Amphotericin B nasal lavages: Not a solution for patients with chronic rhinosinusitis

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Fungal elements are one of the causative agents of CRS, possibly by an allergic mechanism (2107-2110), but controversy has accumulated concerning the prevalence of fungal CRS (2111,2112) and benefits of topical amphotericin B therapy are inconsistent (2113,2114).…”

Chronic sinusitis pathophysiology: The role of allergy

“…Arguments have been made regarding an allergic mechanism in CHES based on the usefulness of "allergy"-targeting therapeutics such as corticosteroids and leukotriene modifiers in CHES. 9,[55][56][57][58][59][60][61][62][63] However, these treatments nonspecifically target the types of inflammation seen in allergic and nonallergic Th2-associated inflammatory disorders, so even if verified, their efficacy can not be used to support an allergic mechanism. For example, leukotriene modifiers and corticosteroids are equally efficacious in allergic and nonallergic presentations of asthma.…”

In response to the Effect of Topical Amphotericin B on Inflammatory Markers in Patients with Chronic Rhinosinusitis: A Multicenter Randomized Controlled Study

“…As no differences in appearance, taste, smell, and osmolarity were allowed, a similar diluent was used in our placebo nasal lavage solution. 2 Although Gerlinger et al suggest that current data on topical antifungal effectiveness or ineffectiveness are too heterogeneous to draw any conclusions, we feel that based on data from one uncontrolled prospective trial 4 and four double-blind, placebo controlled studies 2,[5][6][7] (including our double-blind, placebo-controlled study), 2 we are able to conclude that topical antifungals are ineffective in the treatment of CRS patients with and without nasal polyposis. And, although Gerlinger et al suggest that the double-blind, placebo-controlled trial by Ponikau et al is in support of a positive effect of topical amphotericin B in CRS patients, we question whether modest, nonrelevant, radiological improvements without symptomatic benefit are clinically significant.…”

“…It was against this background that our double-blind, placebocontrolled, multicenter trial was conceived and undertaken. 2 As part of this trial, nasal lavage samples of patients suffering from chronic rhinosinusitis (CRS) with or without nasal polyposis were analyzed before and after the start of topical amphotericin B treatment. Unfortunately, as is correctly observed by Gerlinger et al, a typographic error has occurred in the Laryngoscope publication on the dose of amphotericin B that was used.…”

“…To guarantee adequate access to sinonasal mucosa upon irrigation with amphotericin B, previous endoscopic surgery was obligatory for inclusion in our clinical trial. 2 The statement of Gerlinger et al that amphotericin B was administered before endoscopic sinus surgery is thus incorrect. In addition, Gerlinger et al suggest that it is not clear why sugar was added to the placebo nasal lavage solution.…”