Other forms of aspergillosis:🌿 Allergic Fungal Rhinosinusitis (AFRS), A Complete Patient Guide

👃 What Is AFRS?

Allergic Fungal Rhinosinusitis (AFRS) is a rare, non-invasive allergic condition affecting the sinuses. It occurs when a person develops a strong allergic reaction to fungal spores — most often Aspergillus or other environmental moulds.

This allergic reaction causes:

• Chronic sinus inflammation

• Nasal polyps

• Thick, sticky mucus (called allergic mucin)

• Blocked sinus drainage

• In some cases, bone changes due to pressure from the build-up

Importantly, the fungus does not invade tissues, unlike more serious forms of aspergillosis.

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🧬 AFRS and ABPA: Similar Diseases in Different Places

AFRS is very similar in nature to Allergic Bronchopulmonary Aspergillosis (ABPA), which affects the lungs.

🧠 In short:
AFRS is to the sinuses what ABPA is to the lungs — both are allergic responses to inhaled fungal spores.
In fact, some patients may have both conditions if fungal sensitivity affects multiple airways.

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📉 How Common Is AFRS?

AFRS is uncommon, but may be underdiagnosed. It occurs mostly in people with long-standing sinus problems or fungal allergies.

In the UK, AFRS is less common than in tropical areas — but awareness is growing.

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🛑 Why Is It Often Missed?

• Looks just like chronic rhinosinusitis with nasal polyps (CRSwNP)

• Most patients have symptoms like blocked nose, facial pressure, and mucus

• Doctors may treat these as routine infections without testing for fungal allergy

• Diagnosis requires ENT, allergy testing, imaging, and often surgery

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🧬 Who’s at Risk?

People most at risk of AFRS typically:

• Have asthma, nasal polyps, or severe allergic rhinitis

• Experience long-term or recurring sinus infections

• Have elevated IgE levels or known allergies to fungi

• Live in damp or mould-prone environments

• May have other fungal allergic conditions, including ABPA

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🧪 How Is AFRS Diagnosed?

Diagnosis is based on the Bent and Kuhn criteria, which include:

1. Chronic rhinosinusitis with nasal polyps

2. Characteristic “allergic mucin” seen on CT or during surgery

3. Positive fungal test (PCR or culture)

4. Evidence of IgE-mediated allergy (skin test or blood test)

5. CT scan showing sinus opacification, expansion, or bone thinning

A diagnosis is usually made by an ENT specialist, sometimes with support from allergists and microbiologists.

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💊 Treatment and Management in 2025

1. Endoscopic Sinus Surgery (ESS)

• Clears out mucin and polyps

• Restores drainage and reduces symptoms

• Often the first step in diagnosis and treatment

2. Nasal Corticosteroids

• Long-term sprays or rinses to keep inflammation down

3. Short Courses of Oral Steroids

• Reduce inflammation after surgery or during flare-ups

4. Biologic Medications

• For recurrent or severe cases:

  • Anti-IgE (omalizumab)

  • Anti-IL-5 (mepolizumab, benralizumab)

  • Anti-IL-4/IL-13 (dupilumab)

5. Antifungals?

• Not usually needed

• Oral antifungals have not consistently helped in trials

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🔁 Will It Come Back?

AFRS can recur, especially if polyps return or inflammation flares up. Most patients need ongoing care from an ENT team and occasional follow-up imaging or treatment adjustments.

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✅ Key Takeaways

• AFRS is a rare, allergic form of sinus disease caused by hypersensitivity to fungi like Aspergillus.

• It shares similarities with ABPA, which affects the lungs.

• It is non-invasive, but can be severe and persistent without treatment.

• Diagnosis requires a combination of ENT evaluation, allergy testing, and imaging.

• Most people improve with surgery, nasal steroids, and in some cases, biologic therapy.