Update on allergic fungal rhinosinusitis

Area of Science:

• Otolaryngology
• Immunology
• Pathophysiology

Background:

• Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps and type 2 inflammation.
• Characterized by nasal polyposis, thick eosinophilic mucin, and sinus expansion.
• Current diagnostic criteria (Bent and Kuhn) show limitations in specificity and usability.

Purpose of the Study:

• To review current understanding of AFRS pathophysiology.
• To highlight advancements in identifying key molecular mechanisms.
• To discuss evolving diagnostic and therapeutic strategies.

Main Methods:

• Literature review of recent advancements in AFRS research.
• Analysis of pathophysiological pathways, including immune responses and epithelial barrier function.
• Evaluation of current and emerging treatment modalities.

Main Results:

• Pathophysiology involves impaired histatin function, leading to fungal spore retention and epithelial barrier disruption.
• A type 2 inflammatory cascade is triggered, potentially involving a limited type 3 immune response.
• Current treatments include surgery, corticosteroids, immunotherapy, and antifungals; biologics show promise.

Conclusions:

• Understanding AFRS pathophysiology has advanced, identifying key immune and epithelial defects.
• More specific diagnostic criteria are needed.
• Novel therapeutic strategies targeting underlying mechanisms are emerging, with biologics on the horizon.