Dr. Marple further said that he was worried about an idiosyncrasy in the Mayo Clinic study. Although the Mayo team reported a lessening of mucosal thickening, there was no change in intranasal Alternaria and inflammatory cytokines failed to change in a statistically significant fashion. The fact that nasal carriage of Alternaria was not affected by this therapy appears to challenge the underlying hypothesis that inflammation is actually driven by fungus, he said.
Michael Weschta, MD, from the University of Ulm, Germany, is one of the European researchers who believes that amphotericin B shows no evidence of clinical improvement in CRS patients. His team used a randomized, double-blind, placebo-controlled trial with 78 CRS patients and found no significant benefits from eight weeks of amphotericin B nasal spray therapy (J Allergy Clin Immunol 2004;113:1122-8). The Weschta team further reported in a 2006 study that neither topical amphotericin B therapy nor fungal state before and after treatment had any significant influence on activation markers of nasal inflammatory cells in chronic rhinosinusitis (Arch Otolaryngol Head Neck Surg 2006;132:743-7).
Fenna Ebbens, MD, from the Academic Medical Center in Amsterdam, found in 2006 that treating 116 CRS patients with amphotericin B nasal lavage or placebo failed to show improvement in symptoms, nasal endoscopy scores, and other markers (J Allergy Clin Immunol 2006;118:1149-56). In a 2007 review article in Rhinology (45:178-89), she further stated that we conclude, on the basis of the results of our large, double-blind, placebo-controlled, multicenter study that direct topical administration of intranasal amphotericin B is not a solution for patients with CRS with or without nasal polyps, because neither major improvements nor significant differences between amphotericin B-treated and placebo-treated groups were observed.
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