MMC Mayo research supports link between fungi, sinus problems

Tribune Media Services

DEAR MAYO CLINIC: I was very interested to read your proposal that most chronic sinus infections may be caused by an immune system response to fungi. I have suffered from sinusitis for over 20 years and had numerous operations on my nose and sinuses and tonsils, and none of it helped. Antibiotic treatment was also of no use. I also had no sense of smell for over 20 years despite using antihistamines and steroid nasal sprays. I am sure that there is a fungal link to my sinus problems. Could you give me an update on your research?

Our research findings support the idea that there is a fungal link to the stuffy noses and persistent airway inflammation experienced by people who have chronic rhinosinusitis, or CRS.

Your body's immune system mounts different kinds of responses for different invaders -- bacteria get attacked by different cells or systems than allergy-prompting particles, for example. Our work, published in 2004, shows that several parts of the immune system appear to work together when responding to inhaled airborne fungi. This collaboration results in an abnormally increased immune system response that causes troublesome inflammation and congestion.

The airborne fungi we studied can be found anywhere in the United States. Certain species of airborne fungi produce spores and byproducts called metabolites. When these fungi, spores and metabolites are inhaled, they prompt immune responses that are damaging in certain people. According to our research, 90 percent of CRS patients have an enhanced immune-system response to one fungus in particular, Alternaria. Another common fungus, Cladosporium, can provoke a similar response. These responses produce the distressing CRS symptoms you know so well.


This research is important because CRS is one of the most common chronic illnesses in the United States, with significant costs to society, such as more than 70 million lost activity days each year. As you know, the personal discomfort also is considerable. CRS symptoms include persistent stuffy nose, thick mucus production and loss of the sense of smell.

Although CRS causes significant discomfort and health problems, it is not well understood. Viruses, bacteria and allergic reactions have all been considered as potential causes of CRS symptoms. Results of our recent investigation are encouraging because they support the idea that reducing fungal exposure in sensitive individuals could offer new treatment options. For example, new treatments -- such as taking anti-fungal medicines, or nasal irrigations (flushing with water) that include anti-fungal medications -- could reduce the impact of fungi in patients with CRS.

As your question suggests, it may be time to recognize that some patients are sensitive to airborne fungi. -- Dr. Hirohito Kita, Allergic Diseases Research, Mayo Clinic.

(In accordance with the Bayh-Dole Act of 1980, Mayo Clinic has licensed technology for the treatment of chronic rhinosinusitis with anti-fungals to a commercial entity and will receive royalties from that license.)

To submit a question, write to:, or Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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