Natural history of allergic fungal rhinosinusitis: A 4- to 10-year follow-up

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.