Table 7.

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

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

CRS chronic rhinosinusitis, CRSwNP chronic rhinosinusitis with nasal polyps, AFRS allergic fungal rhinosinusitis, IL interleukin, MCP monocyte chemotactic protein