Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop

Lauren T Roland¹, Cecelia Damask², Amber U Luong³, Antoine Azar⁴, Charles S Ebert Jr⁵, Thomas Edwards⁶, Katherine N Cahill⁷, Do-Yeon Cho⁸, David Corry⁹, Tara L Croston¹⁰, Alexandra F Freeman¹¹, Amin Javer¹², Paneez Khoury¹³, Jean Kim¹⁴, Michael Koval¹⁵, Edward D McCoul¹⁶, James W Mims¹⁷, Anju Peters¹⁸, Jay F Piccirillo¹, Richard P Ramonell^{19

20}, Amali Samarasinghe²¹, Robert P Schleimer¹⁸, Prestina Smith-Davidson²², Andrej Spec²³, Michael E Wechsler²⁴, Sarah K Wise⁶, Joshua M Levy^{22

25}

Affiliations

¹ Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri, USA.
² Orlando Ear, Nose, Throat, & Allergy, Lake Mary, Florida, USA.
³ Department of Otorhinolaryngology, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁴ Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Department of Otolaryngology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Department of Otolaryngology, Emory University, Atlanta, Georgia, USA.
⁷ Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Department of Otolaryngology, University of Alabama, Birmingham, Alabama, USA.
⁹ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹⁰ Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA.
¹¹ Primary Immune Deficiency Clinic, Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA.
¹² St Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Canada.
¹³ Eosinophil Clinical Research Unit, National Institute of Allergy and Infectious Disease, Baltimore, Maryland, USA.
¹⁴ Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁵ Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁶ Department of Otorhinolaryngology, Ochsner Health, New Orleans, Louisiana, USA.
¹⁷ Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹⁸ Department of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁰ Asthma and Environmental Lung Health Institute at UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²¹ Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA.
²² Division of Intramural Research, National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA.
²³ Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
²⁴ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
²⁵ National Smell and Taste Center, National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA.

PMID: 40310935
DOI: 10.1002/alr.23582

Review

Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop

Lauren T Roland et al. Int Forum Allergy Rhinol. 2025 Jun.

. 2025 Jun;15(6):626-641.

doi: 10.1002/alr.23582. Epub 2025 May 1.

Authors

Affiliations

¹ Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri, USA.
² Orlando Ear, Nose, Throat, & Allergy, Lake Mary, Florida, USA.
³ Department of Otorhinolaryngology, McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁴ Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Department of Otolaryngology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Department of Otolaryngology, Emory University, Atlanta, Georgia, USA.
⁷ Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Department of Otolaryngology, University of Alabama, Birmingham, Alabama, USA.
⁹ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹⁰ Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA.
¹¹ Primary Immune Deficiency Clinic, Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Maryland, USA.
¹² St Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Canada.
¹³ Eosinophil Clinical Research Unit, National Institute of Allergy and Infectious Disease, Baltimore, Maryland, USA.
¹⁴ Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁵ Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁶ Department of Otorhinolaryngology, Ochsner Health, New Orleans, Louisiana, USA.
¹⁷ Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹⁸ Department of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁹ Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁰ Asthma and Environmental Lung Health Institute at UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²¹ Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA.
²² Division of Intramural Research, National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA.
²³ Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA.
²⁴ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
²⁵ National Smell and Taste Center, National Institute of Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, USA.

PMID: 40310935
DOI: 10.1002/alr.23582

Abstract

Allergic fungal rhinosinusitis (AFRS) is a unique endotype of chronic rhinosinusitis with nasal polyps (CRSwNP). Despite high recurrence rates and often more severe presenting signs compared with other subtypes of CRSwNP, research dedicated to AFRS has been lacking. Diagnostic criteria are outdated, the mechanistic relationship of AFRS to other associated diseases is unclear, and the pathophysiology of disease and risk factors for recurrence have not been well studied. In December 2023, a multidisciplinary group of rhinologists, otolaryngologists, pulmonologists, allergists, immunologists, scientists, and infectious disease experts met at the National Institute of Health to discuss unmet needs for future AFRS research and care, including patient management, diagnostic criteria, severity, pathophysiology, and related conditions. A summary of these clinical and associated research discussions is included below.

Keywords: allergic fungal sinusitis; allergic sinusitis; chronic rhinosinusitis; fungal sinusitis; invasive fungal sinusitis; nasal polyps.

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References

1. R. R. Orlandi, T. T. Kingdom, T. L. Smith, et al., “International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021,” Int Forum Allergy Rhinol 11, no. 3 (2021): 213–739.
1. M. W. Ryan and B. F. Marple, “Allergic Fungal Rhinosinusitis: Diagnosis and Management,” Current Opinion in Otolaryngology & Head and Neck Surgery 15, no. 1 (2007): 18–22.
1. J. D. Miller, A. M. Deal, K. A. McKinney, et al., “Markers of Disease Severity and Socioeconomic Factors in Allergic Fungal Rhinosinusitis,” Int Forum Allergy Rhinol 4, no. 4 (2014): 272–279.
1. J. P. Champagne, J. L. Antisdel, T. D. Woodard, and S. E. Kountakis, “Epidemiologic Factors Affect Surgical Outcomes in Allergic Fungal Sinusitis,” Laryngoscope 120, no. 11 (2010): 2322–2324.
1. R. D. deShazo and R. E. Swain, “Diagnostic Criteria for Allergic Fungal Sinusitis,” Journal of Allergy and Clinical Immunology 96, no. 1 (1995): 24–35.

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Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop

Affiliations

Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous