sinus Infection
• Ways to Get Rid of Sinus Infection (Sinusitis)
• What is Fungal Sinusitis & How is it Treated? | Type, Causes, Symptoms, and Prevention of Fungal Sinusitis