The Department of Otorhinolaryngology - Head & Neck Surgery at The University of Texas Medical School at Houston
Department of Otorhinolaryngology

Basic Science Research


Understanding Chronic Rhinosinusitis and Allergic Fungal Rhinosinusitis

Amber Luong, MD, PhD

Chronic rhinosinusitis (CRS) is the most prevalent chronic disease affecting over 33 million Americans annually, according to the Centers for Disease Control and Prevention. The socioeconomic impact translates into over $5.8 billion dollars spent for the treatment of sinusitis and on average four work days missed a year per affected person. Despite its prevalence and socioeconomic impact, we have little understanding about the pathophysiology and hence a poor appreciation of the effective means of treating this disease.

Allergic fungal rhinosinusitis (AFRS) represents one severe type of CRS characterized by nasal polyps and a thick, mucin debris filling the sinuses. Its geographic distribution, more prevalent in warm humid environments, places Houston with a large population of AFRS sufferers. This disease is often recalcitrant to our current medical therapy and therefore patients are often faced with multiple surgeries.

Despite its name, little is known about the pathophysiology of this disease. The disease was named allergic fungal rhinosinusitis because of its clinical similarity to a lung disease also characterized by thick mucinous debris. Initial data from our lab supports the role of fungal antigens in the activation of AFRS.3 In addition, we found that fungal antigens in patients with AFRS triggered a release of certain molecules consistent with an allergic inflammatory response. Taken together, this is the first data directly supporting an allergic response to fungal antigens in the pathophysiology of AFRS.

In a collaborative effort with Dr. Yong-Jun Liu, Department Chair of Immunology at MD Anderson Cancer Center whose lab identified and characterized a molecule known as thymic stromal lymphopoietin (TSLP), our goal is to elucidate the molecular pathways leading to this allergic immune response in AFRS. Thymic stromal lymphopoietin is released from respiratory cells and directs immune cells to trigger an allergic immune response. This molecule is the link between the epithelial cells that are bombarded by antigens and the subsequent allergic inflammatory response. We believe that the TSLP pathway may also play a role in AFRS.

Using AFRS as a model for understanding CRS and the immune response within the nose and paranasal sinuses, we hope to identify molecules for which more specific pharmacologic therapies can target.