From the Guidelines
Allergic fungal sinusitis treatment should primarily involve surgical debridement of the involved sinuses, followed by postoperative medical management with oral corticosteroids and topical corticosteroid irrigation, as antifungal medications have limited evidence for effectiveness in this condition. The primary goal of treatment is to remove the antigenic stimulation and provide adequate drainage pathways, which can be achieved through endoscopic sinus surgery 1. Postoperative medical management should include oral corticosteroids, such as prednisone, starting at 0.5mg/kg/day with gradual taper over 2-3 months, and topical corticosteroid irrigation, such as budesonide 0.5mg/2mL mixed with 240mL saline, used twice daily.
Some key points to consider in the treatment of allergic fungal sinusitis include:
- The limited effectiveness of antifungal medications, including itraconazole, in reducing symptoms and preventing recurrence 1
- The importance of regular follow-up with an otolaryngologist to monitor for disease recurrence, which is common
- The need for patients to maintain good sinus hygiene with saline irrigations indefinitely after surgery
- The potential benefits of immunotherapy targeting specific fungal allergens for long-term management in patients with identified fungal sensitivities
It is essential to note that the treatment of allergic fungal sinusitis should be individualized, and the comprehensive approach should address both the mechanical obstruction and underlying inflammatory response that characterize this condition, with the goal of preventing recurrence and maintaining sinus health 1.
From the Research
Treatment Options for Allergic Fungal Sinusitis
- The management of allergic fungal sinusitis (AFS) includes a combination of functional endoscopic sinus surgery and medical treatment in the form of pre- and post-operative systemic steroids, local steroids, and allergic immunotherapy 2.
- Surgical debridement and systemic corticosteroids for less than four weeks followed by intranasal corticosteroids may provide long-term control of AFS 3.
- Postoperative systemic and standard topical nasal steroids are recommended in the medical management of AFRS, while nonstandard topical nasal steroids, oral antifungals, and immunotherapy are options in cases of refractory AFRS 4.
Role of Immunotherapy
- Immunotherapy using both fungal and nonfungal antigens to which hypersensitivity is demonstrated by in vitro and skin testing methods has been shown to be effective in treating patients with allergic fungal sinusitis 5.
- The triad of adequate surgery, frequent follow-up and medical management, and immunotherapy with relevant fungal and nonfungal antigens represents an effective means of treating patients with allergic fungal sinusitis 5.
Antifungal Therapy
- The use of itraconazole, short-burst low-dose oral corticosteroids, topical corticosteroids, and endoscopic surgery is a safe and clinically effective regimen in the management of AFS 6.
- Medical management of recurrent AFS with itraconazole may avoid revision surgery 6.