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


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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  1. 1.
    Meltzer, E.O., Hamilos, D.L., Hadley, J.A., et al. (2004), J Allergy Clin Immunol 114, 155–212.PubMedCrossRefGoogle Scholar
  2. 2.
    Hamilos, D.L., Leung, D.Y.M., Wood, R., et al. (1996), Am J Respir Cell Mol Biol 15, 443–450.PubMedGoogle Scholar
  3. 3.
    Kaliner, M.A., Osguthorpe, J.D., and Fireman, P. (1997), J Allergy Clin Immunol 99, 829.CrossRefGoogle Scholar
  4. 4.
    Harlin, S.L., Ansel, D.G., Lane, S.R., Myers, J., Kephart, G.M., and Gleich, G.J. (1988), J Allergy Clin Immunol 81, 867–875.PubMedCrossRefGoogle Scholar
  5. 5.
    Demoly, P., Crampette, L., Mondain, M., et al. (1994), J Allergy Clin Immunol 94, 95–108.PubMedCrossRefGoogle Scholar
  6. 6.
    Ferguson, B.J. (2000), Laryngoscope 110, 799–813.PubMedCrossRefGoogle Scholar
  7. 7.
    Braunstahl, G.J., Overbeek, S.E., Kleinjan, A., Prins, J.B., Hoogsteden, H.C., and Fokkens, W.J. (2001), J Allergy Clin Immunol 107, 469–476.PubMedCrossRefGoogle Scholar
  8. 8.
    Hamilos, D., Leung, D.Y.M., Wood, R., et al. (1993), J Allergy Clin Immunol 92, 39–48.PubMedCrossRefGoogle Scholar
  9. 9.
    Finotto, S., Ohno, I., Marshall, J.S., et al. (1994), J Immunol 153, 2278–2289.PubMedGoogle Scholar
  10. 10.
    Hamilos, D.L., Leung, D.Y.M., Wood, R., et al. (1995), J Allergy Clin Immunol 96, 537–544.PubMedCrossRefGoogle Scholar
  11. 11.
    Bachert, C., Wagenmann, M., Hauser, U., and Rudack, C (1997), J Allergy Clin Immunol 99, 837–842.PubMedCrossRefGoogle Scholar
  12. 12.
    Minshall, E.M., Cameron, L., Lavigne, F., et al. (1997), Amer. Resp Cell Mol Biol 17, 683–690.Google Scholar
  13. 13.
    Hamilos, D.L., Leung, D.Y.M., Huston, D.P., Kamil, A., Wood, R., and Hamid, Q. (1998), Clin Exp Allergy 28, 1145–1152.PubMedCrossRefGoogle Scholar
  14. 14.
    Denburg, J.A. (2000), Thorax 55, S24-S25.PubMedCrossRefGoogle Scholar
  15. 15.
    Steinke, J.W. (2004), Recent Res Devel Allergy Clin Immunol 5, 15–25.Google Scholar
  16. 16.
    Rachelefsky, G.S. (1999), Ann Allergy Asthma Immunol 82, 296–305.PubMedGoogle Scholar
  17. 17.
    Settipane, G.A., and Chafee, F.H. (1977), J Allergy Clin Immunol 59, 17–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Adkins, T.N., Goodgold, H.M., Hendershott, L., and Slavin, R.G. (1998), Ann Allergy Asthma Immunol 81, 181–184.PubMedGoogle Scholar
  19. 19.
    Gwaltney, J.M., Jr., Hendley, J.O., Phillips, C.D., Bass, C.R., Mygind, N., and Winther, B. (2000), Clin Infect Dis 30, 387–391.PubMedCrossRefGoogle Scholar
  20. 20.
    Borts, M.R., and Slavin, R.G. (1989), J Allergy Clin Immunol 83, 302A.Google Scholar
  21. 21.
    Slavin, R.G., Zilliox, A.P., and Samuels, L.D. (1988), J Allergy Clin Immunol 81, 284A.CrossRefGoogle Scholar
  22. 22.
    Pelikan, Z., and Pelikan-Filipek, M (1990), J Allergy Clin Immunol 86, 484–491.PubMedCrossRefGoogle Scholar
  23. 23.
    Baroody, F.M., Saengpanich, S., deTineo, M., Haney, L., Votypka, V., and Naclerio, R.M. (2002), J Allergy Clin Immunol 109, S84.CrossRefGoogle Scholar
  24. 24.
    Denburg, J.A., Sehmi, R., Saito, H., Pil-Seob, J., Inman, M.D., and O'Byrne, P.M. (2000), J Allergy Clin Immunol 106, S242-S2S6.PubMedCrossRefGoogle Scholar
  25. 25.
    Steinke, J.W., and Borish, L. (2004), Immunol Allergy Clin N Am 24, 45–57.CrossRefGoogle Scholar
  26. 26.
    Schubert, M.S. (2001), Ann Allergy Asthma Immunol 87, 181–188.PubMedCrossRefGoogle Scholar
  27. 27.
    Davis, L.J., and Kita, H. (2004), Immunol Allergy Clin N Am 24, 59–73.CrossRefGoogle Scholar
  28. 28.
    Krakauer, T. (1999), Immunol Res 20, 163–173.PubMedGoogle Scholar
  29. 29.
    Van Zele, T., Gevaert, P., Watelet, J.B., et al. (2004). J Allergy Clin Immunol 114, 981–983.PubMedCrossRefGoogle Scholar
  30. 30.
    Gevaert, P., Holtappels, G., Johansson, S.G., Cuvelier, C., Cauwenberge, P., and Bachert, C (2005), Allergy 60, 71–79.PubMedCrossRefGoogle Scholar
  31. 31.
    Bachert, C., Gevaert, P., Holtappels, G., Johansson, S.G., and van Cauwenberge, P. (2001), J Allergy Clin Immunol 107, 607–614.PubMedCrossRefGoogle Scholar
  32. 32.
    Ponikau, J.U., Sherris, D.A., Kern, E.B., et al. (1999), Mayo Clin Proc 74, 877–884.PubMedCrossRefGoogle Scholar
  33. 33.
    Taylor, M.J., Ponikau, J.U., Sherris, D.A., et al. (2002), Otolaryngol Head Neck Surg 127, 377–383.PubMedCrossRefGoogle Scholar
  34. 34.
    Shin, S.H., Ponikau, J.U., Sherris, D.A., et al. (2004), J Allergy Clin Immunol 114, 1369–1375.PubMedCrossRefGoogle Scholar
  35. 35.
    O'Hollaren, M.T., Yunginger, J.W., Offord, K.P., et al. (1991), N Engl J Med 324, 359–363.PubMedCrossRefGoogle Scholar
  36. 36.
    Halonen, M., Stern, D.A., Wright, A.L., Taussig, L.M., and Martinez, F.D. (1997), Am J Respir Crit Care Med 155, 1356–1361.PubMedGoogle Scholar
  37. 37.
    Ponikau, J.U., Sherris, D.A., Kita, H., and Kern, E.B. (2002), J Allergy Clin Immunol 110, 862–866.PubMedCrossRefGoogle Scholar
  38. 38.
    Weschta, M., Rimek, D., Formanek, M., Polzehl, D., Podbielski, A., and Riechelmann, H. (2004), J Allergy Clin Immunol 113, 1122–1128.PubMedCrossRefGoogle Scholar
  39. 39.
    Ponikau, J.U., Sherris, D.A., Weaver, A., and Kita, H. (2005), J Allergy Clin Immunol 115, 125–131.PubMedCrossRefGoogle Scholar
  40. 40.
    Sampath, D., Castro, M., Look, D.C., and Holtzman, M.J. (1999), J Clin Invest 103, 1353–1361.PubMedCrossRefGoogle Scholar
  41. 41.
    Holtzman, M.J., Look, D.C., Sampath, D., Castro, M., Koga, T., and Walter, M.J. (1998), Proc Assoc Am Physicians 110, 1–11.PubMedGoogle Scholar

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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