Dupilumab use in recalcitrant allergic fungal rhinosinusitis

Lo, R.; Liu, Anne Y.; Valdez, Tulio A.; Gernez, Yaël

doi:10.1016/j.anai.2020.07.014

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…These patients with AFRS tend to have a higher level of IgE antifungal antibodies in addition to eosinophil-rich mucus; both are type 2 responses that have been traditionally described to be caused by an exacerbated Th2 adaptive immune response [1]. In addition, IL-4 and IL-13 are inflammatory cytokines that play an essential role in type 2 inflammation responsible for the pathophysiology of AFRS [13].…”

Section: Discussionmentioning

confidence: 99%

“…In June 2019, the FDA approved dupilumab use for inadequately controlled CFSwNP, but there was no specification for its use in AFRS [14]. Dupilumab is an IL-4 alpha receptor blocker, so its net effect is blocking IL-4 and IL-13 [13]. Moreover, it suppresses the production of type 2 inflammatory markers in peripheral blood and nasal polyp tissue such as eosinophilic cationic protein (ECP), eotaxins, IgE, and IL-4 alphareceptor inhibitor.…”

Section: Discussionmentioning

confidence: 99%

“…The medication was successfully used in two previously reported resistant AFRS with significant efficacy and response [13,15].…”

Section: Discussionmentioning

confidence: 99%

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Successful Use of Dupilumab as a Salvage Therapy for Recalcitrant Allergic Fungal Rhinosinusitis: A Case Report

Mujahed¹,

Marglani²,

Maksood³

et al. 2022

Cureus

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Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) which is distinguished by the presence of eosinophilic mucin, type 1 hypersensitivity reaction resulting from fungi residing within the sinus, and characteristic imaging findings of the paranasal sinuses. Surgical intervention, sinonasal irrigations, and topical and systemic medications are commonly used to reduce the fungal load and antigenic stimulation. Despite the advancement of medical and surgical management of AFRS, a high recurrence rate is still a significant concern. The proper treatment for refractory AFRS remains controversial. Herein, we discuss the use of dupilumab for controlling refractory AFRS. We report a case of a 33-year-old female patient known to have had AFRS for 16 years. Due to the recurring nature of her illness, 16 functional endoscopic sinus surgeries (FESS) have been done to control her symptoms. The last operation was done in our institution; evidence for cure was insufficient with the persistence of symptoms. After a consensus decision with the multidisciplinary management team, she was an appropriate candidate for therapy with dupilumab. After six months of using the medication, magnificent improvement and control of symptoms were noted, and post-treatment CT scans illustrated excellent progression from previous scans. AFRS could be an extremely debilitating disease with significant impairment of quality of life even when standard therapy and extensive surgical interventions are implemented. Dupilumab can be an excellent option as a salvage therapy for recalcitrant AFRS with significant improvement in patients' quality of life and resolution of symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Successful Use of Dupilumab as a Salvage Therapy for Recalcitrant Allergic Fungal Rhinosinusitis: A Case Report

Mujahed¹,

Marglani²,

Maksood³

et al. 2022

Cureus

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“…There is a proven beneficial effect in CRSwNP associated with AERD, 52 , 53 and anecdotal evidence in allergic fungal rhinosinusitis. 54 The relative risk for further surgery after starting dupilumab is considerably reduced. 46 , 47 When combined with intranasal corticosteroids, it reduces sick leave and improves productivity at work.…”

Section: Anti-il-4/il-13 (Dupilumab)mentioning

confidence: 99%

Guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps (CRSwNP) in Brazil

Anselmo‐Lima

Tamashiro

Romano

et al. 2022

Brazilian Journal of Otorhinolaryngology

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“… 5 There are very few numbers of exclusive cases reported in the literature concerning AFRS outcomes after dupilumab administration. 15 , 16 In this report, the authors aimed to discuss 4 AFRS cases that had received dupilumab and resulted in favorable endpoints.…”

Section: Introductionmentioning

confidence: 99%