RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up.
Journal of Allergy and Clinical Immunology 1998 September
BACKGROUND: Previous allergic fungal sinusitis case reports have speculated that oral corticosteroids might reduce the severity of disease and possibly forestall the high rate of recurrent sinus surgery.
OBJECTIVES: Our objective was to comprehensively review 67 consecutive cases of allergic fungal sinusitis for their response to treatment and the utility of monitoring patient serologies during clinical follow-up.
METHODS: Allergic fungal sinusitis cases from a private practice were evaluated and treated with consistent diagnostic criteria and treatment paradigms. An 8-year retrospective review of serologic parameters and clinical response to treatment with or without oral corticosteroids is described.
RESULTS: The total serum IgE was found to correlate with the clinical rhinosinusitis severity (P = .0002). The fungal-specific IgG also correlated with clinical rhinosinusitis severity but less rigorously (P = .004). An increase of 10% or more in total serum IgE during follow-up was found to have significant predictive value for recurrent surgical intervention, with a sensitivity of 79%, specificity of 77%, positive predictive value of 48%, and negative predictive value of 93% (P < .0001). With the use of a modified corticosteroid treatment regimen adapted from allergic bronchopulmonary aspergillosis, as little as 2 months of oral corticosteroids after surgery provided significant clinical improvement for up to 12 months (P < .0001), although patients taking 12 months of treatment fared the best clinically (P = .03). By survival analysis, oral corticosteroids prolonged the time between subsequent sinus surgeries (P = .01) in this highly recurrent disease. No significant side effects of oral corticosteroids were observed during treatment with this dosing regimen.
CONCLUSIONS: Postoperative oral corticosteroids appear to be an effective treatment option for allergic fungal sinusitis, and monitoring of total serum IgE can be helpful in the clinical follow-up of these patients.
OBJECTIVES: Our objective was to comprehensively review 67 consecutive cases of allergic fungal sinusitis for their response to treatment and the utility of monitoring patient serologies during clinical follow-up.
METHODS: Allergic fungal sinusitis cases from a private practice were evaluated and treated with consistent diagnostic criteria and treatment paradigms. An 8-year retrospective review of serologic parameters and clinical response to treatment with or without oral corticosteroids is described.
RESULTS: The total serum IgE was found to correlate with the clinical rhinosinusitis severity (P = .0002). The fungal-specific IgG also correlated with clinical rhinosinusitis severity but less rigorously (P = .004). An increase of 10% or more in total serum IgE during follow-up was found to have significant predictive value for recurrent surgical intervention, with a sensitivity of 79%, specificity of 77%, positive predictive value of 48%, and negative predictive value of 93% (P < .0001). With the use of a modified corticosteroid treatment regimen adapted from allergic bronchopulmonary aspergillosis, as little as 2 months of oral corticosteroids after surgery provided significant clinical improvement for up to 12 months (P < .0001), although patients taking 12 months of treatment fared the best clinically (P = .03). By survival analysis, oral corticosteroids prolonged the time between subsequent sinus surgeries (P = .01) in this highly recurrent disease. No significant side effects of oral corticosteroids were observed during treatment with this dosing regimen.
CONCLUSIONS: Postoperative oral corticosteroids appear to be an effective treatment option for allergic fungal sinusitis, and monitoring of total serum IgE can be helpful in the clinical follow-up of these patients.
Full text links
Trending Papers
Fluid Resuscitation in Patients with Cirrhosis and Sepsis: A Multidisciplinary Perspective.Journal of Hepatology 2023 March 2
Glucagon-Like Peptide 1 Receptor Agonists Versus Sodium-Glucose Cotransporter 2 Inhibitors for Atherosclerotic Cardiovascular Disease in Patients With Type 2 Diabetes.Cardiology Research 2023 Februrary
Management of Heart Failure With Preserved Ejection Fraction in Elderly Patients: Effectiveness and Safety.Curēus 2023 Februrary
Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association.Circulation 2023 March 17
What's New in the Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD).Journal of Clinical Medicine 2023 Februrary 27
Physical interventions to interrupt or reduce the spread of respiratory viruses.Cochrane Database of Systematic Reviews 2023 January 31
Long COVID: major findings, mechanisms and recommendations.Nature Reviews. Microbiology 2023 January 14
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app