The clinical presentation of AFS can be similar to CRS. Patients often report chronic nasal congestion and nasal obstruction that has failed to respond to antibiotic therapy. Examination of the nasal cavity may reveal nasal polyps within the olfactory cleft, middle meatus, and sphenoethmoid recess. Occasionally, locally destructive changes from longstanding polyposis lead to proptosis and malar flattening (7). AFS is unilateral in more than 50% of patients but may involve several sinuses bilaterally, and bone erosion and extrasinus extension have been reported. The allergic mucin characteristic of this condition is thick and glue-like, with a heterogeneous brown appearance that has been compared to peanut butter.
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