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OBJECTIVE: Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis characterized by eosinophilic mucin and hypersensitivity to fungi. Most research has focused on Western populations, while data from the Eastern Mediterranean, where environmental factors may influence fungal prevalence, is limited. This review examines the epidemiological, clinical, and mycological characteristics of AFRS in the Eastern Mediterranean region, with a focus on identifying predominant fungal species. DATA SOURCES: A systematic literature search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar using the keyword "allergic fungal rhinosinusitis." REVIEW METHODS: 37 studies involving 1188 patients were included. Data on patient demographics, clinical features, fungal species, diagnostic methods, treatment, recurrence, and socioeconomic indicators were analyzed. RESULTS: The mean age was 27.7 years, with a slight male predominance (52.1%). Nasal polyps and eosinophilic mucin were frequently reported. Fungal cultures were positive in 67.5% of cases, with Aspergillus species being the most common. A. flavus was predominant (32.8%), followed by A. fumigatus (23.5%) and A. niger (7.1%). Dematiaceous fungi, such as Bipolaris and Curvularia, were detected in 24.5% of cases. Endoscopic sinus surgery and corticosteroid therapy were the main treatments, with a recurrence rate of 19.4%. A higher prevalence of AFRS was noted in patients with lower socioeconomic status. CONCLUSIONS: AFRS in the Eastern Mediterranean has distinct fungal patterns compared to other regions, with A. flavus as the dominant pathogen. These findings highlight the importance of region-specific strategies in AFRS diagnosis and management. PROSPERO REGISTRATION ID: CRD42024495119 LEVEL OF EVIDENCE: This systematic review of observational studies (cohort and cross-sectional) on Allergic Fungal Rhinosinusitis in the Eastern Mediterranean region provides a Level 2 evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.