Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up

Abstract

Background: Previous allergic fungal sinusitis case reports have speculated that oral corticosteroids might reduce the severity of disease and possibly forestall the high rate of recurrent sinus surgery. Objectives: Our objective was to comprehensively review 67 consecutive cases of allergic fungal sinusitis for their response to treatment and the utility of monitoring patient serologies during clinical follow-up. Methods: Allergic fungal sinusitis cases from a private practice were evaluated and treated with consistent diagnostic criteria and treatment paradigms. An 8-year retrospective review of serologic parameters and clinical response to treatment with or without oral corticosteroids is described. Results: The total serum IgE was found to correlate with the clinical rhinosinusitis severity ( P = .0002). The fungal-specific IgG also correlated with clinical rhinosinusitis severity but less rigorously ( P = .004). An increase of 10% or more in total serum IgE during follow-up was found to have significant predictive value for recurrent surgical intervention, with a sensitivity of 79%, specificity of 77%, positive predictive value of 48%, and negative predictive value of 93% ( P < .0001). With the use of a modified corticosteroid treatment regimen adapted from allergic bronchopulmonary aspergillosis, as little as 2 months of oral corticosteroids after surgery provided significant clinical improvement for up to 12 months ( P < .0001), although patients taking 12 months of treatment fared the best clinically ( P = .03). By survival analysis, oral corticosteroids prolonged the time between subsequent sinus surgeries ( P = .01) in this highly recurrent disease. No significant side effects of oral corticosteroids were observed during treatment with this dosing regimen. Conclusions: Postoperative oral corticosteroids appear to be an effective treatment option for allergic fungal sinusitis, and monitoring of total serum IgE can be helpful in the clinical follow-up of these patients. (J Allergy Clin Immunol 1998;102:395-402.)