title: Natural history of allergic fungal rhinosinusitis: a 4- to 10-year follow-up.
abstract: BACKGROUND
  Numerous studies have noted the high rate of recidivism after the initial treatment of allergic fungal rhinosinusitis (AFS). Short-term studies have revealed varying recurrence rates based on therapy; however, little is currently known about the long-term natural history of the disease.
  
  
  OBJECTIVE
  Our goal was to address the question of long-term outcomes in AFS patients and make observations about the natural history of the disease.
  
  
  METHODS
  Seventeen patients with follow-up ranging from 46 to 138 months were examined and interviewed, and their charts were reviewed. A quality-of-life survey was completed, and blood was drawn to measure immunoglobulin levels.
  
  
  RESULTS
  All patients initially underwent treatment with a combination of surgery, systemic and/or topical corticosteroids, and immunotherapy to pertinent fungal and nonfungal antigens. Normalization of sinonasal mucosa (Kupferberg stage 0) was seen in 5 (29%) of 17 patients, whereas 76% demonstrated either normal or slight mucosal edema (Kupferberg stage 0 or 1). Serologic testing revealed fungus-specific IgE significantly elevated in all 17 patients.
  
  
  CONCLUSIONS
  The initial choice of therapy did not appear to affect the long-term outcome, and patients tended to be doing well overall. These results suggest that after successful initial treatment and control of AFS, many patients can achieve a quiescent disease state.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas-Southwestern Medical Center, Dallas 75390, USA. bradley.marple@utsouthwestern.edu
authors.forename: Bradley
authors.initials: B
authors.lastname: Marple
authors.forename: Mark
authors.initials: M
authors.lastname: Newcomer
authors.forename: Nathan
authors.initials: N
authors.lastname: Schwade
authors.forename: Richard
authors.initials: R
authors.lastname: Mabry
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012008:Recurrence; D012221:Rhinitis, Allergic, Perennial / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D012852:Sinusitis / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D013997:Time Factors
chemical_list: D007073:Immunoglobulin E