Mayo Clinic/Fungal Sensitivity in 4-30-03 WSJ article

Question:

On Sat, 10 May 2003 12:31:17 -0700, "JimC" <jchim…@vfr.net> wrote: >Well, after speaking with them for 45 minutes and then having my dr. fax >them an RX, they called and said they can’t ship to California because they >don’t have a license for CA. So, I’m back to square 1. Can’t use steroid >sprays because I developed avascular necrosis from medical use of steroid >products.

I assume you know that topical steroids (nasal sprays) are not significantly absorbed into the system (especially Nasonex), unlike oral steroid medication?

Response:

That’s what they said all along about inhaled steroids for asthma. Now they have linked inhaled steroids with bone loss. After what I have been through with avascular necrosis, I don’t trust what anyone says about them- I just think they don’t know. "Don Brady" <dbr…@pobox.com> wrote in message

news:4kmqbvcpp8jduav5efjfihsflfro9cpof3@4ax.com… – Hide quoted text — Show quoted text -> On Sat, 10 May 2003 12:31:17 -0700, "JimC" <jchim…@vfr.net> wrote: > >Well, after speaking with them for 45 minutes and then having my dr. fax > >them an RX, they called and said they can’t ship to California because they > >don’t have a license for CA. So, I’m back to square 1. Can’t use steroid > >sprays because I developed avascular necrosis from medical use of steroid > >products. > I assume you know that topical steroids (nasal sprays) are not significantly > absorbed into the system (especially Nasonex), unlike oral steroid medication?

Response:

On Sun, 11 May 2003 06:51:06 -0700, "JimC" <jchim…@vfr.net> wrote: >That’s what they said all along about inhaled steroids for asthma. Now they >have linked inhaled steroids with bone loss.

You are correct. > After what I have been through >with avascular necrosis, I don’t trust what anyone says about them- I just >think they don’t know.

OK I understand..

Response:

Hmm, seems like they would have known that ahead of time. Very disappointing of them not to give you further suggestions. They used to have Dr. Grossan on their list of referral docs, maybe he can help you, he is in So. CA. They have a map with other docs to contact, did you check that? I just checked the map and now it says to call them. I’d ask them what’s up with that, is it their web site problem? How are you doing without the anti fungal? You said you were going to see how it worked out. "JimC" jchim…@vfr.net wrote:

<< Well, after speaking with them for 45 minutes and then having my dr. fax them an RX, they called and said they can’t ship to California because they don’t have a license for CA. So, I’m back to square 1. Can’t use steroid sprays because I developed avascular necrosis from medical use of steroid products.<< Sue M.

Response:

I have had to discontinue the anti-fungal as it is no longer available at this time due to production problems. It’s too early to tell if I’m going to get worse not using it. "Sue milham" <suemil…@aol.comnospam> wrote in message

news:20030512164644.13923.00000270@mb-m28.aol.com… – Hide quoted text — Show quoted text -> Hmm, seems like they would have known that ahead of time. Very disappointing > of them not to give you further suggestions. They used to have Dr. Grossan on > their list of referral docs, maybe he can help you, he is in So. CA. They have > a map with other docs to contact, did you check that? I just checked the map > and now it says to call them. I’d ask them what’s up with that, is it their > web site problem? How are you doing without the anti fungal? You said you > were going to see how it worked out. > "JimC" jchim…@vfr.net wrote: > << Well, after speaking with them for 45 minutes and then having my dr. fax > them an RX, they called and said they can’t ship to California because they > don’t have a license for CA. So, I’m back to square 1. Can’t use steroid > sprays because I developed avascular necrosis from medical use of steroid > products.<< > Sue M.

Response:

If your anti fungal medication is not available, ask your doctor about using pulsatile irrigation. I think that some of the effects of Hydro Pulse are due to removal of some of the eosinophile toxic products, but haven’t had an opportunity to get a valid proof. Anyone know where I can get a grant? Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/

Response:

I have been told I will probably have to use it forever. Due to the unavailability of the drug right now, I’m off it. I guess this will be a good test as to how effective it’s been in preventing a recurrence of polyps. "Sue milham" <suemil…@aol.comnospam> wrote in message

news:20030502202348.27098.00000450@mb-m26.aol.com… – Hide quoted text — Show quoted text -> Jim, I’m wondering why you have to be using it so long. Wouldn’t it have done > it’s work long before 6 months? > "JimC" jchim…@vfr.net wrote: > < history of chronic polyps and sinus infections, with polyps having to be > removed about every 3-6 months. Since I have been on this drug there has > been no recurrence of polyps and I’ve had no sinus infections. There is now > a shortage of this drug in the U.S., which I find is strangely coincidental > with the Mayo Clinic getting a patent on the use of this generic drug for > sinus disease.>> > Sue M.

Response:

Sue milham wrote: > Jim, I’m wondering why you have to be using it so long. Wouldn’t it have done > it’s work long before 6 months?

No. Mayo’s own studies have shown that it takes a few months before their patients have seen any improvement. I tried it but I couldn’t stick it out that long. The problem is this. You have to be on it continuously. And you cannot irrigate frequently when you use that drug because irrigation will wash the drug out of your nose. Before the drug could have a chance to take effect, I caught a cold, it turned into a bad sinus infection, and the only relief I got was from frequent irrigation. That meant that I couldn’t use the ampho anymore. I did try an oral antifungal (Diflucan). It didn’t help a bit. — Steven D. Litvintchouk Email: sdlit…@earthlink.net

Response:

It seems the steroid nasal sprays might give you the control over the polyps. Sinucare.com sells the anti-fungal in a spray and solution for irrigation, I believe. You could check their web site. I don’t think it would be good for maintenance control tho’. "JimC" jchim…@vfr.net wrote:

<< I have been told I will probably have to use it forever. Due to the unavailability of the drug right now, I’m off it. I guess this will be a good test as to how effective it’s been in preventing a recurrence of polyps.>> Sue M.

Response:

Sue, thank you for suggesting Sinucare. They indeed do have the Amphotericin B solution I need. I will get it from them until my local pharmacist can get it again. Sinucare does charge about twice the price I was paying locally, but that includes overnight shipping. "Sue milham" <suemil…@aol.comnospam> wrote in message

news:20030504195516.28211.00000606@mb-m14.aol.com… – Hide quoted text — Show quoted text -> It seems the steroid nasal sprays might give you the control over the polyps. > Sinucare.com sells the anti-fungal in a spray and solution for irrigation, I > believe. You could check their web site. I don’t think it would be good for > maintenance control tho’. > "JimC" jchim…@vfr.net wrote: > < unavailability of the drug right now, I’m off it. I guess this will be a > good test as to how effective it’s been in preventing a recurrence of > polyps.>> > Sue M.

Response:

Your welcome. I hope it works for you. They have a very helpful pharmacist to talk to also. How about the steroid nasal spray to control the polyps? Have you looked into that? "JimC" jchim…@vfr.net wrote:

<<Sue, thank you for suggesting Sinucare. They indeed do have the Amphotericin B solution I need. I will get it from them until my local pharmacist can get it again. Sinucare does charge about twice the price I was paying locally, but that includes overnight shipping.<< >> Sue M.

Response:

Well, after speaking with them for 45 minutes and then having my dr. fax them an RX, they called and said they can’t ship to California because they don’t have a license for CA. So, I’m back to square 1. Can’t use steroid sprays because I developed avascular necrosis from medical use of steroid products. "Sue milham" <suemil…@aol.comnospam> wrote in message

news:20030507214726.01710.00000828@mb-m28.aol.com… – Hide quoted text — Show quoted text -> Your welcome. I hope it works for you. They have a very helpful pharmacist to > talk to also. > How about the steroid nasal spray to control the polyps? Have you looked into > that? > "JimC" jchim…@vfr.net wrote: > <<Sue, thank you for suggesting Sinucare. They indeed do have the Amphotericin > B solution I need. I will get it from them until my local pharmacist can get > it again. Sinucare does charge about twice the price I was paying locally, > but that includes overnight shipping.<< > >> > Sue M.

Response:

Jim, I’m wondering why you have to be using it so long. Wouldn’t it have done it’s work long before 6 months? "JimC" jchim…@vfr.net wrote:

<< I have been using the Amphotericin B for about six months now. I have had a history of chronic polyps and sinus infections, with polyps having to be removed about every 3-6 months. Since I have been on this drug there has been no recurrence of polyps and I’ve had no sinus infections. There is now a shortage of this drug in the U.S., which I find is strangely coincidental with the Mayo Clinic getting a patent on the use of this generic drug for sinus disease.>> Sue M.

Response:

Would you be kind enough to detail how you use the ampho? Do you add to distilled water? How much and how often? Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/

Response:

My pharmacist mixes 100mg of Ampho B IV in 1000ml of sterile water. I then irrigate each nostril with 20cc’s of the solution twice a day. "ENTconsult" <entcons…@aol.comnospam> wrote in message

news:20030501125220.04540.00000656@mb-m06.aol.com… – Hide quoted text — Show quoted text -> Would you be kind enough to detail how you use the ampho? Do you add to > distilled water? How much and how often? > Murray Grossan, M.D. > http://www.ent-consult.com > http://www.hydromedonline.com/presentingthehydropulse/

Response:

I have been using the Amphotericin B for about six months now. I have had a history of chronic polyps and sinus infections, with polyps having to be removed about every 3-6 months. Since I have been on this drug there has been no recurrence of polyps and I’ve had no sinus infections. There is now a shortage of this drug in the U.S., which I find is strangely coincidental with the Mayo Clinic getting a patent on the use of this generic drug for sinus disease. "aneil mishra" <aneil.mis…@mba.wfu.edu> wrote in message

news:d40ca53f.0304301610.2683d6b0@posting.google.com… – Hide quoted text — Show quoted text -> With New Patent, Mayo Clinic > Owns a Cure for the Sniffles > Center’s Sweeping Rights for Treatment > That Isn’t Yet Proven Angers Others > By PETER LANDERS > Staff Reporter of THE WALL STREET JOURNAL > ROCHESTER, Minn. — Jens Ponikau of the Mayo Clinic says he has made a > breakthrough in treating one of America’s most common diseases. Now > Mayo has made a breakthrough of its own: It locked up the rights to > that discovery. > The disease is chronic inflammation of the sinuses, which leaves some > 32 million Americans with a persistent stuffy nose. Dr. Ponikau, a > 37-year-old German citizen, believes the condition is caused by an > immune response to common fungi in the air. In his nine-year quest to > prove his ideas, colleagues have called him crazy. Even his father, an > ear, nose and throat doctor in Hof, Germany, suggested that Dr. > Ponikau drop his research and return to the family clinic. > The Mayo Clinic is adding a modern twist to this age-old tale of a > maverick scientist challenging established medicine. Tuesday, the > nonprofit clinic captured an unusually broad patent that could give it > a chokehold over a new generation of treatments for chronic sinus > inflammation, or sinusitis. > The patent, in effect, blocks others from selling an antifungal agent > to treat the condition without Mayo’s approval. That adds to a > similarly broad patent Mayo received in 2001 for treatment of chronic > asthma, a disease that Dr. Ponikau says has the same cause. Mayo filed > both patents, which received little public notice, in October 1998. > Broad patents such as Mayo’s, called "method patents," are rare for a > basic reason: Researchers very rarely claim to have discovered the > root causes of a disease. In most cases, researchers seek to patent > only specific treatments. Approval by the patent office doesn’t mean > that a product is considered safe or effective — just that the rights > to that product are protected. > The new patent may add to the growing debate about nonprofits’ role as > handmaidens to the drug companies, doing the high-risk basic research > that shareholders won’t pay for. Some critics fear nonprofits will > grow so enamored of that role that they will neglect research without > commercial potential. Meanwhile, the patent is also likely to add to > the already fierce criticism of Dr. Ponikau and Mayo by some doctors, > who accuse the clinic of blocking future innovation by stifling > research. "That is ethically wrong," says Berrylin J. Ferguson, a > sinus specialist at the University of Pittsburgh. > Dr. Ponikau and Mayo executives disagree. They say they sought the > broadest possible patents because they wanted to be sure that they > could attract a pharmaceutical company to license the patents and > bring the advances to patients. As is typical at research > institutions, the clinic owns the patents obtained by employees such > as Dr. Ponikau, although he is eligible for a portion of future > royalties. > "Nobody will put the resources behind this if you don’t have a > patent," says Dr. Ponikau. "This whole thing will die if we don’t do > this." Mayo will soon enter negotiations to license its patents, and > officials say they’re looking for a drug company that can sell an > antifungal spray world-wide. > The Food and Drug Administration has yet to approve any drugs for > chronic sinusitis, although it is common for doctors to prescribe > inhaled steroids or antihistamines. America’s 17 million asthmatics do > have several FDA-approved drugs, but these merely relieve the symptoms > of the disease and many have severe side effects, such as glaucoma and > weight gain. Asthma kills more than 4,000 people each year in the U.S. > Dr. Ponikau says his quest to solve the sinusitis mystery goes back to > an assignment he received in 1994 during a six-month stint at Mayo. > Eugene Kern, a veteran ear, nose and throat expert at Mayo, asked him > to do a report on a handful of seemingly anomalous cases in which > fungi — a common class of organism that includes molds and yeasts — > were detected in patients with chronically inflamed sinuses. The > problem: Many patients had symptoms that suggested an immune response > to fungi, but actual fungi were detected in only 3% to 4% of them. Dr. > Ponikau headed home to his father’s small ear, nose and throat clinic > in Hof convinced that fungi must exist in more patients. > The answer lay in an unorthodox area of investigation: human mucus. > Traditionally, pathologists have studied sinusitis by examining the > excised tissue of patients who undergo sinus surgery. In such surgery, > doctors usually suction out the mucus first and discard it. By > removing the mucus, which traps dust and other particles in the > airways, "you destroy the evidence," says Dr. Ponikau, chuckling at > the way scientists sometimes miss clues right under their noses. "You > won’t believe what we all did to make sure we didn’t find anything." > For more health coverage, visit the Online Journal’s Health Industry > Edition at wsj.com/health1 and receive daily Health e-mails2. > At the Hof clinic, Dr. Ponikau took liquefied mucus samples and ran > them through a centrifuge that would force any fungi to drift to the > bottom. When he put the solution on a bed of nutrients, fungi grew > like crazy, proving they had been present in the original mucus. > He proceeded to offer a few patients at the clinic an antifungal > solution. Soon noses that had been stuffed for years cleared up. Dr. > Ponikau called Dr. Kern at the Mayo Clinic and told him of the > results. "Buy an airplane ticket and get here right away!" Dr. Kern > remembers responding. > Dr. Ponikau persuaded his then-girlfriend to go with him to Minnesota. > (Today they are married with two children and have settled in > Rochester.) He had less luck convincing his father, Joachim, that it > was the right move. According to Dr. Ponikau, his father wanted to > know: "Why don’t you get a real job?" The elder Dr. Ponikau says he > was concerned that his son would "toil for years researching something > no one would take seriously … even though he might have the right > idea." > Soon after returning to Mayo in 1996 as a full-time researcher, Dr. > Ponikau came upon what looked like a fatal flaw in his theory: The > fungi were present not only in sick people but also in healthy ones. > David Sherris, a Mayo ear, nose and throat doctor who would become Dr. > Ponikau’s closest collaborator, feared the research was at a dead end > and joked with Dr. Ponikau that Mayo might as well put the "crazy > German" on a boat back home. > But, Dr. Ponikau wondered, if the fungi were harmless bystanders, why > did the antifungal treatments seem to help his patients in Hof? Once > again, the answer lay in the patients’ mucus. When Dr. Ponikau put > samples under an electron microscope, he discovered white blood cells > called eosinophils clustering around the fungi. These cells, which > help fight off infection, were well-known to occur in the sinus tissue > of patients, but the reason for their presence wasn’t known. > Dr. Ponikau realized that the white blood cells were marching through > the sinus tissue to get to the open space of the sinus, a gathering > space for fungi that the patients inhaled. Once there, the white blood > cells fired off toxins to subdue the fungi — but the toxins also were > destroying the outer lining of the sinus tissue, clearing the way for > a bacterial infection that caused inflammation. Dr. Ponikau then > looked at the mucus of healthy people. The eosinophil cells were > absent, meaning the destructive immune-system response never got > started. > In 1999, Dr. Ponikau published his theory, and many specialists > scoffed. "I think it’s fundamentally flawed," Dr. Ferguson of the > University of Pittsburgh told the Washington Post. > Many veteran nose doctors believe Dr. Ponikau’s theory accounts for > only a small fraction of sinusitis cases. They think other factors are > more likely to be responsible, such as bacterial infections with other > causes and different kinds of immune responses. Ralph Metson of the > Massachusetts Eye and Ear Infirmary says he’s tried antifungal agents > on some patients, and "I’ve not been impressed with the improvement." > Dr. Ponikau insists that some veteran doctors are stuck in old > textbooks and want to keep up demand for sinus surgery. The procedure, > which removes sinus tissue to give a patient more breathing room, can > cost $10,000 or more. "It’s such a step out of the box," he says. > "We’re telling everybody else they’ve been wrong for 30 years." > Dr. Ponikau has won over one of the field’s biggest guns — Heinz > Stammberger, a pioneer in sinus surgery at Austria’s University of > Graz. Dr. Stammberger says that when he first read the Mayo paper in > 1999, he assumed the report of fungus everywhere was a mistake. But > when his lab replicated the results, he changed his mind. "We’re > talking about a significant group of patients," he now says, adding > that Dr. Ponikau’s research is "the most exciting step in many, many > years." > Mayo doctors have now prescribed their antifungal agents to more than > 1,000 patients, making it a standard treatment for chronic sinusitis > at the clinic, although the method isn’t approved by

Response:

With New Patent, Mayo Clinic Owns a Cure for the Sniffles Center’s Sweeping Rights for Treatment That Isn’t Yet Proven Angers Others By PETER LANDERS Staff Reporter of THE WALL STREET JOURNAL ROCHESTER, Minn. — Jens Ponikau of the Mayo Clinic says he has made a breakthrough in treating one of America’s most common diseases. Now Mayo has made a breakthrough of its own: It locked up the rights to that discovery. The disease is chronic inflammation of the sinuses, which leaves some 32 million Americans with a persistent stuffy nose. Dr. Ponikau, a 37-year-old German citizen, believes the condition is caused by an immune response to common fungi in the air. In his nine-year quest to prove his ideas, colleagues have called him crazy. Even his father, an ear, nose and throat doctor in Hof, Germany, suggested that Dr. Ponikau drop his research and return to the family clinic. The Mayo Clinic is adding a modern twist to this age-old tale of a maverick scientist challenging established medicine. Tuesday, the nonprofit clinic captured an unusually broad patent that could give it a chokehold over a new generation of treatments for chronic sinus inflammation, or sinusitis. The patent, in effect, blocks others from selling an antifungal agent to treat the condition without Mayo’s approval. That adds to a similarly broad patent Mayo received in 2001 for treatment of chronic asthma, a disease that Dr. Ponikau says has the same cause. Mayo filed both patents, which received little public notice, in October 1998. Broad patents such as Mayo’s, called "method patents," are rare for a basic reason: Researchers very rarely claim to have discovered the root causes of a disease. In most cases, researchers seek to patent only specific treatments. Approval by the patent office doesn’t mean that a product is considered safe or effective — just that the rights to that product are protected. The new patent may add to the growing debate about nonprofits’ role as handmaidens to the drug companies, doing the high-risk basic research that shareholders won’t pay for. Some critics fear nonprofits will grow so enamored of that role that they will neglect research without commercial potential. Meanwhile, the patent is also likely to add to the already fierce criticism of Dr. Ponikau and Mayo by some doctors, who accuse the clinic of blocking future innovation by stifling research. "That is ethically wrong," says Berrylin J. Ferguson, a sinus specialist at the University of Pittsburgh. Dr. Ponikau and Mayo executives disagree. They say they sought the broadest possible patents because they wanted to be sure that they could attract a pharmaceutical company to license the patents and bring the advances to patients. As is typical at research institutions, the clinic owns the patents obtained by employees such as Dr. Ponikau, although he is eligible for a portion of future royalties. "Nobody will put the resources behind this if you don’t have a patent," says Dr. Ponikau. "This whole thing will die if we don’t do this." Mayo will soon enter negotiations to license its patents, and officials say they’re looking for a drug company that can sell an antifungal spray world-wide. The Food and Drug Administration has yet to approve any drugs for chronic sinusitis, although it is common for doctors to prescribe inhaled steroids or antihistamines. America’s 17 million asthmatics do have several FDA-approved drugs, but these merely relieve the symptoms of the disease and many have severe side effects, such as glaucoma and weight gain. Asthma kills more than 4,000 people each year in the U.S. Dr. Ponikau says his quest to solve the sinusitis mystery goes back to an assignment he received in 1994 during a six-month stint at Mayo. Eugene Kern, a veteran ear, nose and throat expert at Mayo, asked him to do a report on a handful of seemingly anomalous cases in which fungi — a common class of organism that includes molds and yeasts — were detected in patients with chronically inflamed sinuses. The problem: Many patients had symptoms that suggested an immune response to fungi, but actual fungi were detected in only 3% to 4% of them. Dr. Ponikau headed home to his father’s small ear, nose and throat clinic in Hof convinced that fungi must exist in more patients. The answer lay in an unorthodox area of investigation: human mucus. Traditionally, pathologists have studied sinusitis by examining the excised tissue of patients who undergo sinus surgery. In such surgery, doctors usually suction out the mucus first and discard it. By removing the mucus, which traps dust and other particles in the airways, "you destroy the evidence," says Dr. Ponikau, chuckling at the way scientists sometimes miss clues right under their noses. "You won’t believe what we all did to make sure we didn’t find anything." For more health coverage, visit the Online Journal’s Health Industry Edition at wsj.com/health1 and receive daily Health e-mails2. At the Hof clinic, Dr. Ponikau took liquefied mucus samples and ran them through a centrifuge that would force any fungi to drift to the bottom. When he put the solution on a bed of nutrients, fungi grew like crazy, proving they had been present in the original mucus. He proceeded to offer a few patients at the clinic an antifungal solution. Soon noses that had been stuffed for years cleared up. Dr. Ponikau called Dr. Kern at the Mayo Clinic and told him of the results. "Buy an airplane ticket and get here right away!" Dr. Kern remembers responding. Dr. Ponikau persuaded his then-girlfriend to go with him to Minnesota. (Today they are married with two children and have settled in Rochester.) He had less luck convincing his father, Joachim, that it was the right move. According to Dr. Ponikau, his father wanted to know: "Why don’t you get a real job?" The elder Dr. Ponikau says he was concerned that his son would "toil for years researching something no one would take seriously … even though he might have the right idea." Soon after returning to Mayo in 1996 as a full-time researcher, Dr. Ponikau came upon what looked like a fatal flaw in his theory: The fungi were present not only in sick people but also in healthy ones. David Sherris, a Mayo ear, nose and throat doctor who would become Dr. Ponikau’s closest collaborator, feared the research was at a dead end and joked with Dr. Ponikau that Mayo might as well put the "crazy German" on a boat back home. But, Dr. Ponikau wondered, if the fungi were harmless bystanders, why did the antifungal treatments seem to help his patients in Hof? Once again, the answer lay in the patients’ mucus. When Dr. Ponikau put samples under an electron microscope, he discovered white blood cells called eosinophils clustering around the fungi. These cells, which help fight off infection, were well-known to occur in the sinus tissue of patients, but the reason for their presence wasn’t known. Dr. Ponikau realized that the white blood cells were marching through the sinus tissue to get to the open space of the sinus, a gathering space for fungi that the patients inhaled. Once there, the white blood cells fired off toxins to subdue the fungi — but the toxins also were destroying the outer lining of the sinus tissue, clearing the way for a bacterial infection that caused inflammation. Dr. Ponikau then looked at the mucus of healthy people. The eosinophil cells were absent, meaning the destructive immune-system response never got started. In 1999, Dr. Ponikau published his theory, and many specialists scoffed. "I think it’s fundamentally flawed," Dr. Ferguson of the University of Pittsburgh told the Washington Post. Many veteran nose doctors believe Dr. Ponikau’s theory accounts for only a small fraction of sinusitis cases. They think other factors are more likely to be responsible, such as bacterial infections with other causes and different kinds of immune responses. Ralph Metson of the Massachusetts Eye and Ear Infirmary says he’s tried antifungal agents on some patients, and "I’ve not been impressed with the improvement." Dr. Ponikau insists that some veteran doctors are stuck in old textbooks and want to keep up demand for sinus surgery. The procedure, which removes sinus tissue to give a patient more breathing room, can cost $10,000 or more. "It’s such a step out of the box," he says. "We’re telling everybody else they’ve been wrong for 30 years." Dr. Ponikau has won over one of the field’s biggest guns — Heinz Stammberger, a pioneer in sinus surgery at Austria’s University of Graz. Dr. Stammberger says that when he first read the Mayo paper in 1999, he assumed the report of fungus everywhere was a mistake. But when his lab replicated the results, he changed his mind. "We’re talking about a significant group of patients," he now says, adding that Dr. Ponikau’s research is "the most exciting step in many, many years." Mayo doctors have now prescribed their antifungal agents to more than 1,000 patients, making it a standard treatment for chronic sinusitis at the clinic, although the method isn’t approved by the FDA. A study published last year by the Mayo team showed that a common, generic antifungal drug, amphotericin B, reduced nasal obstruction in 38 of 51 patients, removing it completely in 25 cases. (Daily doses of the drug are needed to prevent recurrence.) A larger placebo-controlled double-blind trial is now under way at Mayo. Long-term effects of the treatment, including potential side effects, aren’t known yet. Side effects of amphotericin B — when used in other treatments — could include fever and vomiting. At this point, there’s nothing to stop a doctor from prescribing a standard antifungal drug such as amphotericin B for sinusitis. But few doctors are familiar with the treatment, and a pharmacist would have to prepare the drug — which comes in a variety of forms, from ointments to pills — so that it could be taken nasally. The Mayo Clinic says it doesn’t plan to … read more »

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Mayo Clinic/Fungal Sensitivity in 4-30-03 WSJ article

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