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Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients

Abstract

Background

Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic.

Patients and Methods

A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months.

Results

Patients of group B were better clinically and also by endoscopic examination.

Conclusion

Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.

References

  1. 1

    Nikakhlagh S, Khodadadi A, Kanani M, Karampour L, Saki N. The effect of the oral itraconazole on the management of allergic fungal sinusitis. Biomed Pharmacol J 2015; 8:85–89.

    Article  Google Scholar 

  2. 2

    Ryan M, Clark C. Allergic fungal rhinosinusitis and the unified airway: the role of antifungal therapy in AFRS. Curr Allergy Asthma Rep 2015; 15:75.

    Article  Google Scholar 

  3. 3

    Khalil Y, Tharwat A, Abdou A, Essa E, Elsawy AH, Elnaidany NF. The role of antifungal therapy in the prevention of recurrent allergic fungal rhinosinusitis after functional endoscopic sinus surgery: a randomized controlled study. Ear Nose Throat J 2011; 90:E1–7.

    Article  Google Scholar 

  4. 4

    Rojita M, Samal S, Pradhan P, Venkatachalam V. Comparison of steroid and itraconazole for prevention of recurrence in allergic fungal rhinosinusitis: a randomized controlled trial. J Clin Diagn Res 2017; 11: MC01–MC03.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. 5

    Kuhn F, Javer A. Allergic fungal sinusitis: a four year follow up. Am J Rhinol 2000; 14:149–156.

    CAS  Article  Google Scholar 

  6. 6

    Bent J, Kuhn F. Antifungal activity against allergic fungal sinusitis organisms. Laryngoscope 1996; 106:1331–1334.

    Article  Google Scholar 

  7. 7

    Ferguson B. Categorization of eosinophilic chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2004; 12:237–242.

    Article  Google Scholar 

  8. 8

    Kuhn F, Javer A. Allergic fungal rhinosinusitis: our experience. Arch Otolaryngol Head Neck Surg 1998; 124:1179–1180.

    CAS  Article  Google Scholar 

  9. 9

    Marple B, Marby R. Allergic fungal sinusitis: learning from our failure. Am J Rhinol 2000; 14:223–226.

    CAS  Article  Google Scholar 

  10. 10

    Gupta A, Shah N, Kamezwaran M, Rai D, Janakiram TN, Chopra H, et al. Allergic fungal rhinosinusitis. Clin Rhinol An Int J 2012; 5:72–86.

    Article  Google Scholar 

  11. 11

    Chan K, Genoway K, Javer A. Effectiveness of itraconazole in the management of refractory allergic fungal rhinosinusitis. J Otolaryngol Head Neck Surg 2008; 37:870–874.

    PubMed  Google Scholar 

  12. 12

    Shubert M, Goetz D. Evaluation and treatment of allergic fungal sinusitis. J Allergy Clin Immunol 1998; 102:395–402.

    Article  Google Scholar 

  13. 13

    Rains B, Mineck C. Treatment of allergic fungal sinusitis with high dose itraconazole. Am J Rhinol 2003; 17:1–8.

    Article  Google Scholar 

Download references

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Correspondence to Ramez Reda MD.

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Reda, R., Wageh, W., Fawaz, M. et al. Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients. Egypt J Otolaryngol 35, 25–29 (2019). https://doi.org/10.4103/ejo.ejo_64_18

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Keywords

  • allergic fungal rhinosinusitis
  • antifungal treatment
  • itraconazole