Q:

11/16/2011
63 y/o white female with difficult sinus infection:
1. Fungal elements confirmed by ENT--CT sinuses shows pansinusitis
2. Doesn't respond to topical steroids or topical itraconazole given by NasoNeb (ASL pharmacy)
3. IgE of 1--no specific allergens on SPT
4. Normal antibody production and good response to Pneumovax
5. Is my treatment limited to oral steroids and/or oral Sporonox?
Any suggestions would be helpful. Thank-you.

A:

Thank you for your recent inquiry.

This type of recalcitrant sinusitis is, as you know, not uncommon in the practice of Allergy/Immunology. There is certainly no "easy answer." The therapy you mentioned is standard and along with antibiotics and is the cornerstone of treatment. However, there are several other modalities which you can consider. For example, other contributing conditions such as gastroesophageal reflux, ciliary dysfunction, et cetera, can be evaluated. Adjunctive therapies also can be utilized. A detailed discussion of these is beyond the scope of this response. However, there is an excellent succinct summary of all available treatments in the Allergy Parameters on Sinusitis (1). I have copied below, for your convenience, a link to the Parameters. The treatment section begins on Page S35. It discusses the evidence supporting other ancillary treatments.

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

Link:
http://allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/2005%20Sinusitis

Reference:
Slavin RG, et al. The diagnosis and management of sinusitis: a Practice Parameter update. J Allergy Clin Immunol 2006; 116:S13-47.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology