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The value of antifungal therapy in allergic fungal rhinosinusitis
Background:
Allergic fungal rhinosinusitis (AFS) is considered to part of the disease spectrum of chronic rhinosinusitis, which affects between five to fifteen per cent of the population. Currently, there is uncertainty relating to the pathological process and therefore optimal management of AFS. Studies assessing antifungal use have shown mixed results. The aim of this review is to assess the effect of antifungals on patients with AFS.
Methods:
A systematic review of the literature to include all published trials searching Pubmed, Medline (Ovid), CINAHL (EBSCO) and the Cochrane central register of controlled trials (CENTRAL) databases.
Results:
Sixteen studies (two systematic reviews, two meta-analysis, four randomised controlled trials, five prospective cohort studies and three retrospective studies) were included in this review. There was found to be no overall benefit of topical or oral antifungals upon endoscopic findings or patient reported outcome measures in AFS. There were no statistically significant differences in adverse effect profiles between treatment and control groups.
Conclusion:
There is limited evidence to support the use of topical or oral antifungal agents in patients with AFS. Future research recommendations include large multicentre randomised trials with better matched patient groups and appropriate dosage and timing of antifungals.
Insights
This review found no overall benefit of antifungal treatments for allergic fungal rhinosinusitis (AFS). Further research is needed to determine optimal management strategies for this common condition.
Area of Science:
- Otolaryngology
- Allergy Immunology
Background:
- Allergic fungal rhinosinusitis (AFS) is a common condition within the chronic rhinosinusitis spectrum, affecting 5-15% of the population.
- Current understanding of AFS pathology and optimal treatment remains uncertain, with mixed results from antifungal studies.
Purpose of the Study:
- To systematically review the existing literature on the efficacy of antifungal agents in managing AFS.
- To assess the impact of topical and oral antifungals on clinical outcomes and patient-reported measures in AFS patients.
Main Methods:
- A comprehensive systematic literature review was conducted.
- Searches included major databases like PubMed, Medline, CINAHL, and CENTRAL, encompassing various study designs.
Main Results:
- Sixteen studies were included, comprising systematic reviews, meta-analyses, RCTs, and cohort studies.
- No significant overall benefit of topical or oral antifungals was observed for endoscopic findings or patient-reported outcomes in AFS.
- Adverse event profiles did not differ significantly between antifungal treatment and control groups.
Conclusions:
- Limited evidence supports the use of topical or oral antifungals for AFS.
- Recommendations include conducting large, multicenter randomized trials with well-matched patient groups and optimized antifungal dosing and timing.
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