AFS appears to be an allergic reaction to aerosolized, environmental fungi that occurs in immunologically normal hosts. The immune response is believed to be an IgE-mediated type-I hypersensitivity reaction. The ensuing inflammation manifests as noninvasive fungal rhinosinusitis. It was first described in 1981 by Millar and Lamb. Katzenstein further detailed the histopathologic findings in 1983, describing allergic mucin characterized by necrotic inflammatory cells, eosinophils, and Charcot-Leyden crystals.

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