Vandana, Aravind (2020) Can Serum IgE Levels Predict The Disease Status In Allergic Fungal Rhinosinusitis? Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND: Allergic fungal rhinosinusitis (AFRS) is a type of non-invasive fungal sinusitis. An IgE mediated allergic pathogenesis has been proposed for AFRS. The association between IgE levels and endoscopic evidence of disease in patients on follow up after surgical excision of disease has not been studied well. In our study, we followed up patients with AFRS who have undergone functional endoscopic sinus surgery and correlated endoscopic appearance (Kupferberg staging) with pre and postoperative total serum IgE levels. AIM OF THE STUDY: 1. The aim of the study was to ascertain pre- and postoperative total serum IgE levels in patients with AFRS and correlate the changes in endoscopic appearence postoperatively with these levels following therapy. 2. To determine whether serum total IgE level may be used as a prognostic indicator of disease stage in patients who had undergone functional endoscopic sinus surgery for AFRS. OBJECTIVES: 1. To ascertain preoperative endoscopic grading (Kupferberg stage) as well as total serum IgE levels in patients with clinical and histological characteristics of AFRS. 2. To ascertain the postoperative endoscopic grading (Kupferberg stage) as well as total serum IgE levels in those patients with AFRS who underwent endoscopic sinus surgery. 3. To assess changes in endoscopic staging and total serum IgE levels in patients with AFRS who had undergone endoscopic sinus surgery. 4. To ascertain the sensitivity of total serum IgE level in predicting the disease stage in patients with AFRS on postoperative follow up. METHODOLOGY: The study was a prospective observational study. Patients diagnosed with AFRS by standard criteria were recruited for the study. Preoperative endoscopic staging was done along with total serum IgE levels and skin allergy test for all patients. Postoperatively the patients underwent repeat endoscopy and serum IgE level testing at 3 to 6 months follow up. Statistical analysis was performed to note the sensitivity, specificity and positive and negative predictive value of total serum IgE in predicting disease stage. RESULTS: We had 34 patients in the age group of 21 -57 years in the study. The majority of the patients in the study group were males (61.8%). Coincident allergic rhinitis was seen in 16 patients (47.1%). Twenty seven (84.4%) patients had allergy to dust mite and 17(53%) were allergic to various fungal species. Four (11.8%) out of 34 patients had history of bronchial asthma. In our study 27 of 34 patients had a fall in postoperative total serum IgE levels when compared to their preoperative values. Twenty one of these patients had stage 0 disease on their postoperative rigid nasal endoscopy and 6 patients had stage 1 or 2 disease. The sensitivity of total serum IgE levels in this study was, therefore, 84%. Seven patients had a rise in serum IgE levels postoperatively. Of these, 4 patients had stage 0 disease, while 3 had stage 1 disease. The specificity of total serum IgE level was only 33.3% in our study. The positive predictive value and negative predictive value of total serum IgE was found to be 77.78% and 42.86% respectively. CONCLUSION: This study on patients with AFRS who underwent total serum IgE estimation and rigid nasal endoscopy both pre and post operatively shows that total serum IgE levels is a reasonably good prognostic indicator in patients with AFRS. However, the test has low specificity. A combination of both total serum IgE levels and clinical findings may be ideal for prognostication for the individual patients with AFRS.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221714356 |
| Uncontrolled Keywords: | Serum IgE, Allergic fungal rhinosinusitis (AFRS), Skin allergy test. |
| Subjects: | MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Feb 2021 05:31 |
| Last Modified: | 15 Feb 2021 05:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14237 |
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