Diagnostic and treatment challenges in management of allergic fungal rhinosinusitis

Abhishek Bahadur Singh, Rashmi Upadhyay, Nitesh Tayal

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):38-44

Among infections pertaining to head and neck rhinosinusitis holds a significant position both with regard to the prevalence and morbidity. Allergic fungal rhinosinusitis (AFRS) was initially considered a counterpart of allergic bronchopulmonary aspergillosis when first diagnosed by Sa firstein in 1976 due to its clinical presentations and seemingly similar pathogenesis. Initially only Aspergillus was known as the causative, but now various other fungal species are known to cause chronic rhinosinusitis; hence, the terminology allergic fungal sinusitis was preferred. Exposure to fungi results in similar as asthma in atopic individuals, but then, some nonatopic individuals may also present with similar symptoms. It has also been studied that the presence of serum immunoglobulin E does not ensure the presence of allergy. Till date, there are several controversies regarding pathogenesis, whether humoral or immune mediated, population at risk, variations in presentations, diagnostic parameters, and treatment protocols. In this review, we try to revisit and learn from past documented experiences to further our attempt toward better understanding of the disease process, its diagnosis, and management.

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