Immunotherapy for allergic fungal sinusitis: the second year

Area of Science:

• Otolaryngology
• Allergy and Immunology

Background:

• Allergic fungal sinusitis (AFS) is a non-invasive fungal hypersensitivity of the paranasal sinuses.
• Current treatment often involves surgical management, but recurrence rates can be high.

Purpose of the Study:

• To evaluate the efficacy of a treatment protocol for allergic fungal sinusitis.
• To assess the safety and effectiveness of immunotherapy as an adjunct to surgery for AFS.

Main Methods:

• Histologically confirmed AFS patients underwent surgical extirpation of involved sinuses.
• Post-surgery, patients received immunotherapy with fungal and nonfungal antigens based on hypersensitivity testing.
• Patients were monitored for symptom recurrence and need for corticosteroids.

Main Results:

• All patients experienced a marked decrease in nasal crusting.
• Recurrent polypoid mucosa and the need for corticosteroids (systemic or topical) were significantly reduced.
• No patients showed worsening of their condition due to immunotherapy; two with pre-existing residual disease improved after revision surgery and continued immunotherapy.

Conclusions:

• A treatment regimen combining adequate surgery, frequent follow-up, medical management, and immunotherapy with relevant antigens is effective for AFS.
• Immunotherapy appears safe and beneficial in managing AFS, reducing symptoms and corticosteroid dependence.
• Longer-term studies are needed to definitively establish the role of immunotherapy in AFS management.