الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The concept of “one airway one disease” is further strengthened with the detection of the association between ABPA and AAS, reflecting fungal hypersensitivity in both the upper and lower airways.
Although both Allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) are classified as Aspergillus-related hypersensitivity respiratory disorders, their co-occurrence appears to be an infrequently recognized phenomenon. This could perhaps be attributed to the fact that these two diseases are often treated by two different specialties. A high index of suspicion is required to establish the diagnoses of ABPA and AAS.
Unfortunately, there are little data on the pathophysiologic relationship between ABPA and AFS. Does postnasal drainage of Aspergillus containing mucus into the airways influence the development or severity of ABPA? Or both AFS and ABPA have the same mechanism, which likely to be releasing antigenic material from Aspergillus initiates a chain of immunologic reactions leading to the development of both AFS and ABPA.
Of all the pulmonary fungal diseases only both ABPA and aspergilloma are identified in three cases of fungal rhinosinusitis, these cases were included in AFS group.
Concomitant ABPA and AFS identified in the three patients, one of them had an association of ABPA, AFS and aspergilloma. This confirms that the pathogenesis of ABPA and AFS is similar to each other, and differ from any other category of fungal rhinosinusitis. In addition patients with AFS are at risk of developing ABPA and vice versa.
All patients with AFRS along with sensitization to Aspergillus antigens and asthma are at an increased risk of developing ABPA.
Patients who presented with passage of nasal and sputum plugs should alert the physician to the possibility of coexistent ABPA and AAS.
Presence of haemoptysis in ABPA patient considers an alarming manifestation for developing aspergilloma in this patient.
Any AFS patient presented with highly elevated total serum IgE should raising the suspicious of having ABPA.
Presence of double dense lesions in the nasal CT and central bronchiectasis in the chest radiography of the same patient should strength the suspicious of having concomitant ABPA and AFS in this patient.
It seems to be both nasal allergic mucin of AFS and pulmonary mucous plug of ABPA have the same constitute and thus the hypothesis that AFS and ABPM share the same immunopathogenic mechanism is further supported.
If AFS patient presented with obstructive ventilator defect; this should alert the physician to the possibility of coexistent ABPA.
Then AFRS patients associated with high serum IgE, douple dense lesion in C.T nose and paranasal sinuses, bronchiectasis in chest radiography and has an obstructive ventilation defect should be considered at high risk to developed APBA, then close and regular follow up is required. These also help in reaching to ideal treatment modality for both AFRS and ABPA
Recommendation
Emphasis on early recognition of chest symptoms in patients with AAS and nasal symptoms in patients with ABPA may help in early diagnosis of concurrent involvement. The clinician should routinely consider the diagnosis of SAM in patients who have either AFS or ABPM.
Further studies and research with larger samples are essential for establishing the high risk group of development SAM and the suspicious criteria for diagnosis of SAM. Early initiation of appropriate therapy could probably alter the course of the disease processes and prevent the possible development of long term squeal.
These entities share similar immunopathologic mechanisms, and the mainstay of treatment for both these diseases is oral prednisolone even after the nasal surgical management.
Long term follow up is recommended for patients with either AFS or ABPA, as the association of AFS and ABPA may be concomitant or not with a possible time lag of several years between the onsets of both diseases ”remote in time”, even after recovery from the original episode.
As this study proved concomitant occurrence of pulmonary fungal diseases in patients with fungal rhino-sinusitis; further studies searching for concomitant occurrence of fungal rhino-sinusitis with other body systems are recommended.
Emphasis on early recognition of chest symptoms in patients with AAS and nasal symptoms in patients with ABPA may help in early diagnosis of concurrent involvement. The clinician should routinely consider the diagnosis of SAM in patients who have either AFS or ABPM.
Further studies and research with larger samples are essential for establishing the high risk group of development SAM and the suspicious criteria for diagnosis of SAM. Early initiation of appropriate therapy could probably alter the course of the disease processes and prevent the possible development of long term squeal.
These entities share similar immunopathologic mechanisms, and the mainstay of treatment for both these diseases is oral prednisolone even after the nasal surgical management.
Long term follow up is recommended for patients with either AFS or ABPA, as the association of AFS and ABPA may be concomitant or not with a possible time lag of several years between the onsets of both diseases ”remote in time”, even after recovery from the original episode.
As this study proved concomitant occurrence of pulmonary fungal diseases in patients with fungal rhino-sinusitis; further studies searching for concomitant occurrence of fungal rhino-sinusitis with other body systems are recommended.