Allergic fungal sinusitis.

AFS is an increasingly recognized form of HSD, now reported throughout the world. It is probably the most frequently occurring fungal rhinosinusitis disorder. The term fungal sinusitis is no longer appropriate because the five categories of fungal rhinosinusitis can now be differentiated. Each category of fungal rhinosinusitis disorder carries different treatment approaches and prognosis. Diagnostic error can be minimized by adhering to strict diagnostic criteria. The analogy (but not identity) of AFS to ABPA has been supported by histopathology, immunopathology, and the clinical response to OCS treatment. AFS represents a true medical surgical disorder in which both surgery and postoperative medical treatment, if properly coordinated between medical and surgical specialists, leads to the best patient outcomes. Continued advances in the understanding of the immunogenetics and immunopathogenesis of AFS may provide fundamental insights into molecular mechanisms operant in other chronic inflammatory disorders, including other chronic eosinophilic-lymphocytic respiratory mucosal disorders such as common forms of HSD and chronic severe asthma.