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
PMCID: PMC12645459
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
PMCID: PMC12645459
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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Conflict of interest statement

L. T. Roland: research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR002346. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Honorarium: AAOA, Medical Advisory Board: Sanofi/Regeneron. C. Damask: clinical research funding: AstraZeneca, GSK, and Regeneron. Honorarium: AstraZeneca, GSK, OptiNose, Regeneron, and Sanofi. A. U. Luong: Advisory board fees—Amgen, AstraZeneca, Genentech, GlaxoSmithKline Regeneron Pharmaceuticals Inc., and Sanofi; Consultant—Maxwell Bioscience, Lyra Therapeutics, Medtronic, SoundHealth, and Stryker; Clinical trial funding - Insmed, Eli Lily, Lyra Therapeutics, Sanofi. She owns stock in Aerin Medical. K. N. Cahill: Scientific advisory board member for AstraZeneca, Sanofi, Genentech, Regeneron, Novartis, and GlaxoSmithKline, consultant for Ribon Therapeutics, Third Harmonic Bio, and Verantos, royalties from UpToDate, research support from Novo Nordisk, and grant support from NIAID. J. M. Levy: Sanofi/Regeneron—research funding. This research was supported by funds from the NIDCD Division of Intramural Research (DC000098 to J.M. L.). A. Spec: research funding from Astellas, Mayne, Basilia, and F2G; consulting with GSK, F2G, and Scynexis. S. Wise: Consultant/Advisory Board—AstraZeneca, Lilly, OptiNose, Sanofi, SoundHealth Research—Sanofi Speaker—GSK. M. Koval: Sanofi—research funding; support from NIH R01-HL158979. J. Piccirillo: royalty payments from Washington University for the licensing of the SNOT, NOSE-HHT, SNORE-25 licensed by Washington University in St Louis; receives compensation for serving as the Editor of JAMA Otolaryngology–Head & Neck Surgery; receives honorarium for serving on the External Advisory Boards of the Georgia Clinical & Translational Science Alliance and Frontiers Clinical and Translational Science Institute; receives honorarium for serving as a scientific consultant and Co-Chair of the Study Advisory Committee of the Nasal Steroids, Irrigation, Oral Antibiotics and Subgroup; Targeting for Effective Management of Sinusitis study (Merenstein, PI). J. Kim: Genentech Roche: grant funding, GSK: grant funding, NIH: grant funding, Grifols: consulting. C. S. Ebert: consultant for Acclarent and 3D Matrix. P. Khoury: funded, in part, by the Division of Intramural Research, NIAID/NIH. D. Corry: basic research funding: Maxwell, Inc. and Sanofi, Inc. R. Ramonell: research reported in this publication was supported by a Parker B. Francis Fellowship Grant and a University of Pittsburgh Competitive Medical Research Fund grant. T. Edwards: scientific advisory board member and research support from Sanofi-Aventis U.S., LLC, and Regeneron Pharmaceuticals, Inc. A. Javer: consultant—GSK, Sanofi, iView Therapeutics. A. Freeman: This research has been supported in part by the Intramural research Program of the National Institute of Allergy and Infectious Diseases, National Institutes of Health. A Peters: Research funding: Sanofi Regeneron, Astra Zeneca, Insmed. Consulting: Eli Lilly, Sanofi Regeneron, AstraZeneca, GSK, Chiesi, and Novartis Royalties: UptoDate. M Wechsler: Dr. Wechsler has received consulting/advising/speaking honoraria from the following: Allakos, Areteia Therapeutics, Arrowhead Pharmaceutical, Avalo Therapeutics, Belenos Bio, Celldex, Connect Biopharma, Eli Lilly, Equillium, Incyte, Jasper Therapeutics, Kinaset, Kymera, Merck, MyBiometry, Pharming, Phylaxis, Pulmatrix, Rapt Therapeutics, recludix Pharma, Roche/Genentech, Sentien, Sound Biologics, Tetherex Pharmaceuticals, Uniquity Bio, Verona Pharma, Zurabio. Dr. Wechsler has received consulting/advising/speaking honoraria from AstraZeneca, Amgen, Regeneron, Glaxosmithkline, Sanofi/Genzyme and is doing research sponsored by them.Dr.Wechsler has received consulting honoraria and stock options and is doing research sponsored by Upstream Bio.

Figures

**FIGURE 1.**
Presenting features and diagnostic criteria.

**FIGURE 2.**
Active areas of translational research.

See this image and copyright information in PMC

References

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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

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

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