C u r ren t C o n c e p t s i n t h e

Management of Allergic
Fungal Rhinosinusitis
a b,c,
Matthew A. Tyler, MD , Amber U. Luong, MD, PhD *

KEYWORDS
 Allergic fungal rhinosinusitis  Chronic rhinosinusitis  Nasal polyps
 Type 2 inflammation  Allergic sinusitis  Fungal sinusitis  Fungal allergy
 Eosinophilic mucin rhinosinusitis

KEY POINTS
 The Bent and Kuhn diagnostic criteria serve as the framework for diagnosis of allergic
fungal rhinosinusitis (AFRS).
 The pathophysiology of AFRS is hypothesized to result from a combination of defective
mucosal barrier function, altered innate immune signaling, and fungal overgrowth, which
culminate in a localized, hyperallergic type 2 immune response.
 Standard therapy for AFRS includes complete surgery in combination with systemic and
topical steroids.
 Adjunctive treatments like immunotherapy, antifungal therapy, and biologic therapy may
have some benefit in recalcitrant cases of AFRS.

INTRODUCTION

Katzenstein and colleagues1,2 were among the first to describe a unique type of
fungal sinusitis in 7 patients, characterized by the presence of thick, mucinous ma-
terial with impacted fungal elements and termed it, “allergic Aspergillus sinusitis.”
The investigators noted a striking similarity with allergic bronchopulmonary

a
Department of Otolaryngology–Head and Neck Surgery, University of Minnesota Medical
School, 516 Delaware Street Southeast, # 8A, Minneapolis, MN 55455, USA; b Department of
Otorhinolaryngology–Head & Neck Surgery, McGovern Medical School at the University of
Texas Health Science Center, Texas Sinus Institute, 6431 Fannin Street, MSB 5.036, Houston, TX
77030, USA; c Center for Immunology and Autoimmune Diseases, Institute of Molecular
Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston,
TX, USA
* Corresponding author. Department of Otorhinolaryngology–Head & Neck Surgery, McGovern
Medical School at the University of Texas Health Science Center, Texas Sinus Institute, 6431 Fan-
nin Street, MSB 5.036, Houston, TX 77030.
E-mail address: amber.u.luong@uth.tmc.edu

Immunol Allergy Clin N Am 40 (2020) 345–359

https://doi.org/10.1016/j.iac.2019.12.001 immunology.theclinics.com
0889-8561/20/ª 2019 Elsevier Inc. All rights reserved.