The following is the summary of “Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics” published in the December 2022 issue of Allergy and Clinical Immunology by Luong, et al.

Immunocompetent atopic individuals are more likely to develop allergic fungal rhinosinusitis (AFRS), a noninvasive subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), which is more prevalent in climates with warm temperatures and high humidity, ideal conditions for the growth of environmental fungi. It is common for patients with allergic fungal rhinosinusitis to report mild sinus symptoms despite unusual CT scan findings and a heavy burden of polyps. Serum total and fungal-specific IgE levels are typically substantially increased in patients with AFRS. 

Adjuvant medicinal therapy is crucial to the success of surgery as a treatment option. To be more specific, oral and/or topical steroid use has been the standard adjuvant therapy until very recently. Although oral corticosteroids reduce recurrence after surgery, other adjunctive pharmacologic agents, such as topical and oral antifungal agents and immunotherapy, are not effect therefore not recommended by recent guidelines such as the International Consensus of Allergy and Rhinology. Recent approvals of thIn addition, recentgics omalizumab, dupilumab, and mepolizumab for the treatment of CRSwNP in general have not, included, AFRS yet to includelinical trials. 

The effectiveness of these biologics on the AFRS subset of patients has been recently demonstrated in case reports and modest prospective studies. Clinical reports on the use of biologics in the treatment of AFRS are included, as well as a summary of the current understanding of the pathophysiology of AFRS and its consequences. Since biologics are recommended for treating CRSwNP, more research focusing on real-world evidence for AFRS are warranted.