Fungal immunotherapy in patients with allergic fungal sinusitis.
BACKGROUND
Allergic fungal sinusitis is a disease for which optimal treatment is unclear. Previous studies using fungal immunotherapy reported less recurrence after surgery. There has been concern that traditional high-dose immunotherapy could induce systemic hypersensitivity in patients with this condition.


OBJECTIVE
To determine the safety of high-dose subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis.


METHODS
Safety of high-dose subcutaneous fungal immunotherapy was assessed in 14 patients from our clinic who met diagnostic criteria for allergic fungal sinusitis. Results were compared to a control group of 14 patients with chronic rhinosinusitis without allergic fungal sinusitis who received subcutaneous fungal immunotherapy. We also performed a literature search to identify all previous reports of subcutaneous fungal immunotherapy.


RESULTS
No differences between numbers of immediate local or large local reactions, delayed local reactions, or required dose adjustments were noted between patient and control groups. One patient from each group experienced a mild systemic urticarial reaction to immunotherapy. Similarly, there were no differences in complications in either group that also received immunotherapy with nonfungal allergens. No patient developed evidence of immune complex disease. Eight publications were identified for inclusion in our literature analysis, 7 of which used low-dose subcutaneous immunotherapy. None of these noted complications more serious than local reactions.


CONCLUSIONS
Our data demonstrate that subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis is unlikely to cause adverse reactions other than those occurring with pollen immunotherapy. Clinical trials of high-dose, traditional immunotherapy with fungal allergens for efficacy may proceed in patients with allergic fungal sinusitis without undue concern.
Department of Medicine, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson, USA.
Bradley
B
Greenhaw
Richard D
RD
deShazo
Jeanette
J
Arnold
Leigh
L
Wright
D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects*; D000946:Antigens, Fungal / Q000008:administration & dosage / Q000009:adverse effects*; D003888:Desensitization, Immunologic; D054796:Drug Dosage Calculations; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005658:Fungi; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D010256:Paranasal Sinuses / Q000187:drug effects / Q000276:immunology / Q000382:microbiology; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D012852:Sinusitis; D014581:Urticaria / Q000209:etiology
D000485:Allergens; D000946:Antigens, Fungal; D004364:Pharmaceutical Preparations