Recent advances in allergic rhinosinusitis management: from traditional therapies to precision medicine

Abstract Background Allergic rhinosinusitis is a complex IgE-mediated inflammatory disorder affecting millions globally, with significant epidemiological, immunological, and clinical heterogeneity. Recent advances in molecular profiling, biologic therapies, and diagnostic technologies have driven a paradigm shift in understanding and managing this disease. Purpose This review synthesizes contemporary knowledge on the pathophysiology, traditional and innovative treatment modalities, diagnostic innovations, and future directions in allergic rhinosinusitis management, emphasizing precision medicine and integrated therapeutic approaches. Main body The immunopathogenesis involves intricate Type 2 immune responses modulated by genetic polymorphisms such as ZNF608, environmental allergens, and immune dysregulation. Traditional therapies, including antihistamines and intranasal corticosteroids, remain foundational but are limited by adherence and side effects. Emerging biologics targeting IgE and cytokines (omalizumab, dupilumab, mepolizumab) and novel small molecule inhibitors demonstrate enhanced efficacy in severe and refractory cases. Advances in immunotherapy, including sublingual and subcutaneous approaches with novel delivery systems, offer personalized treatment options. Cutting-edge diagnostic technologies—molecular genetic testing, high-resolution imaging, AI-driven tools, and wearable biosensors—enable precise allergen identification and real-time monitoring. Non-pharmacological adjuncts such as laser and ozone therapies, nutraceuticals, and physical therapies provide complementary benefits. Surgical interventions, enhanced by navigation and minimally invasive techniques, optimize outcomes for refractory disease. Conclusion Integrating multi-omics, biologic therapies, and digital health tools heralds a new era of precision medicine in allergic rhinosinusitis. Future research should focus on gene therapy, nanomedicine, and AI-enabled personalized protocols to overcome current therapeutic limitations and improve long-term patient outcomes. Graphical Abstract