Recently, a team led by Dr. Liang (Riverside School of Medicine, Rutgers New Jersey Medical School, University of California, Kaiser Permanente Oakland Medical Center) conducted a study to compare the differences in socioeconomic, demographic, and disease severity factors between patients with chronic rhinosinusitis (CRS) and those with allergic fungal rhinosinusitis (AFRS). The study findings were presented at the American Rhinologic Society (ARS) Annual Meeting (Philadelphia, PA, USA, September 9-10, 2022),
CRS is a common inflammatory disease characterized by nasal discharge, sinonasal edema, and sinus discomfort, with an estimated prevalence of 12% in the United States. AFRS is a chronic condition with severe complications and a high recurrence rate that requires long-term follow-up. AFRS was first described in 1981 by Millar et al. as allergic bronchopulmonary aspergillosis of the paranasal sinuses. It is identified as a distinct subtype of CRS and accounts for approximately 5-10% of all CRS. However, even after many decades since it was first described, there is still a lot of confusion about the true pathophysiology and causes of AFRS. At the same time, there has been a lot of talk about how to treat this condition.
This presentation exhibited a retrospective chart review of adult patients with AFRS and CRS between 2010-2019. Bent and Kuhn criteria were used to determine the AFRS. Nasal polyps, hypersensitivity, positive fungal stain, distinct radiologic findings, and eosinophilic mucin without fungal invasion were all considered. Primary criteria (CT scan with orbitocranial extension or CT scan with bony erosion) and minor criteria (sinus surgeries, oral corticosteroids, and Lund Mackay score) were used to assess disease severity. Chi-square and t-tests were used to compare demographic and socioeconomic differences between the AFRS and CRS cohorts. The risk factors associated with severe AFRS were evaluated using multivariate logistic regression.
According to the findings, the AFRS and CRS cohorts differed significantly in age, with an average age of 48.7 years for AFRS and 51 years for CRS. The percentage of black patients in the AFRS and CRS groups was 26.2 and 4.9, respectively, indicating that the proportion of black patients in the AFRs group was significantly greater than that of other races. There were also no significant differences in gender, comorbidities, SES measures, or Medicaid status between the AFRS and CRS groups. Aside from that, the findings revealed that no demographic or clinical factors were linked to severe AFRS disease. Furthermore, it was discovered that AFRS is more common in Black patients, and they have a significantly lower risk of progressing to severe AFRS. These findings support the notion that AFRS should be classified as a distinct subtype of CRS.
In previous studies, AFRS has also been noted to be more common in African American patients. However, that patients with AFRS failed to demonstrate higher severity of the disease is associated with lower socioeconomic status and less access to primary medical care than those with other CRS subtypes. As a result, genetic predispositions may explain the differences, which require further investigation. In terms of clinical relevance, clinicians can benefit from understanding that AFRS is a distinct subtype of CRS with distinct histologic and pathophysiologic features, disease presentation, and patient population.
This knowledge can help clinicians develop diagnoses, appropriate treatment, and care coordination for these patients.