Itraconazole in the Treatment of Refractory Allergic Fungal
Rhinosinusitis
Date and Time: Sunday, Sep 19, 11:30 am to 11:38 am
Location: Room Special Events Hall DMR
Category: Rhinology


Authors
Amin R Javer, MD , Kwai Onn Chan, MD  (Presenter)


Abstract
Objectives: The conventional management of Allergic Fungal Sinusitis
(AFS) after surgery consists of systemic and topical steroids to
immunomodulate the body¡¦s response to fungi. However, there are
significant side effects to prolonged steroid use and there are a
group of patients who are unresponsive to standard treatment. The role
of systemic anti-fungal drugs in AFS is still largely unknown. This
pilot study was carried out to evaluate the effectiveness of
itraconazole, an oral anti-fungal drug in the treatment of refractory
AFS.

Methods: Twenty-four patients with AFS who had had image-guided
surgery and were refractory to prednisone, topical steroid and
Amphotericin B nasal sprays were treated with itraconazole for at
least three months. All patients were evaluated with pre and
post-treatment endoscopic examinations, serum IgE and RSOM-31
questionnaires. Monthly liver function tests were done to monitor for
hepatic side effects of itraconazole.

Results: Nine patients had an improvement in endoscopic stage. Nine
had no difference and five had a worse endoscopic stage after three
months. One patient had to stop treatment due to abnormal liver
function tests. Mean pre-treatment IgE was 722ƒÝg/L and post-treatment
IgE was 700ƒÝg/L. Subjectively, seven patients reported significant
improvement, eight had moderate improvements and eight reported little
or no change. No correlation was noted between the subjective and the
endoscopic findings.

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