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Wednesday, March 12, 2014
Allergic fungal sinusitis
I`ve just had my 4th sinus surgery in 5 years and have finally been diagnosed with Allergic Fungal Sinusitis. My ENT has recommended long term low dose steroids inorder to combat this problem.
My questions - Can specific allergy testing be done to pinpoint the exact type of fungus that causes this problem and then can Allergy Shots be administered to combat this?
What allergy specialist in Ohio can do this type of testing, put me on long term steroids, and allow me flexible hours or take home allergy shots?
Yes, allergy testing can be done to determine whether there is a allergic component to the fungus found at surgery. First, the fungus must be recovered and cultured or identified so that an allergist can determine if IgE (allergic antibody) exists to this particular fungus. This can be done by skin tests or RAST tests.
Allergic Fungal Rhinosinusitis (AFRS) is a complex disease and is not just an allergy to the fungus. Therefore, multiple treatments are necessary to keep symptoms under control and limit the need for surgical intervention. In addition to long term steroid therapy, some patients will also respond to systemic or topical antifungal therapy. Allergen immunotherapy (shots) were shown to be beneficial in one paper, but this is still somewhat controversial.
It would be best to speak with your primary care physician or ENT physician to determine the correct referral based on the surgical findings and the information he/she already has.
Regarding home immunotherapy, this varies by physician. The official position of the American Academy of Allergy, Asthma and Immunology is: Location of allergen immunotherapy administration Physician's office. Summary Statement 59: The preferred location for administration of allergen immunotherapy is in the office of the physician who prepared the patient's allergen immunotherapy extract. Summary Statement 60: Patients at high risk of systemic reactions, where possible, should receive immunotherapy in the office of the physician who prepared the patient's allergen immunotherapy extract. Other locations. Summary Statement 61: Regardless of the location, allergen immunotherapy should be administered under the supervision of an appropriately trained physician and personnel. Home administration. Summary Statement 62: In rare and exceptional cases, when allergen immunotherapy cannot be administered in a medical facility and withholding this therapy would result in a serious detriment to the patients' health (eg, VIT for a patient living in a remote area), very careful consideration of potential benefits and risks of at-home administration of allergen immunotherapy should be made on an individual patient basis. If this approach is used, informed consent should be obtained from the patient, and the person administering the injection to the patient must be educated about how to administer immunotherapy and recognize and treat anaphylaxis.
David Hauswirth, MD
Clinical Assistant Professor
Pulmonary, Allergy, Crtitical Care & Sleep
College of Medicine
The Ohio State University