Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

Table 1

Review of sinus disease categories and features.

Sinus diseases of immunocompetent hosts
Type	Pathogen	Host features	Treatment	Pearls
Fungal ball	Aspergillus species	Females over ~50 years of age	Outpatient surgery	High cure rate
Granulomatous invasive fungal rhinosinusitis	Aspergillus flavus	All demographics, in Sudan, India, Pakistan, and Saudi Arabia	Outpatient surgery and systemic antifungals	Postoperative itraconazole may reduce relapse rate
Allergic fungal rhinosinusitis	Aspergillus sp., Alternaria sp., Bipolaris sp., and Curvularia sp.	Atopic patient	Outpatient surgery, allergic treatments (nasal steroids), and considering allergen immunotherapy	Best evidence is for allergen immunotherapy initiation 4–6 weeks after surgery
Sinus diseases limited to immunocompromised hosts
Type	Pathogen	Host features	Treatment	Pearls
Acute invasive fungal rhinosinusitis	Aspergillus species, Rhizopus sp., and Mucor sp.	Reduced neutrophil number of functions, HIV	Inpatient surgery, systemic antifungals, and immune reconstitution	Must be distinguished from noninvasive disease in immunocompromised host, high mortality
Chronic invasive fungal rhinosinusitis	Aspergillus species, Rhizopus sp., and Mucor sp.	Less severe impairment such as diabetes, systemic corticosteroids, and HIV	Outpatient surgery, systemic antifungals, and immune reconstitution	Must be distinguished from noninvasive disease in immunocompromised host; recurrence is possible

Modified from Callejas and Douglas, 2013 [1].