Evaluation and treatment of allergic fungal sinusitis. II

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Presentation transcript:

Evaluation and treatment of allergic fungal sinusitis. II Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up Mark S. Schubert, MD, PhDa, David W. Goetz, MD, PhDb Journal of Allergy and Clinical Immunology Volume 102, Issue 3, Pages 395-402 (September 1998) DOI: 10.1016/S0091-6749(98)70126-5 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Requirement for repeat sinus surgery during follow-up of AFS is significantly correlated with increase of 10% or more in total IgE. If increase of 10% or more in total serum IgE is used as a test for recurrent sinus disease that requires additional surgical intervention, test sensitivity is 79%, specificity is 77%, positive predictive value is 48%, and negative predictive value is 93% (P < .0001). Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Severity of clinical rhinosinusitis at any time during clinical course of AFS is significantly associated with concurrent total serum IgE. total serum lgE (IU/mL) is shown as mean ± SEM. Number of clinical data points (n) for each rhinosinusitis severity is shown. Individual comparisons were significant for none versus severe (P < .0001), moderate (P = .004), and mild rhinosinusitis (P = .02); overall P = .0002. Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Change in clinical rhinosinusitis severity between evaluations is significantly associated with concurrent change in total serum IgE. Percent change in total serum IgE (mean ± SEM) and number of clinical data points (n) are shown for each change in clinical rhinosinusitis severity. Individual comparisons were significant for decrease versus increase in severity (P < .0001) and for no change versus increase in severity (P = .003); overall P < .0001. Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Severity of clinical rhinosinusitis at any time during the clinical course of AFS is significantly associated with the concurrent B spicifera specific –IGG. Specific IGG (U/ML) is shown as mean ± SEM. Number of clinical data points (n) for each rhinosinusitis severity is shown. individual comparisons were significant for none versus severe (P = .0004) and moderate versus severe rhinosinusitis (P = .04); overall P = .004. Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Rhinosinusitis severity 2 months after surgical intervention was significantly superior when patients were treated with OCS compared with not receiving OCS. Number of clinical data points is shown above each bar (P < .0001). Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 6 rhinosinusitis severity 12 months after surgical intervention was significantly superior when patients were treated with OCS for 12 months compared with treatment with ocs for less than 12 months and with no ocs during the 12 months. number of clinical data points is shown above each bar (P = .03). Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 7 Survival analysis describing time to recurrence of rhinosinusitis surgical intervention in all patients with AFS entered into study. If patients received at least 2 months of OCS treatment, time to recurrence was significantly longer than if OCS were not given (P = .01). Journal of Allergy and Clinical Immunology 1998 102, 395-402DOI: (10.1016/S0091-6749(98)70126-5) Copyright © 1998 Mosby, Inc. Terms and Conditions