Allergic fungal rhinosinusitis (AFRS) is a chronic disorder with significant morbidity and a high recurrence rate needing long-term follow-up. Even after its first description many decades ago, there is still considerable uncertainty about managing this condition. In this chapter, we breakdown the topic “Optimal management of allergic fungal rhinosinusitis” into sub-headings to discuss the latest research and available literature under each topic in great detail. Every attempt has been made to incorporate the highest level of evidence available at the time of writing.

Preoperative diagnosis and further management before surgery are essential. Steroids help in reducing inflammation and help improve the surgical field. Surgery remains the mainstay in the management of this condition, along with long-term medical management. Oral steroids are reserved for acute flare-ups in the background of associated lung concerns. Oral and topical antifungal agents have no role in the control of the disease. Biological agents are being prescribed predominantly by respiratory physician colleagues, mainly to control chest-related issues rather than for sinus disease. Immunotherapy as an adjunct with surgery is promising.

AFRS is a disease with many variables and a wide range of symptomatic presentation. It takes a keen clinician to identify the disease and subsequently manage the condition. Treatment involves long-term follow-up with early detection of recurrence or flare-ups. Any of the mentioned management modalities may be employed to control the condition effectively, and treatment protocols will have to be tailor-made to suit each patient. Various medications and drugs such as Manuka honey, antimicrobial photodynamic therapy, hydrogen peroxide, and betadine rinses appear promising. More robust studies need to be undertaken to ascertain their routine use in clinical practice.