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Clinical Challenges
October 1998

What Role Do Systemic Corticosteroids, Immunotherapy, and Antifungal Drugs Play in the Therapy of Allergic Fungal Rhinosinusitis?

Author Affiliations


Arch Otolaryngol Head Neck Surg. 1998;124(10):1174-1178. doi:10.1001/archotol.124.10.1174

A prolonged course of systemic corticosteroids, immunotherapy, and antifungal drugs is beneficial after surgery for allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) was first appreciated as a distinct entity in 1981 by Millar et al1 because of its histological similarity to allergic bronchopulmonary aspergillosis (ABPA). Both he and subsequently Katzenstein et al2 termed the histological presence of eosinophilic mucin concretions with Charcot-Leydon crystals and hyphal fragments from the sinuses allergic aspergillus sinusitis. Subsequently, it was recognized that a variety of fungi, particularly dematiaceous fungi, such as Bipolaris, Curvularia, and Alternaria, can be grown from this mucin, in addition to various Aspergillus species, and the term was changed to allergic fungal rhinosinusitis to reflect this finding. Histopathologically, it is impossible to definitively identify the species of various fungi that can be associated with the disease process, and concomitant fungal cultures are required to determine the particular fungus.3

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