REACTION OF NASAL POLYPS IN ALLERGEN-SPECIFIC IMMUNOTHERAPY WITH FUNGAL ALLERGENS IN PATIENTS WITH NASAL POLYPS ON THE BACKGROUND OF FUNGAL SENSITIZATION
Authors: Gerych O. M. 
Published: July 2022

Fungal flora is one of the causes of inflammation, including nasal polyposis. Therefore, researches aimed at reducing the impact of fungal sensitization (FS) on the course of chronic rhinosinusitis with nasal polyps (CRSwNP) are relevant.

The research included 90 patients with chronic rhinosinusitis with nasal polyps combined with fungal sensitization. The patients were divided into two groups — the first clinical group (G1) and the second clinical group (G2). Group G1 received allergen-specific immunotherapy (ASIT) according to the scheme. Group G2 received basic treatment according to the protocol № 181 of 24.03.2009 (“Protocol for providing medical care to patients with chronic sinusitis”). Indications for allergen-specific therapy were hyperreactivity to fungi (positive allergy history of FS), the presence of specific IgE antibodies to fungal allergens, positive skin tests with fungal allergens, and high levels of total IgE. The research aimed to evaluate the effect of allergen-specific therapy on nasal polyps in patients with CRSwNP on the background of fungal sensitization. The specific oral treatment was carried out in two phases: the first — cumulative or initial, and the second — maintaining, in which the maximum tolerated dose was reached by gradually increasing the allergen concentration. The first phase duration was about 2.5–3 months. In the second phase, which lasted up to 6 months, the patient received the maximum allowable dose of the allergen to achieve a state of persistent hyposensitization. The therapeutic allergen was administered in the morning, 30 minutes before meals. The right amount of drops were dosed per teaspoon from the bottle with the allergen.

Treatment was initiated during the period of clinical remission. ASIT was performed with basic anti-inflammatory treatment. The treatment efficiency was evaluated after 3, 6, and 12 months of treatment.

Evaluation of the clinical efficiency of allergen-specific immunotherapy was made on the 4-point scale, where excellent results (4 points) — complete remission of the disease during the follow-up period (6-12 months); good results (3 points) — exacerbation of the disease 1-2 times per year, in mild form and removed by expectant treatment; fair results (2 points) — the number of exacerbations did not decrease, poor results (1 point) treatment is stopped due to lack of effect or the patient's symptoms constantly worsen after the introduction of an allergen. The size and distribution of nasal polyps were assessed by the results of nasal endoscopy using the IV-grade scale: I degree - polyps are not visible on endoscopic examination but present on CT scan; II degree - polyps visible in the middle nasal passages; III degree - polyps visible outside the middle nasal passages; IV - degree – nasal polyps obturate the nasal cavity.

Improvement of nasal endoscopy picture (the number of G1 patients diagnosed with stage III of nasal polyps after 12 months decreased by 11.1%), reducing the volume of basic therapy. Satisfactory treatment results were determined in 13.8% of patients, in whom the number of exacerbations did not decrease, but the general well-being became much better than before specific immunotherapy, which indicates a stable effect after the treatment.

Conclusions. The results conclude that the use of ASIT treatment is pathogenetically justified and significantly improves the clinical condition and quality of life in patients with chronic rhinosinusitis with nasal polyps and fungal sensitization.

The severity of the polypous process in G1 patients was 1.6 times lower compared to G2, which contributed to the positive clinical effect of treatment in 86.1% of patients.

The conducted research has shown high efficacy, good tolerability, and safety of the non-invasive method of treatment (ASIT) in chronic rhinosinusitis with nasal polyps and fungal sensitization.