Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up.
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.


OBJECTIVE
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.
Schubert
M S
MS
Allergy Asthma Clinic, Phoenix, Ariz 85013, USA.
Goetz
D W
DW
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000097:blood / Q000150:complications / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000097:blood / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D012220:Rhinitis / Q000097:blood / Q000209:etiology / Q000628:therapy; D012852:Sinusitis / Q000097:blood / Q000209:etiology / Q000628:therapy*
D000305:Adrenal Cortex Hormones; D007073:Immunoglobulin E