Allergic fungal rhinosinusitis (AFRS) is a non-invasive, immune-mediated form of chronic rhinosinusitis characterized by an extremely high postoperative recurrence rate. This article provides a systematic review of recent advances in diagnostic tools, imaging characteristics, surgical and medical management, as well as biologic agents for AFRS. It focuses on the ongoing paradigm shifts: from traditional diagnostics towards molecular diagnostics, and from empiric medical therapy towards targeted treatments. The selection of various biologic agents is also discussed. The aim is to offer clinical insights into diagnostic approaches and therapeutic strategies, thereby promoting the standardization and precision of AFRS management.