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Table 7 Summary of the evidence for ‘efficacy of systemic steroids in allergic fungal rhinosinusitis’

From: Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Study Year LOE (1a to 5) Study design Study groups Clinical end-point efficacy Conclusion
Woodworth et al. 2004 3b Prospective case control study Adults with CRSwNP from which 8 AFRS en 6 eosinophilic mucin rhinosinusitis were treated with oral prednisone (60 mg for 3 days, 40 mg for 3 days, 30 mg for 3 days, 20 mg for 12 days) 1. SNOT-20
2. Nasal endoscopy score
3. Mucosal IL-5, IL-13, eotaxin, MCP-4
Significant reduction in nasal endoscopy scores and inflammatory markers, non-significant reduction in SNOT-20 scores
Landsberg et al. 2007 3b Prospective case control study Adult AFRS and CRSwNP patients received 1 mg/kg prednisone for 10 days 1. CT Lund Mackay scores
2. Nasal endoscopy score, but no scoring system used
CT score changes were significantly greater in AFRS patients compared to CRSwNP
Kupferberg et al. 1997 4 Retrospective case control study Adult and adolescent AFRS patients (13–69 years) that underwent surgery and receiving: (1) no treatment; (2) oral steroids (4 days 40 mg, then 4 days 30 mg, then 20 mg/day until 1 month postop); (3) oral steroids and oral antifungals; (4) oral antifungals 1. Nasal endoscopy score
2. Symptom scoring
Postoperative treatment with oral steroids alone improved 90% of the patients, however, disease recurrence was seen after cessation of steroids
Kuhn and Javer 2000 4 Case series Postoperative steroids in adult AFRS patients (0.4 mg/kg/day for 4 days, then 0.3 mg/kg/day for 4 days, then 0.2 mg/kg/day maintenance dose) Nasal endoscopy score Endoscopic stage 0 maintained if oral steroid was maintained for an average of 4.5 months
  1. CRS chronic rhinosinusitis, CRSwNP chronic rhinosinusitis with nasal polyps, AFRS allergic fungal rhinosinusitis, IL interleukin, MCP monocyte chemotactic protein