Dupilumab as an emerging treatment for refractory allergic fungal rhinosinusitis: a case series and literature review

Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.