Allergic fungal rhinosinusitis

The urgency of the problem of allergic fungal rhinosinusitis (AFRS) is caused by clinical course severity, resistance to conservative therapy, high recurrence rate after surgery and high intraoperative risk due to frequent destruction of the orbit and skull base. Objective. To present current views on the pathophysiology, diagnosis and treatment of AFRS. Material and methods. A bibliographic search was carried out in RSCI, PubMed, ScienceDirect databases by the following keywords: allergic fungal rhinosinusitis, eosinophilic fungal rhinosinusitis, rhinosinusitis with eosinophilic mucin, fungal rhinosinusitis. Results. It has been revealed that the disease pathogenesis involves a complex interactions of genetic, ecological and immunological factors although the mechanisms of this interaction have not been fully studied. Existing AFRS diagnostic criteria are largely based on the examination of pathological content in the sinuses obtained during the surgery. Endoscopic incision of the affected sinuses is the basic treatment for AFRS. Topical and systemic corticosteroids are drugs with the most convincing evidence base in the absence of generally accepted treatment standards for AFRS. Additional treatment methods such as immunotherapy and antifungal therapy may provide some benefit in cases of resistant AFRS. The development of biological therapy methods is a promising direction for AFRS treatment.