过敏性真菌性鼻-鼻窦炎(AFRS)是慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的一种非侵袭性亚型,通常在有免疫能力的特应性个体中发展,在以温暖的温度和高湿度为特征的地理区域中更常见。有利于较高的环境真菌的存在。过敏性真菌性鼻窦炎通常表现为独特的计算机断层扫描结果和显著的息肉负担。然而,患者通常报告轻微的鼻窦症状。患有AFRS的患者通常具有极升高的血清总IgE水平和真菌特异性IgE水平。治疗几乎总是需要手术,其中辅助药物治疗对成功至关重要。然而,直到最近,辅助治疗的选择主要包括口服和/或外用类固醇.虽然口服皮质类固醇可减少手术后的复发,其他辅助药物的有效性数据,包括局部和口服抗真菌药物和免疫疗法,目前仍不清楚,因此不建议在最近的指南中,包括国际过敏和鼻学共识。三种生物制品,奥马珠单抗,dupilumab,和美泊利单抗,最近被批准用于治疗CRSwNP,但迄今为止使用这些生物制剂的临床试验并未涉及AFRS患者.最近发表的病例报告和较小的前瞻性研究表明,这些生物制剂对AFRS患者亚组具有良好的疗效。本文概述了对AFRS病理生理学的理解,这种理解对生物制品可能作用的影响,以及使用生物制剂治疗AFRS的临床报告。因为生物制剂用于治疗CRSwNP,AFRS需要后续的真实世界证据研究。
Allergic fungal rhinosinusitis (
AFRS) is a noninvasive subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) that usually develops in immunocompetent atopic individuals and is more common in geographic regions characterized by warm temperatures and high humidity, conducive to higher environmental fungal presence. Allergic fungal rhinosinusitis usually presents with unique computed tomography findings and significant polyp burden, yet patients often report minimal sinus symptoms. Patients with
AFRS often have extremely elevated serum total and fungal-specific IgE levels. Treatment almost always requires surgery, in which adjuvant medical therapy is critical to success. However, until recently the choice of adjuvant therapy has consisted primarily of either oral and/or topical steroids. Although oral corticosteroids decrease recurrence after surgery, data for the effectiveness of other adjunctive pharmacologic agents, including topical and oral antifungal agents and immunotherapy, have remained unclear and hence are not recommended in recent guidelines including the International Consensus of Allergy and Rhinology. Three biologics, omalizumab, dupilumab, and mepolizumab, have recently been approved for treating CRSwNP in general, but clinical trials to date with these biologics did not involve
AFRS patients. Recently published case reports and smaller prospective studies have shown good efficacy of these biologics on the
AFRS subgroup of patients. This article provides an overview of the understanding of the pathophysiology of
AFRS, implications of this understanding on the possible role of biologics, and clinical reports on the use of biologics in treating AFRS. Because biologics are indicated for treating CRSwNP, follow up real-world evidence studies are needed for AFRS.