Chronic Sinusitis Studies – Strong Evidence Of Fungi

The Mayo Clinic determined in 1999 that sinusitis treatments for bacteria or “allergies” were inappropriate because the problem is fungi related. Following their studies others corroborated the Clinic’s findings. Below are three publications on the subject. [The highlights are mine.]

Best of Health,

DD

http://findarticles.com/p/articles/mi_m0ISW/is_268/ai_n15788180

Is sinusitis caused by allergy to fungus?

Townsend Letter for Doctors and Patients,  Nov, 2005  by Alan R. Gaby

Two hundred-ten consecutive patients with chronic sinusitis, of whom 101 were treated surgically, were studied. Fungal cultures of nasal secretions were positive in 202 (96%) of the patients. Candida albicans was cultured in 15.4% of patients, Alternaria in 44.3%, Penicillium in 43.3%, Cladosporium in 39%, and Aspergillus spp. in 29.5%; a wide range of other organisms were cultured less frequently. Allergic mucin (containing clusters or sheets of degenerating eosinophils) was found in 97 (96%) of the 101 surgical cases. Fungal elements (hyphae, destroyed hyphae, conidiae, and spores) were found histologically in 82 (81%) of the 101 surgical specimens. Allergic fungal sinusitis was diagnosed in 94 (93%) of the 101 surgical cases, based on histopathologic findings and culture results. An elevated IgE level to at least one fungal species was found in only 28% of 95 patients tested, and skin-prick tests were positive to at least one fungal allergen in only 25% of 179 patients tested.

Comment: The results of this study suggest that, among patients with chronic sinusitis, allergy to common airborne fungi appeared to be a causative factor in at least 93% of cases. Conventional tests for fungal allergy (e.g., IgE levels and skin-prick tests) failed to detect fungal allergy in the majority of patients with allergic fungal sinusitis. The research group that performed this study subsequently demonstrated that patients with chronic sinusitis have an exaggerated immune response to airborne fungi (J Allergy Clin Immunol 2004;114:1369-1375). They have also reported, in open (J Allergy Clin Immunol 2002; 110:862-866) and double-blind (J Allergy Clin Immunol 2005; 115:125-131) trials, that intranasal administration of the antifungal drug amphotericin B resulted in clinical improvement and a reduction in mucosal thickening. In the open trial, of 51 patients treated, 75% improved and 35% became disease-free.

In my experience, some patients with chronic sinusitis show marked improvement after identifying and avoiding allergenic foods. A few patients have shown a dramatic response to intravenous nutrient therapy (the Myers' cocktail; see Altern Med Rev 2002;7:389-403).

Ponikau JU, et al. The diagnosis and incidence of allergic fungal sinusitis. Mayo Clin Proc 1999;74:877-884.

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group

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http://www.sciencedaily.com/releases/1999/09/990910080344.htm
 

Source: Mayo Clinic - September 10, 1999

Mayo Clinic Study Implicates Fungus As Cause Of Chronic Sinusitis

Science Daily — "We can now begin to treat the cause of the problem instead of the symptoms"

ROCHESTER, MINN. -- Mayo Clinic researchers say they have found the cause of most chronic sinus infections -- an immune system response to fungus. They say this discovery opens the door to the first effective treatment for this problem, the most common chronic disease in the United States.

An estimated 37 million people in the United States suffer from chronic sinusitis, an inflammation of the membranes of the nose and sinus cavity. Its incidence has been increasing steadily over the last decade. Common symptoms are runny nose, nasal congestion, loss of smell and headaches. Frequently the chronic inflammation leads to polyps, small growths in the nasal passages which hinder breathing.

"Up to now, the cause of chronic sinusitis has not been known," say the Mayo researchers: Drs. David Sherris, Eugene Kern and Jens Ponikau , Mayo Clinic ear, nose and throat specialists. Their report appears in the September issue of the journal Mayo Clinic Proceedings.

"Fungus allergy was thought to be involved in less than ten percent of cases," says Dr. Sherris. "Our studies indicate that, in fact, fungus is likely the cause of nearly all of these problems. And it is not an allergic reaction, but an immune reaction."

The researchers studied 210 patients with chronic sinusitis. Using new methods of collecting and testing mucus from the nose, they discovered fungus in 96 percent of the patients' mucus. They identified a total of 40 different kinds of fungi in these patients, with an average of 2.7 kinds per patient.

In a subset of 101 patients who had surgery to remove nasal polyps, the researchers found eosinophils (a type of white blood cell activated by the body's immune system) in the nasal tissue and mucus of 96 percent of the patients.

The results, the researchers say, clearly portray a disease process in which, in sensitive individuals, the body's immune system sends eosinophils to attack fungi and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation.

"This a potential breakthrough that offers great hope for the millions of people who suffer from this problem," says Dr. Kern. "We can now begin to treat the cause of the problem instead of the symptoms."

More research is underway at Mayo Clinic to confirm that the immune response to the fungus is the cause of the sinus inflammation. The researchers are also working with pharmaceutical companies to set up trials to test medications to control the fungus. They estimate that it will be at least two years before a treatment will be widely available.

The researchers distinguish chronic sinusitis -- sinusitis that lasts three months or longer -- from acute sinusitis, which lasts a month or less. They say that the cause of the acute condition is usually a bacterial infection.

Antibiotics and over-the-counter decongestants are widely used to treat chronic sinusitis. In most cases, antibiotics are not effective for chronic sinusitis because they target bacteria, not fungi. The over-the-counter drugs may offer some relief of symptoms, but they have no effect on the inflammation.

"Medications haven't worked for chronic sinusitis because we didn't know what the cause of the problem was," says Dr. Ponikau. "Finally we are on the trail of a treatment that may actually work."

Thousands of kinds of single-cell fungi (molds and yeasts) are found everywhere in the world. Fungal spores (the reproductive part of the organism) become airborne like pollen. Some people develop allergies to fungi. The new evidence from the Mayo study suggests that many people also develop a different kind of immune system response.

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http://findarticles.com/p/articles/mi_m0ISW/is_268/ai_n15788176

Chronic sinus infection & fungi

Townsend Letter for Doctors and Patients,  Nov, 2005  by Jule Klotter

Mayo Clinic scientists have found a connection between chronic rhinosinusitis (CRS) and a person's response to common airborne fungal spores. Their research is shifting attention away from the bacterial infections that characterize CRS and towards underlying inflammation. The scientists found spores from Alternaria, Aspergillus, Penicillium, and Cladosporium in the upper airway secretions belonging to healthy people as well as those with chronic sinusitis. People with CRS, however, "show exaggerated humoral and cellular responses ... to common airborne fungi, particularly Alternaria." Alternaria, whose spore is larger than the other fungi, has been associated with asthma in several countries.

In a December 2004 study, scientists took blood samples from 18 patients with CRS and 15 normal individuals and looked for cellular and humoral immune responses to airborne fungi. Although all serum samples had IgG antibodies to the fungi, people with CRS had higher levels: "The median serum IgG antibody level to Alternaria was about 5-fold higher for patients with CRS." IgE antibodies to the fungi, however, appeared in less than 30% of those with CRS. Cell cultures showed that about 90% of people with CRS produced the cytokines IL-5 and IL-13 when exposed to Alternaria. In addition, cells from people with CRS responded to Alternaria with significantly more IFN-[greater than or equal to] than cells from normal people did. The scientists also collected nasal secretions from nine additional patients and nine controls and checked the samples for fungal proteins and inflammatory mediators. All of the samples from the CRS group showed "markedly elevated levels of eosinophil [major basic protein] (4093 [+ or -] 878 mg/mL, mean [+ or -] SEM) and IL-5 (226 [+ or -] 69 pg/mL) compared with the undetectable levels in secretions from 9 other normal individuals (P = .0003 and .0092, respectively)."

In a later study, published in Journal of Allergy and Clinical Immunology (August 2005), Mayo Clinic scientists reported that the nasal and sinus mucus taken from people with CRS contains activated white blood cells (eosinophils) that produce a toxic protein (Major Basic Protein). Although Major Basic Protein was not found in the tissue itself, levels in the mucus "far exceeded that needed to damage the nasal and sinus membranes and make them more susceptible to infections such as chronic sinus infection." Mayo Clinic ear, nose and throat specialist Jens Ponikau, MD, stated in a Mayo Clinic news release that "some surgeons have already started to change the way they do surgery for patients with chronic sinus infections, focusing now on removing the mucus, which is loaded with toxins from the inflammatory cells, rather than the tissue during surgery."

Chronic Sinus Infection Thought to Be Tissue Issue, Mayo Clinic Scientists Show It's Snot. www.mayoclinic.org 28 July 2005

Shin, Seung-Heon, MD et al. Chronic rhinosinusitis: An enhanced immune response to ubiquitous airborne fungi. J Allergy Clin Immunol December 2004

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group