Treatment of allergic fungal sinusitis: a comparison trial of postoperative immunotherapy with specific fungal antigens.
OBJECTIVE
To determine the effect of immunotherapy (IT) with fungal antigens on clinical outcome in patients with allergic fungal sinusitis (AFS).


METHODS
Prospective case control.


METHODS
In this comparison study, 22 patients meeting the diagnostic criteria of allergic fungal sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent sinusitis. Eleven patients received postoperative immunotherapy (IT) with fungal and nonfungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy.


RESULTS
The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P < .001) and a sinusitis-specific quality-of-life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P < .001) and topical nasal (P = .043) corticosteroid therapy to control disease. Follow-up was similar in the two groups and was not a determinant of differences in outcome (P = .7).


CONCLUSIONS
Results from this study indicate that specific IT with fungal antigens improves patient outcome in AFS.
Folker
R J
RJ
Department of Otorhinolaryngology, University of Texas Southwestern Medical Center, Dallas 75235-9035, USA.
Marple
B F
BF
Mabry
R L
RL
Mabry
C S
CS
D000281:Administration, Intranasal; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000627:therapeutic use*; D016022:Case-Control Studies; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000601:surgery / Q000628:therapy; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D011182:Postoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012130:Respiratory Hypersensitivity / Q000601:surgery / Q000628:therapy*; D012852:Sinusitis / Q000276:immunology / Q000382:microbiology* / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000946:Antigens, Fungal