Allergic Fungal Rhinosinusitis in Europe: Literature Review and Own Experience

Allergic fungal rhinosinusitis (AFRS) is primary, Th2-mediated, chronic rhinosinusitis, which is diagnosed when the criteria defined by Bent and Khun are met. The disease is most common in countries located in the subtropical and tropical regions characterized by high temperatures and high levels of humidity, which favour the wider occurrence of fungi in the environment. The presence of specific IgE antibodies directed against fungal allergens, which is one of the diagnostic criteria, proves the systemic nature of the disease and allows one to distinguish AFRS from eosinophilic fungal rhinosinusitis. There is no unified treatment method for AFRS described in the literature, and relapses are common. Sinus surgery remains the treatment of choice. Oral and topical steroid therapy plays an important role in the treatment process. The effectiveness of antifungal treatment and immunotherapy is unclear. Biological treatment, the results of which are promising, has raised great hopes. The aim of this study was to reveal how often AFRS occurs in European countries, what environmental factors influence its development, and how important it is to specify its diagnostic criteria and treatment methods. We present an overview of the available literature. In addition, we share our own experience and describe two cases of AFRS diagnosed and treated at our centre.

Automated summary

Allergic fungal rhinosinusitis (AFRS) is a Th2-mediated, chronic rhinosinusitis, mainly occurring in subtropical and tropical regions with high temperatures and humidity, which promote fungal growth. Specific IgE antibodies against fungal allergens play a diagnostic role in distinguishing AFRS from eosinophilic fungal rhinosinusitis. Treatment options for AFRS vary and relapses are common, with sinus surgery being the preferred method. Steroid therapy is important, while the effectiveness of antifungal treatment and immunotherapy remains unclear. This study aims to investigate the prevalence and environmental factors of AFRS in Europe, as well as the importance of diagnostic criteria and treatment methods, providing an overview of the literature and sharing two case studies.