TABLE 3 Immunotherapy Protocol for AFS

1. Surgical exenteration of disease from the sinuses and pathologic confirmation of the diagnosis.

2. Allergy evaluation and testing (RAST or quantitative skin test) for typical nonfungal antigens and all molds and fungi available.

3. Instruct patient in avoidance measures for molds.

4. Prepare a vial of all positive nonfungal antigens and a second vial of all positive fungal antigens. Perform a skin test with each.

5. Administer immunotherapy weekly, with dose advancement as tolerated, placing one injection from each vial in a different arm.

6. Observe the patient at regularly scheduled intervals, adjusting dosage as necessary if local reactions or changes in nasal symptoms occur. Patients should also undergo regular endoscopic examination to monitor for reaccumulation of allergic mucin or reformation of polyps and for cleaning and adjustment of medical management.

7. Once dosage advancement is completed, the antigens may be combined into one vial and treatment continued for a 3-5 yr regimen.

Abbreviation: AFS, allergic fungal sinusitis; RAST, radioallergosorbent test. Source: From Ref. 2

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