Abstract
11:30 AM
Objectives: The conventional management of allergic fungal sinusitis (AFS) after surgery consists of systemic and topical steroids to immunomodulate the body's response to fungi. However, there are significant side effects to prolonged steroid use and there are a group of patients who are unresponsive to standard treatment. The role of systemic antifungal drugs in AFS is still largely unknown. This pilot study was carried out to evaluate the effectiveness of itraconazole, an oral antifungal drug in the treatment of refractory AFS.
Methods: Twenty-four patients with AFS who had had image-guided surgery and were refractory to prednisone, topical steroid, and Amphotericin B nasal sprays were treated with itraconazole for at least 3 months. All patients were evaluated with pre- and posttreatment endoscopic examinations, serum IgE and RSOM-31 questionnaires. Monthly liver function tests were done to monitor for hepatic side effects of itraconazole.
Results: Nine patients had an improvement in endoscopic stage. Nine had no difference and 5 had a worse endoscopic stage after 3 months. One patient had to stop treatment due to abnormal liver function tests. Mean pretreatment IgE was 722 μg/L and posttreatment IgE was 700 μg/L. Subjectively, 7 patients reported significant improvement, 8 had moderate improvements, and 8 reported little or no change. No correlation was noted between the subjective and the endoscopic findings.
Conclusions: Itraconazole appears to have a modest benefit as an adjunct in the management of refractory AFS. Steroids continue to remain the mainstay of treatment and more research is needed to define the role of systemic antifungal drugs.