Fungus and mold are always present in the air, so it is reasonable to expect that they are also found in our nasal passages. Recent research at the Mayo Clinic has confirmed this to be true. In people with CAID, an immune response to the fungi results in a thickening of the mucous membrane, leading to the disease’s symptoms. The presence of fungus triggers certain white blood cells to secrete substances that attract other white blood cells to defend the body against the fungus, which in normal patients may be harmless. These white blood cells secrete a protein called major basic protein (MBP), a substance that is directly toxic to the fungi. However, MBP can also damage the sensitive nasal mucous membrane. Over time, this damage leads to swelling and breaks in the membrane. It can also make the mucous membrane vulnerable to invasion by other bacterial and viral organisms.
Clinical studies at the Mayo Clinic have demonstrated that topical antifungals are effective in treating and altering the disease progression of CAID by eliminating fungal elements that can exacerbate the disease. In addition, studies of topical antifungal therapies have demonstrated that the agents can decrease mucous membrane swelling and thickening.
CAID patients who use topical antifungal drugs avoid the side effects common with oral and intravenous antifungal formulations. Topical administration allows a high dose to be applied to the fungus while limiting the patient’s exposure to the drug. Side effects reported by patients are minimal but include burning and worsening of congestion.
In clinical studies, the following topical antifungals have been used at the indicated doses:
Amphotericin B: 100 mg/L of sterile water (up to 200 mg/L has been used)
Itraconazole: 100-200 mg/L of sterile water
Voriconazole: 1000 mg/L of normal saline
ANTIVIRAL PREVENTATIVE MEASURES
It has been shown that yearly flu shots are effective in decreasing the incidence of flu in patients. Typically, people with the flu will experience sinusitis symptoms, which can be prevented with the vaccine.