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Allergic fungal rhinosinusitis

Rodney J Schlosser, MD
Daniel L Hamilos, MD
Section Editor
Jonathan Corren, MD
Deputy Editor
Anna M Feldweg, MD


Allergic fungal rhinosinusitis (AFRS) is a distinct type of chronic rhinosinusitis (CRS), accounting for between 5 and 10 percent of all CRS cases. AFRS is believed to result from chronic, intense allergic inflammation directed against colonizing fungi. Patients with AFRS are immunocompetent and show evidence of allergy to one or more fungi. Definitive diagnosis is usually confirmed after sinus surgery. Successful treatment involves a combination of surgical and medical management.

The pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and management of AFRS are reviewed here. More general topics about CRS are found separately. (See "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Chronic rhinosinusitis: Management".)


Allergic fungal rhinosinusitis (AFRS) is defined as a specific subtype of chronic rhinosinusitis (CRS). All forms of CRS are defined as inflammatory conditions involving the paranasal sinuses and linings of the nasal passages that last 12 weeks or longer. The diagnosis of all forms of CRS requires objective evidence of mucosal inflammation. (See "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis", section on 'Definition'.)

AFRS is a distinct subtype of CRS that arises as a result of a localized allergic reaction to noninvasive fungal growth in areas of compromised mucus drainage [1,2]. AFRS is defined as an intense, localized allergic/eosinophilic inflammatory sinus disease that results in the accumulation of eosinophilic (allergic) mucin (a thick, tenacious eosinophilic secretion), which contains fungal hyphae, intense eosinophilic inflammation, and characteristic radiographic findings. The diagnostic criteria for AFRS require:

The presence of chronic rhinosinusitis with nasal polyposis (CRS with NP), unless the patient has undergone surgery or aggressive medical therapy with systemic glucocorticoids to remove or shrink the polyps.

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Literature review current through: Nov 2017. | This topic last updated: Aug 30, 2016.
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