Natural History of Allergic Fungal Rhinosinusitis: A 4- to 10-Year Follow-Up

Abstract

BACKGROUND: Numerous studies have noted the high rate of recidivism after the initial treatment of allergic fungal rhinosinusitis (AFS). Short–term studies have revealed varying recurrence rates based on therapy; however, little is currently known about the long–term natural history of the disease. OBJECTIVE: Our goal was to address the question of long–term outcomes in AFS patients and make observations about the natural history of the disease. PATIENTS AND METHODS: Seventeen patients with follow–up ranging from 46 to 138 months were examined and interviewed, and their charts were reviewed. A quality–of–life survey was completed, and blood was drawn to measure immunoglobulin levels. RESULTS: All patients initially underwent treatment with a combination of surgery, systemic and/or topical corticosteroids, and immunotherapy to pertinent fungal and nonfungal antigens. Normalization of sinonasal mucosa (Kupferberg stage 0) was seen in 5 (29%) of 17 patients, whereas 76% demonstrated either normal or slight mucosal edema (Kupferberg stage 0 or 1). Serologic testing revealed fungus-specific IgE significantly elevated in all 17 patients. CONCLUSION: The initial choice of therapy did not appear to affect the long–term outcome, and patients tended to be doing well overall. These results suggest that after successful initial treatment and control of AFS, many patients can achieve a quiescent disease state.