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Clinical and Translational Allergy

Open Access

Allergic fungal rhinosinusitis (AFRS) - more than a fungal disease?

  • Tineke Dutre1,
  • Surayie Al Dousary2,
  • Nan Zhang3 and
  • Claus Bachert3
Clinical and Translational Allergy20133(Suppl 2):P15

Published: 16 July 2013

Allergic fungal rhinosinusitis (AFRS) is characterized by the growth of fungi, mostly Aspergillus sp., in the paranasal sinuses together with the formation of nasal polyps, peanut-butter like "allergic mucin" with fungal hyphae and typical CT-findings, as well as increased serum total IgE and Aspergillus-specific IgE concentrations. We here hypothesize that the increase in serum total IgE is caused by the local symbiosis of Asp. sp. with Staphylococcus aureus, a germ which is known for the production of enterotoxins with superantigenic properties. We demonstrate the presence of S. aureus specific IgE antibodies in the sera of AFRS patients, correlating with total serum IgE concentrations, as well as the coexistence of both, A. fumigatus and S. aureus, in biofilm-like formations on the sinus mucosa. Similar mechanisms and findings may apply for Allergic Broncho-Pulmonary Aspergillosis/Mykosis (ABPA/M). This knowledge may result in new diagnostic and therapeutic approaches including anti-IgE strategies.

Authors’ Affiliations

University Hospital Ghent, Ghent, Belgium
Department of Otorhinolaryngology, Rhinology Research Chair, Medical College, King Saud University, Riyadh, Saudi Arabia
Department of Otorhinolaryngology, Upper Airway Research Laboratory, University Ghent, Ghent, Belgium


© Dutre et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.