Bent and Kuhn listed criteria for making the diagnosis of allergic fungal rhinosinusitis (AFRS). Other authors prefer the term reactive fungal rhinosinusitis (RFRS). The authors are from the Medical College of Georgia in Augusta.
Features of allergic fungal rhinosinusitis:
(1) evidence of Type I hypersensitivity on an allergy evaluation (elevated serum total IgE, positive skin test, positive RAST, strong history of mold allergies, peripheral eosinophilia)
(2) immunocompetence
(3) nasal polyposis
(4) eosinophilic mucus
(5) positive fungal stain and/or culture of sinus contents
(6) no evidence of fungal invasion into sinus tissue
(7) double density sign on CT scan of the nasal sinus
Variable finding may include:
(1) asthma
(2) Charcot-Leyden crystals
(3) some degree of radiographic bone erosion
The more of these findings that are present the more certain the diagnosis.
The presence of tissue invasion would exclude a purely allergic/reactive process.
