Allergic fungal rhinosinusitis (AFRS) is a fungal infection that affects your nasal passages and sinuses. Typical symptoms include nasal congestion and polyps. Medications and home treatments typically help, but severe cases may require surgery.

Hypersensitivity or an allergic reaction to certain types of fungi in your sinuses can lead to a condition known as allergic fungal rhinosinusitis (AFRS).

AFRS often causes symptoms similar to chronic sinusitis, including nasal congestion, facial pain, and headache. It’s often seen in people with a history of allergies and asthma, and it can be challenging to diagnose and manage.

Read on to learn more about AFRS and its causes, symptoms, diagnosis, and treatment options.

AFRS symptoms may include:

Consider talking with a healthcare professional for a proper diagnosis if you experience these symptoms.

To diagnose AFRS, a doctor will first take a detailed medical history, including your symptoms, their duration, and any history of allergies or sinus problems. They’ll then physically examine your nose and sinuses, looking for signs of inflammation, polyps, or other irregularities.

Nasal endoscopy is a common diagnostic tool for AFRS. A doctor will insert a thin, flexible tube with a light and camera into your nasal passages to provide a close-up view of the sinuses. This can reveal nasal polyps, a typical feature of AFRS.

Sometimes, doctors may use imaging like CT scans to get a detailed view of your sinuses. These images can help confirm the extent of sinus involvement and the presence of any fungal masses.

A doctor may also order blood or allergy tests to identify specific fungal allergens triggering your symptoms. This can help confirm the allergic component of AFRS.

Treating AFRS usually involves a combination of antifungal medications and surgical intervention to remove fungal debris and reduce inflammation in the sinuses. Managing underlying allergies is also important in controlling allergic fungal rhinosinusitis.

Treatment options may include:

  • Antifungal medications: A doctor may prescribe topical antifungals, though some research suggests these are not helpful.
  • Corticosteroids: Medications such as fluticasone (Flonase), either in nasal spray or pill form, can help reduce inflammation and manage symptoms.
  • Biologics: Biologics like dupilumab (Dupixent) and omalizumab (Xolair) may help reduce and even reverse inflammation, reducing the need for steroids and antifungals.
  • Nasal irrigation: Regular sinus flushes with saline solutions can help remove mucus and irritants from your nasal passages, relieving congestion and improving sinus health.
  • Surgery: If medications and conservative treatments are ineffective, or if nasal polyps are causing severe blockage, a doctor may recommend sinus surgery. Endoscopic sinus surgery can remove polyps and clear fungal debris from your sinuses, helping to restore your typical sinus function.
  • Allergy management: Allergen avoidance strategies and, in some cases, allergy shots may help desensitize your immune system to the specific allergens.

The exact cause of AFRS is not fully understood. Still, researchers believe it results from an exaggerated immune response to certain airborne fungi, including:

These fungi can trigger an allergic reaction in your nasal and sinus passages, causing typical AFRS symptoms.

While scientists are still studying the exact reasons behind this immune response, factors like your genes, the environment, allergies, and exposure to fungal spores may lead to AFRS.

Importantly, AFRS is not contagious. It doesn’t spread from one person to another.

People most likely to develop AFRS have certain characteristics. These may include:

  • a history of allergies or asthma
  • being exposed to warm, humid climates
  • a family history of AFRS
  • having a weakened immune system
  • adolescents and young adults

If you suspect you have AFRS, consider speaking with a doctor for a proper evaluation to understand your specific risk factors.

Preventing AFRS may not always be possible, but you can take steps to reduce your risk. These may include:

  • Allergy management: Manage your allergies by avoiding allergens and seeking treatment if needed. This can help reduce your susceptibility to allergic fungal rhinosinusitis.
  • Environmental control: Minimize exposure to fungal spores by keeping indoor environments dry and well-ventilated, using air purifiers, and managing mold problems.
  • Maintain good sinus health: Treat and manage chronic sinus conditions promptly to prevent complications.
  • Regular checkups: Regular checkups with an ear, nose, and throat specialist can help monitor and manage sinus health.

The outlook for people with AFRS is generally good with appropriate treatment. Medical and surgical interventions can help manage symptoms and control the condition. However, long-term monitoring and management may be necessary to prevent recurrences and relieve symptoms.

Here are some frequently asked questions about AFRS.

How common is allergic fungal rhinosinusitis?

Experts estimate that AFRS affects about 5–10% of all people with chronic rhinosinusitis, making it the most common type of fungal sinusitis.

Is allergic fungal rhinosinusitis a medical emergency?

AFRS is not a medical emergency but a chronic condition that requires ongoing management.

However, acute invasive fungal rhinosinusitis is a different and rare subtype of fungal sinusitis that could lead to death without prompt medical treatment.

Can you have sinus surgery for allergic fungal sinusitis?

Endoscopic sinus surgery is a treatment option for AFRS to help remove polyps, allergic mucin, and fungal balls.

Will a CT scan show fungal sinusitis?

A CT scan can show signs of fungal sinusitis, including fungal masses or sinus cavity abnormalities.

AFRS is an inflammatory condition triggered by an exaggerated immune response to airborne fungi. While it’s not a medical emergency, prompt diagnosis and treatment are essential.

Managing AFRS may involve medication, sinus flushes, and lifestyle changes. Advanced cases may require surgery.

With proper care, the outlook for people with AFRS can be positive, but you may require long-term monitoring to maintain symptom relief and prevent recurrences.