title: Effectiveness of itraconazole in the management of refractory allergic fungal rhinosinusitis.
abstract: OBJECTIVE
  Conventional management of allergic fungal rhinosinusitis (AFRS) after surgery consists of the use of steroids to immunomodulate the body's response to fungi. However, there are many side effects to prolonged steroid use, and some patients are unresponsive to standard treatment. The role of systemic antifungal drugs in AFRS is still largely unknown. This was a pilot study to evaluate the effectiveness of itraconazole, an oral antifungal drug, in the treatment of refractory AFRS.
  
  
  METHODS
  Thirty-two patients with AFRS who had had surgery and were refractory to prednisone, steroid, and amphotericin B nasal sprays were treated with itraconazole for at least 3 months. They were evaluated with pre- and posttreatment endoscopic examinations, serum immunoglobulin E (IgE), and the 31-Item Rhinosinusitis Outcome Measure (RSOM-31) questionnaires. Monthly liver function tests were done to monitor for the hepatic side effects of itraconazole.
  
  
  RESULTS
  Twelve cases had endoscopic improvement. Fifteen had no difference, and five had a worse endoscopic stage after 3 months. One patient had to stop treatment due to abnormal liver function tests. The mean pre- and posttreatment IgE levels were 581 microg/L and 766 microg/L, respectively. Subjectively, 9 patients (28%) reported a significant improvement, 9 (28%) had moderate improvements, and 14 (44%) reported little or no change. There was no correlation between the subjective and the endoscopic changes.
  
  
  CONCLUSIONS
  Itraconazole may be useful as an adjunct in the management of AFRS. However, more studies, including a prospective randomized clinical trial, are required to determine if itraconazole is effective in the management of AFRS.
authors.affiliation: Department of Otolaryngology, Changi General Hospital, Singapore.
authors.forename: Kwai-Onn
authors.initials: KO
authors.lastname: Chan
authors.forename: Krista A
authors.initials: KA
authors.lastname: Genoway
authors.forename: Amin R
authors.initials: AR
authors.lastname: Javer
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005658:Fungi; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012130:Respiratory Hypersensitivity / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole