Change in Serum IgE Levels Following Surgery in Patients with Allergic Fungal Rhinosinusitis is Predictive of Disease Status

Abstract

Objective: We aimed to correlate post-operative endoscopic disease status and reduction in serum total IgE levels inpatients with allergic fungal rhinosinusitis (AFRS) and to ascertain whether this reduction has prognostic significance.Material and Methods: A prospective cohort of 50 patients with biopsy-proven AFRS underwent preoperativeendoscopy and serum total IgE assessment. Following endoscopic excision of polyps and allergic mucin and postoperative steroid therapy, patients were re-evaluated at 3-6 months with nasal endoscopy with Kupferberg stagingand serum total IgE levels.Results: There were 27 (54%) male and 23 (46%) female patients. Preoperative endoscopy showed grade 3 polyps in33 (66%) patients and grade 2 polyps in 17 (34%) patients. Post-operatively, 37 (74%) patients had Stage 0, 11 (22%)had Stage 1, and two (4%) had Stage 2 diseases. Preoperative IgE levels ranged from 153.2 to 6,548.2 IU mL1. Postoperative IgE levels were reduced in 42 of 50 (84%) patients and ranged from 79.9 to 3,900 IU mL1. There was a negative correlation between percentage change in IgE and post-operative endoscopic score, which was significant (r ¼0.25; P ¼ .032). Based on receiver operating characteristic analysis, a percentage reduction in IgE of 32% had a sensitivity of 69.2% (95% CI: 38.6-90.9) and specificity of 67.6% (95% CI: 50.2-82.0) in predicting endoscopic stage.Conclusion: Post-operative reduction in serum total IgE levels negatively correlates with endoscopic stage in AFRSpatients who undergo surgery and post-operative steroid therapy. A cutoff of 32% in change in IgE levels is predictive of endoscopic Stage 0 disease.