Anti-fungus drug useful for sinus problem

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Treatment with a nasal spray containing the anti-fungal drug amphotericin B reduces the swelling and inflammation that occurs with chronic rhinosinusitis, a common cause of stuffy nose and facial pain, new research shows.

Amphotericin B is an old drug that can cause serious side effects, particularly to the kidneys. However, when given as a nasal spray, the drug does not get absorbed, effectively avoiding these effects, researchers report in the Journal of Allergy and Clinical Immunology.

The findings, which stem from a study of 30 patients, lend weight to the notion that fungi are involved in the development of chronic rhinosinusitis.

In an interview with Reuters Health, lead author Dr. Jens U. Ponikau, from the Mayo Clinic in Rochester, Minnesota, said that fungi appear to play a key role in chronic rhinosinusitis by causing certain immune cells to show up in the mucous layer of the nose. Once there, the cells release toxic compounds that damage the fungi, but also the surrounding nasal tissue.

Still, the hypothesis that fungi are involved in chronic rhinosinusitis is controversial and it remains to be determined why only certain people develop the condition when nasal fungi are so common, Ponikau noted.

He and his colleagues reasoned that if the immune cells are in the mucous membranes because of the fungi, then maybe reducing the fungi would reduce the inflammation caused by the immune cells and “ultimately improve the patient’s symptoms.”

Compared with inactive “placebo”, 6 months of treatment with amphotericin B nasal spray led to a significant reduction in mucous swelling, as determined by CT scans and other tests. Moreover, such therapy seemed to reduce the number of immune cells present.

“These findings have completely changed the way we approach Sinusitis patients at Mayo,” Ponikau noted, adding that “thousands of chronic rhinosinusitis patients are now being treated with antifungals.”

Larger studies will begin later this year, he said.

SOURCE: Journal of Allergy and Clinical Immunology, January 2005.

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