Document Detail


Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up.
MedLine Citation:
PMID:  9768579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
M S Schubert; D W Goetz
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  102     ISSN:  0091-6749     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-11-05     Completed Date:  1998-11-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  395-402     Citation Subset:  AIM; IM    
Affiliation:
Allergy Asthma Clinic, Phoenix, Ariz 85013, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Adult
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Hypersensitivity / blood,  complications,  therapy*
Immunoglobulin E / blood
Male
Middle Aged
Mycoses / blood,  complications,  therapy*
Retrospective Studies
Rhinitis / blood,  etiology,  therapy
Sinusitis / blood,  etiology,  therapy*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 37341-29-0/Immunoglobulin E

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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