Treatment of allergic fungal sinusitis with high-dose itraconazole.
BACKGROUND
Since its original description in the early 1980s, our understanding of allergic fungal sinusitis (AFS) has continued to evolve. The goal of this research was to characterize the typical AFS patient and describe a treatment protocol using endoscopic sinus surgery, high-dose itraconazole, low-dose bursts of oral corticosteroids, and topical corticosteroids.


METHODS
A 12-year retrospective chart review was conducted to extract demographic and management data on 139 patients meeting the AFS criteria of atopy, characteristic radiographic findings, eosinophilic mucin, nasal polyposis, and a positive fungal culture or stain.


RESULTS
The typical AFS patient presented at 42.8 years of age, was female, and had 3.5 positive fungal cultures over an average of 31.4 months of follow-up. Although 69 patients (50.3%) experienced recurrence, reoperation was required in only 17 (20.5%) of 83 patients initially managed by our protocol. There were no serious adverse effects attributed to itraconazole over the 36,000 doses prescribed.


CONCLUSIONS
The use of itraconazole, short-burst low-dose oral corticosteroids, topical corticosteroids, and endoscopic surgery is a safe and clinically effective regimen in the management of AFS. Our clinical experience suggests medical management of recurrent AFS with itraconazole may avoid revision surgery.
Rains
B Manrin
BM
Mid-South Sinus Center, Memphis, Tennessee, 38018, USA.
Mineck
Corey W
CW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000009:adverse effects; D008111:Liver Function Tests; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012086:Reoperation; D012130:Respiratory Hypersensitivity / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000935:Antifungal Agents; D005938:Glucocorticoids; D017964:Itraconazole; D011241:Prednisone; D008775:Methylprednisolone