What is Allergic Fungal Sinusitis?

Many people are exposed to environmental fungi on a regular basis without suffering from any serious effects. Other people develop an allergic reaction known as allergic fungal sinusitis (AFS). The condition affects approximately 15 percent of people in the United States.

Allergic fungal sinusitis is characterized by the presence of mucin, which is a combination of fungus and mucus that builds up in the sinus cavity and creates a blockage. The mucin ranges in color from tan to dark green or even black. The symptoms of infection include fever, swelling around the eyes, a pus-filled discharge from the nose and throat, headaches, earaches, and pain in the teeth or face. Some people also experience a stuffy nose, sore throat or cough. In severe cases of allergic fungal sinusitis, the sinus blockage can press outward, making the face and eyes appear uneven or asymmetrical.

The type of environmental fungi varies depending on geographic location. The Curvularia and Bipolaris fungi are most commonly responsible for allergic fungal sinusitis infections in the United States. Curvularia infections are more prevalent in the southeast, while the Bipolaris fungus affects people in the western and central regions. Aspergillus, Alternaria, Fusarium and many others also cause allergic reactions or infections in susceptible people.

Teenagers and young adults are in a higher-risk category of developing allergic fungal sinusitis than middle-aged or older people. Men and women become infected at approximately equal rates, although women tend to be slightly older than men at the time of infection. People with weak immune systems are at higher risk of developing symptoms. People who live in warm, humid climates are at higher risk than those who live in cool or dry locations.

Several different approaches are commonly used to treat allergic fungal sinusitis. Fungicidal medicines and oral antibiotics are usually administered first. Patients are often treated with medications such as antihistamines that reduce allergic symptoms, or with corticosteroids to bring down the swelling. Doctors may also recommend immunotherapy procedures such as allergy shots to reduce the body's allergic reaction to the fungus. People who do not respond to medical treatment or immunotherapy may require surgery.

Most surgical procedures are performed on an outpatient basis using a local anesthetic. In a procedure called functional endoscopic sinus surgery (FESS), the doctor inserts a fiber-optic endoscope inside the nose. The device contains a light and a camera so the physician can see the inside of the sinus cavity. The doctor will use specialized tools to remove the blockage.