Skip to main content
  • Original article
  • Open access
  • Published:

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

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

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

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ramez Reda MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejo.ejo_64_18

Keywords