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

Woodworth et al.

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.

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.

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

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