Clinical Reviews in Allergy & Immunology

, Volume 30, Issue 3, pp 195–203 | Cite as

Fungi in chronic hyperplastic eosinophilic sinusitis

Reasonable doubt
  • Larry Borish
  • Lanny Rosenwasser
  • John W. Steinke
Article

Abstract

Chronic hyperplastic eosinophilic sinusitis (CHES) is a T-helper (Th)2-like, lymphocyte-initiated, eosinophil-rich inflammatory disease. The complex immune interactions required to orchestrate these processes begin with the presentation of antigen by mature dendritic cells to Th lymphocytes that display the appropriate antigen-specific T-cell receptor. The objective of sinus research must be to identify and target that antigen; this will lead to the cure for this condition. This article reviews numerous models that may be responsible for the pathophysiology of this disorder, including putative roles for allergens, bacteria, and bacterial-derived superantigens, as well as recent interest in fungal-derived antigens. Additionally, we speculate that whatever the inciting cause of CHES may be, it is plausible that once initiated, cellular differentiation pathways may lead to the development of an antigen-independent permanent phase. More than one of these may be valid in different subjects and, furthermore, this list almost assuredly does not explain all cases of CHES. The concept that fungal antigens colonizing the sinuses are responsible for CHES represents an intriguing, but unproven, hypothesis. Presently, the case for the fungus remains circumstantial. The case for fungi will be proved only with definitive proof that T-cells within the sinuses are actively responding to fungal antigens present in the sinus and with the further demonstration that removal of those fungal antigens ameliorates the disease.

Index Entries

Chronic sinusitis allergic inflammation fungal colonization bacterial superantigen eosinophil 

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Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Larry Borish
    • 1
  • Lanny Rosenwasser
    • 2
  • John W. Steinke
    • 1
  1. 1.Asthma and Allergic Disease Center, Beirne Carter Center for Immunology ResearchUniversity of Virginia Health SystemCharlottesville
  2. 2.Dee Lyons/Missouri Endowed Chair in Pediatric Immunology Research, Children's Mercy Hospitals and ClinicUniversity of MissouriKansas City

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