As more and more people visit their doctors to report sinus problems, experts are pinning much of the blame on an unknown organism.
Allergy sufferers hit by mystery fungus
ABU DHABI // Afrah Shamim is maintaining her standing as an A-grade pupil, despite spending most of the school year battling allergies in the intensive care units of various hospitals. Afrah, 15, who sits her O-levels this year at the Islamia English School in Abu Dhabi, suffers from severe allergic reactions and has chronic sinusitis.
The catalyst of her illness is not pollen, which is often behind such ailments, but grains of sand. "Living in a place like the UAE has a lot of advantages," said Afrah's mother, Fazmina Shamim, from Pakistan. "But its effect on my daughter's health is not one of them, and we don't know why." Despite, or perhaps because of, the dominant dry desert climate of the Middle East, the number of people with chronic sinusitis - a constant irritation and swelling of the nasal passages, which makes it difficult to breathe - is rising steadily.
WrongDiagnosis.com, a leading provider of online medical health information that also gathers facts for heath professionals, reports that more than 300,000 people in the UAE have this condition. A study by Vanderbilt University School of Medicine in Nashville, Tennessee, found that one in six people worldwide suffer from chronic sinusitis. Recent studies by ear, nose and throat specialists in the region have tried to pinpoint the causes, suggesting that the climate breeds an unknown type of fungus that can contribute to severe allergy complications, dubbed allergic fungal sinusitis (AFS).
Dr Muaaz Tarabichi, the head of the ear, nose and throat department at American Hospital Dubai, said AFS as a complication of chronic sinusitis was becoming common in the Emirates, and "has debilitating effects". "AFS is one of the more challenging pathologies to otolaryngologists as they have faced this clinical problem for quite some time now," said Dr Tarabichi. "Despite the proper medical and surgical lines of management, it seems there is a high recurrence rate of the disease."
In the eight years he spent in a busy practice in Chicago, Dr Tarabichi did not see a single case of AFS. In the 10 years that he has been in Dubai, he has made about 15 such diagnoses each month. "We used to hear about AFS occurring in the southwestern US, desert areas," he said. "It is well documented in scientific literature that it is something almost exclusively caused by a desert environment, and more specifically, a combination of coastal areas with humidity. This makes the UAE a perfect-picture situation for this kind of an allergy.
"I would say 20 per cent of operations we do here for sinuses are related to this specific condition." Dr Nassiba Gabouze, an ear, nose and throat specialist and allergist at Gulf Diagnostic Centre Hospital in Abu Dhabi, said the symptoms of AFS were similar to those of the more common chronic sinusitis. "I see patients with chronic sinusitis at an almost daily frequency," she said, and in some cases the problem turns out to be AFS.
In AFS, the growth of fungus in the tubes connecting the sinuses to the nose causes a swelling of membranes which results in a blockage. This gives the fungus an even better environment in which to grow, and a vicious cycle continues. Almost 10 per cent of patients who have chronic sinusitis could have AFS as well, due to fungal antigens present in the desert, Dr Gabouze said. She said AFS was "hard to diagnose, and even harder to pinpoint what species of environmental fungi is the cause".
Afrah, who was born and raised in the UAE, has had allergies throughout her life. The reactions occur almost monthly and render her helpless. But she had never heard about AFS. "I feel a heat in my face, and it feels like my throat and tongue and everything inside is growing so much that I can't breath - everything closes off," she said. "I've been having these allergic reactions for years and tried so many different treatments, but nothing ever works for long. I don't think my doctors know what is causing my reactions, they are still trying to figure it out."
Her mother said the attacks were exacerbated when the weather changed. "When we get those sandstorms, even mild ones, I never let Afrah out of the house," she said. "Even if she misses school, it's fine with me, as long as I can avoid more of those attacks that always make us rush to the hospital." Doctors have been unable to reach a complete diagnosis or prescribe a treatment that could control Afrah's reactions before she has to go to hospital, Mrs Shamim said.
Dr Tarabichi said health experts would be examining how to treat ear, nose and throat ailments at the Otolaryngology Exhibition & Conference in Dubai on February 14. "So far, treatment has not been handled particularly well," he said. "This lack of understanding means that doctors focus on correcting anatomical deformities rather than carrying out the necessary advanced sinus surgery that is needed to treat the disease.
"We have new procedures now to examine the sinuses - endoscopes, or a surgical navigation system not unlike what you have in your car - that give us continuous feedback on the exact location of the sinuses. "That might sound like not a big deal, but for sinuses it is, because if you are two or three millimetres out of position, you can reach the eye or brain. It is very serious." Dr Tarabichi said theories abounded about what kind of fungus particles caused AFS, but what had been proved was that the fungus was a desert dweller.
"Almost 100 per cent of all cases are reported in desert areas," he said. email@example.com