Q:

7/15/2014
I am aware of the standard use of prednisone in a patient with allergic fungal sinusitis. In some cases of ABPA I have used an oral antifungal as well when steroids alone seemed inadequate. Is there any experience/success with oral antifungal agents in allergic fungal sinusitis? (This 20 year old female patient has a CF variant, with severe sinusitis but totally normal chest, documented on spirometry and CT of chest. Fungal hyphae were removed from her sinuses in May 2014 during yet another sinus procedure.)

A:

Thank you for your inquiry.

Yes, there are several articles on the treatment of allergic fungal sinusitis with both topical and systemic antifungal agents. Results have varied. The references copied below will give you a sample of this literature (1-5). Reference Number 1 is a case report of successful treatment. It is available to you free of charge online using the link below the reference. Reference Number 4 also is a report of successful treatment. References Numbers 2, 3, and 5 are nice reviews of allergic fungal sinusitis which present discussions on the use of antifungal agents in the course of therapy and will give you further references in this regard.

Thank you again for your inquiry and we hope this response is helpful to you.

1) Clin Infect Dis. 2000 Jul;31(1):202-4. Report of successful prolonged antifungal therapy for refractory allergic fungal sinusitis. Andes D1, Proctor R, Bush RK, Pasic TR.

2) Allergic Fungal Sinusitis Treatment & Management

3) Clin Exp Allergy. 2013 Aug;43(8):835-49. doi: 10.1111/cea.12118. Fungal rhinosinusitis: what every allergist should know. Callejas CA1, Douglas RG.

4) Rains, B.M. III and Mineck, C.W. Treatment of allergic fungal sinusitis with high-dose itraconazole. Am J Rhinol. 2003; 17: 1–8.

5) Allergic fungal rhinosinusitis. Marianella Paz Silva, Fuad M. Baroody. DOI: http://dx.doi.org/10.1016/j.anai.2012.12.021. Annals of Allergy, Asthma & Immunology, Vol. 110, Issue 4, p217–222.
Published in issue: April, 2013

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology