title: Role of immunotherapy in allergic fungal rhinosinusitis.
abstract: OBJECTIVE
  Our understanding of the pathogenesis and treatment of allergic fungal rhinosinusitis (AFRS) continues to evolve. This article serves to update the reader on the diagnosis and management of AFRS and pays particular attention to the recent literature regarding efficacy and safety of immunotherapy in this patient population.
  
  
  RESULTS
  The mainstay of treatment of AFRS remains a thorough surgery; however, adjunctive medical management is also critical to achieve optimal outcomes. Oral steroid use in AFRS remains recommended. Immunotherapy, both fungal and nonfungal, may be considered for patients exhibiting a type I hypersensitivity to specific allergens. To date, limited studies do show improvement with reduction of postoperative exacerbations and revision surgeries. There remains no evidence of unusual side-effects or formation of immune complexes from immunotherapy in AFRS patients. Double-blind placebo controlled trials on immunotherapy and AFRS are lacking, and ultimately, conclusive evidence of efficacy is not present to date.
  
  
  CONCLUSIONS
  Treatment of AFRS requires multimodality therapy with immunotherapy playing a significant, yet inconclusive, role. Further studies remain warranted.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA.
authors.forename: Monica O
authors.initials: MO
authors.lastname: Patadia
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Welch
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D009181:Mycoses / Q000628:therapy*; D065631:Rhinitis, Allergic / Q000175:diagnosis / Q000628:therapy*; D012852:Sinusitis / Q000175:diagnosis / Q000628:therapy*