| Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up. | |
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MedLine Citation:
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PMID: 9768579 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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M S Schubert; D W Goetz |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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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:
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Created Date: 1998-11-05 Completed Date: 1998-11-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1275002 Medline TA: J Allergy Clin Immunol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 395-402 Citation Subset: AIM; IM |
Affiliation:
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Allergy Asthma Clinic, Phoenix, Ariz 85013, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Cortex Hormones
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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:
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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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