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Zhang H, Sun Y, Shen C, Jin P, Yue W, Zhang Q, Zhu F, Zhang H. Evaluation Value of Allergy in Adenoid Hypertrophy Through Blood Inflammatory Cells and Total Immunoglobulin E. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:139-144. [PMID: 36473200 DOI: 10.1089/ped.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Previous reports have indicated the close association of allergy with adenoid hypertrophy (AH). The aim of this study was to evaluate whether the inflammatory cells and total immunoglobulin E (IgE) in blood could be useful in the diagnosis of allergy in AH. Methods: Two hundred thirty-four children who underwent adenoidectomy were retrospectively enrolled in this study. Blood routine parameters were recorded, and total IgE as well as specific IgE (sIgE) of common allergens were tested perioperatively. The diagnostic utility of blood inflammatory cells and total IgE compared with serum sIgE testing was assessed. Results: In our study, 35.47% of AH children were atopic. Dermatophagoides farinae (d2), Dermatophagoides pteronyssinus (d1), and mold (mx2) were the most common sensitizing allergens. Significantly elevated eosinophil count, eosinophil to lymphocyte value, and total IgE were found in allergic AH children. As a result of receiver operating characteristic analysis, systemic total IgE could be a method to diagnose allergy in AH with a cutoff value of 46.55 and higher (area under curve [AUC] = 0.837; P < 0.001). Peripheral eosinophil count and eosinophil to lymphocyte were also able to predict positive allergy test result in AH children, with a cutoff value of 0.295 (AUC = 0.721; P < 0.001) and 0.082 (AUC = 0.685; P < 0.001), respectively. Conclusion: The presence of allergy can be distinguished by looking at peripheral total IgE and/or blood eosinophils in AH, which will guide us to the precise treatment of AH and also reduce the cost considerably.
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Affiliation(s)
- Hailing Zhang
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Yanliang Sun
- Department of Otolaryngology, Ningjin County People's Hospital, Dezhou, People's Republic of China
| | - Chaofan Shen
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Peng Jin
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Wei Yue
- Department of Otolaryngology, Liaocheng Dongchangfu People's Hospital, Liaocheng, People's Republic of China
| | - Qinqin Zhang
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Fengjuan Zhu
- Department of Otolaryngology-Head and Neck Surgery, The People's Hospital of Rizhao, Rizhao, People's Republic of China
| | - Hongping Zhang
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of China
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Chuanprasitkul C, Veeravigrom M, Sunkonkit K, Tansrirattanawong S, Sritippayawan S. Incidence / predictors of pediatric obstructive sleep apnea with normal oximetry. Pediatr Int 2021; 63:1376-1380. [PMID: 33606330 DOI: 10.1111/ped.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The polysomnogram (PSG) is the "gold standard" for diagnosing obstructive sleep apnea (OSA). However, nocturnal oximetry is a practical screening tool for children with adenotonsillar hypertrophy (ATH). This study aimed to investigate the incidence of, and predictive factors for, OSA in children with ATH and normal / inconclusive overnight oximetry. METHODS The prospective study enrolled children aged 3-15 years with ATH and normal / inconclusive overnight oximetry. All participants underwent full-night PSG. To evaluate the predictors of OSA, we used logistic regression analysis, including sex, history of allergic rhinitis, body mass index z-score, neck circumference-height ratio, and polysomnographic parameters (obstructive apnea-hypopnea index (OAHI), nadir oxygen saturation (SpO2), peak end-tidal CO2 , and arousal index). RESULTS The participants were 189 children; 167 (88%) were diagnosed with OSA by PSG. A history of allergic rhinitis (P = 0.033), and the PSG findings for nadir SpO2 (P = 0.027) and arousal index (P = <0.001) predicted the diagnosis of OSA. We divided patients with OSA into two groups (mild versus moderate to severe OSA). Patients with OAHI ≥5/h were defined as having moderate-to-severe OSA. No clinical factors significantly predicted OAHI ≥5. Of the 189 participants, 58 children (31%) were diagnosed with severe OSA (OAHI ≥10). The only PSG factor that predicted severe OSA was the arousal index (P < 0.001). CONCLUSIONS The observed incidence of OSA in children aged 3-15 years with ATH and normal/inconclusive overnight oximetry was very high. A history of allergic rhinitis may help to triage the patients. The arousal index was a predictor of pediatric OSA.
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Affiliation(s)
| | - Montida Veeravigrom
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Section of Neurology and Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital/ The Thai Red Cross Society, Bangkok, Thailand
| | - Kanokkarn Sunkonkit
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakanya Tansrirattanawong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchada Sritippayawan
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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3
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Lam ME, Kitipornchai L, Ball N, Sarkissian L, Sands T, Grundy L, MacKay SG. Incidence of allergen-specific and total immunoglobulin E positivity in children undergoing adenotonsillectomy. J Paediatr Child Health 2021; 57:1228-1233. [PMID: 33682263 DOI: 10.1111/jpc.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
AIM To conduct a prospective, consecutive cohort study to evaluate the incidence of allergen-specific and total immunoglobulin E (IgE) in a paediatric population undergoing adenotonsillectomy for sleep-disordered breathing. METHODS A total of 64 consecutive patients presenting for adenotonsillectomy at a single centre were recruited over a period of 3 months. All patients underwent adenotonsillectomy and had allergen-specific and total IgE serum testing at the time of anaesthesia induction. Pre-operative history and examination were conducted to determine clinical allergy. Caregivers completed the Sleep-Related Breathing Disorder scale of the Paediatric Sleep Questionnaire and the Mini Rhinoconjunctivitis Quality of Life Questionnaire at baseline and at 6 weeks post-operatively. RESULTS A total of 37 (57.8%) patients had either allergen-specific or total IgE positivity. House dust mite was the most prevalent allergen-specific IgE finding, being present in moderate to high levels in 14 (21.9%) patients. A total of 17 (26.6%) patients had a history of atopy, while 34 (53.1%) had examination findings suggestive of allergy. Neither serum IgE testing nor clinical history and examination were independently associated with residual symptoms post adenotonsillectomy. Patients with concomitant serum IgE positivity and clinical allergy had higher residual symptom scores compared to those who did not using both Sleep-Related Breathing Disorder scale of the Paediatric Sleep Questionnaire (P = 0.035) and Mini Rhinoconjunctivitis Quality of Life Questionnaire (P = 0.02) questionnaires. CONCLUSIONS Our prospective, consecutive cohort of patients reflect a greater incidence of serum IgE positivity compared to historical figures. When utilised with clinical findings on history and examination, serum IgE is a useful adjunct that is associated with greater residual symptoms post-adenotonsillectomy.
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Affiliation(s)
- Matthew E Lam
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra Health Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leon Kitipornchai
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Natelle Ball
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Lernik Sarkissian
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Terry Sands
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Liam Grundy
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Stuart G MacKay
- Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, New South Wales, Australia
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De Corso E, Galli J, Di Cesare T, Lucidi D, Ottaviano G, Seccia V, Bussu F, Passali GC, Paludetti G, Cantone E. A systematic review of the clinical evidence and biomarkers linking allergy to adeno-tonsillar disease. Int J Pediatr Otorhinolaryngol 2021; 147:110799. [PMID: 34153930 DOI: 10.1016/j.ijporl.2021.110799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION allergy may be an important risk factor for adenotonsillar disease in children, although conflicting results have been reported in the literature. In previous articles, authors often failed in distinguishing between adeno-tonsillar hypertrophy and recurrent tonsillitis and in not discriminating between isolated or combined adenoid and tonsillar hypertrophy. AIM to evaluate clinical evidence and biomarkers linking allergy to different phenotypes of adeno-tonsillar disease. Furthermore, we questioned whether anti-allergy treatment might prevent occurrence of adeno-tonsillar disease or improve its specific management. METHODS our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1010 articles finally screened. This resulted in 21 full texts that were included in a qualitative analysis. RESULTS literature data support the association between allergy and combined adeno-tonsillar hypertrophy and isolated adenoid hypertrophy, whereas describe a mainly negative correlation between allergy and isolated tonsillar hypertrophy. The results of this review suggest that local allergic inflammation may play a role in adeno-tonsillar hypertrophy. Data correlating bacterial recurrent tonsillitis and allergy are few, although evidence from the lab revealed that allergy might suppress innate immunity in tonsillar tissue by reducing levels of anti-microbial proteins. CONCLUSION basing on our qualitative analyses allergy should not be misdiagnosed in children with combined adenotonsillar hypertrophy or isolated adenoid hypertrophy, whereas evidence do not support a link between allergy and isolated tonsil hypertrophy. Finally, some data support a link between allergy and recurrent adeno-tonsillar infection although future studies are required to confirm this data. We summarized our conclusions in a practical algorithm.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Tiziana Di Cesare
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy.
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Veronica Seccia
- Otolaryngology Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Bussu
- Azienda Ospedaliero Universitaria, Sassari, Otorinolarinoiatria, Dipartimento Delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Italy
| | - Giulio Cesare Passali
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Department of Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences - ENT Section, University "Federico II", Naples, Italy
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Walter LM, Tamanyan K, Nisbet L, Weichard AJ, Davey MJ, Nixon GM, Horne RSC. Pollen levels on the day of polysomnography influence sleep disordered breathing severity in children with allergic rhinitis. Sleep Breath 2019; 23:651-657. [PMID: 30838494 DOI: 10.1007/s11325-019-01819-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Allergic rhinitis (AR) is a common risk factor for sleep disordered breathing (SDB) in children. Allergy to pollen is a trigger for allergic rhinitis, causing nasal inflammation, upper airway congestion and obstruction. We aimed to determine if the pollen count on the day of diagnostic polysomnography for SDB affected the result. METHODS Children (3-18 years; n = 90) who participated in research studies between 1 October and 31 December, when daily regional pollen counts were available, in the years 2005-2016 were eligible for inclusion. All children underwent overnight polysomnography for assessment of SDB severity. Pollen was categorised as grass or other pollen. Multiple stepwise linear regression was performed to determine whether the pollen count for that day, a diagnosis of asthma, age, and BMI-z-score were determinants of respiratory parameters measured on polysomnography, including the obstructive apnoea hypopnoea index (OAHI), SpO2 nadir, average SpO2 drop, SpO2 < 90%, oxygen desaturation index > 4% (ODI4), and average transcutaneous CO2 (TCM). RESULTS Sixteen/90 children had AR. In children with AR, an increase in grass pollen of 1 grain/m3 predicted an increase in OAHI of 0.2 events/h, ODI4 of 0.18 times/h, SpO2 < 90% of 0.03 times/h, and TCM of 0.07 mmHg. None of the factors were determinants of SDB severity in children without AR. CONCLUSION Our findings highlight that daily pollen counts may be an important factor influencing the severity of SDB on a single night of polysomnography in children with clinical allergic rhinitis and should be taken into account when determining treatment options.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Lauren Nisbet
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Aidan J Weichard
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia
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Association between allergic and nonallergic rhinitis and obstructive sleep apnea. Curr Opin Allergy Clin Immunol 2018; 18:16-25. [PMID: 29135515 DOI: 10.1097/aci.0000000000000414] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. RECENT FINDINGS In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep-wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea-hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. SUMMARY Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.
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Cho KS, Kim SH, Hong SL, Lee J, Mun SJ, Roh YE, Kim YM, Kim HY. Local Atopy in Childhood Adenotonsillar Hypertrophy. Am J Rhinol Allergy 2018; 32:160-166. [PMID: 29649882 DOI: 10.1177/1945892418765003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although the cause of adenotonsillar hypertrophy remains unknown, some studies have shown that allergy may be a risk factor. Purpose This study determined the levels of allergen-specific immunoglobulin E (sIgE) in the adenotonsillar tissues of children with adenotonsillar hypertrophy and evaluated the clinical significance of local atopy in adenotonsillar tissues. Methods We measured 21 types of specific immunoglobulin E in the serum and adenotonsillar tissues of 102 children with adenotonsillar hypertrophy and compared the sensitization patterns of the serum and local tissues. The patients were divided into three groups-atopy, local atopy, and nonatopy-according to the sensitization of serum and adenotonsillar tissues, and the clinical symptoms among the groups were analyzed. Results Seventy-two (70.6%) children with adenotonsillar hypertrophy were sensitized to more than one allergen in the serum and/or adenotonsillar tissue. Thirty (29.4%) children had no IgE positivity to any allergen in both serum and adenotonsillar tissues. Fifty-five (53.9%) were sensitized to at least one allergen in the serum. Seventy (68.6%) were sensitized to at least one allergen in the adenotonsillar tissue. Seventeen (36.2%) of 47 children with specific immunoglobulin E-negative serum had specific immunoglobulin E-positive adenotonsillar tissues. The rate of specific immunoglobulin E was significantly higher in local tissues than in serum. The rate of inhalant allergen specific immunoglobulin E was significantly higher in the adenoids than in the tonsils. However, the rate of food allergen specific immunoglobulin E was significantly higher in the tonsils than adenoids. The lifetime prevalence of asthma and allergic rhinitis, recent symptoms or treatment of allergic rhinitis, and severity of nasal symptoms (rhinorrhea, sneezing, and nasal itching) were significantly higher in children with local atopy than with nonatopy. Conclusions These results confirm that allergic response may be a risk factor for adenotonsillar hypertrophy. Local allergic inflammation may play an important role in childhood adenotonsillar hypertrophy, and local atopy in adenotonsillar tissues can cause respiratory allergic symptoms in children.
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Affiliation(s)
- Kyu-Sup Cho
- 1 Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong Heon Kim
- 2 Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea.,3 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung-Lyong Hong
- 1 Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jaeyoung Lee
- 4 Department of Nursing Science, College of Natural Sciences, Kyungsung University, Busan, Republic of Korea
| | - Sue Jean Mun
- 5 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Young Eun Roh
- 6 Department of Pediatrics, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Young Mi Kim
- 6 Department of Pediatrics, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Hye-Young Kim
- 6 Department of Pediatrics, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
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Zhang J, Zhao J, Chen M, Liu S, Zhang X, Zhang F, Zhang Y, Chen H, Ni X. Airway resistance and allergic sensitization in children with obstructive sleep apnea hypopnea syndrome. Pediatr Pulmonol 2016; 51:426-30. [PMID: 26284311 DOI: 10.1002/ppul.23264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the airway resistance in Chinese children with obstructive sleep apnea hypopnea syndrome (OSAHS) by impulse oscilloetry (IOS) and investigate the association of the severity of OSAHS with the airway resistance and allergic sensitization. METHOD A total of 120 children (92 boys) treated for snoring in Beijing Children's Hospital between October 2010 and March 2011 were included in this study. Ninety-three children were diagnosed with OSAHS and 27 did not show OSAHS. Total airway resistance (R5), proximal airway resistance (R20), and peripheral airway resistance (X5) were determined by IOS. Serum levels of total IgE and allergen-specific IgE (sIgE) were also determined. RESULTS R5 in the OSAHS group was significantly higher than that in the non-OSAHS group (P = 0.0025), whereas R20 and X5 were similar in the two groups. R5 was positively correlated with apnea hypopnea index and obstructive apnea index and negatively correlated with the lowest arterial oxygen saturation significantly (all P < 0.05). The percentage of children with abnormal serum levels of total IgE or abnormal allergen-specific IgEs was comparable in OSAHS and non-OSAHS groups. The proportions of abnormal R5 and of abnormal serum levels of total IgE were significantly higher in children with severe OSAHS compared with children with mild or moderate OSAHS (all P < 0.05). CONCLUSIONS Total airway resistance was significantly increased in Children with OSAHS. Allergic sensitization might contribute to the exacerbation of existing OSAHS in children. Large scale studies are required to further validate these findings.
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Affiliation(s)
- Jie Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Jing Zhao
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Min Chen
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Shilin Liu
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Xuexi Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Fengzhen Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Yamei Zhang
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, P. R. China
| | - Xin Ni
- Department of Otorhinolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Beijing Children's Hospital, Head and Neck Surgery Beijing Pediatric Research Institute, Capital Medical University, Beijing, P. R. China
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Evcimik MF, Dogru M, Cirik AA, Nepesov MI. Adenoid hypertrophy in children with allergic disease and influential factors. Int J Pediatr Otorhinolaryngol 2015; 79:694-7. [PMID: 25758194 DOI: 10.1016/j.ijporl.2015.02.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/15/2015] [Accepted: 02/17/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Adenoid hypertrophy (AH) may cause several comorbid conditions including sleep apnea, chronic serous otitis and sinusitis. Such conditions are more common among children with allergic diseases. In our study, we aimed to determine the patient profile associated with higher incidence of adenoid hypertrophy and the related influential factors. METHODS The study included 1322 children being treated and followed up for allergic conditions. 100 children with no allergic diseases presenting during the same period to the clinic were included as the control group. Skin prick test for the same allergens was performed for all patients. Adenoid tissue was analyzed by an ENT specialist and the diagnosis was confirmed based on the patient history, endoscopic physical examination and radiology. RESULTS Of the patients, 765 (57.9%) were males and 557 (42.1%) were females and their mean age was 5.9±3.3 years. In the control group, 56 (56%) children were males and 44 (44%) were females and their mean age was 6.3±4.1 years. Children with allergic disease and control subjects did not differ significantly by age and gender. Adenoid hypertrophy was identified in 164 (12.4%) of the patients with allergic disease and in 3 (3%) of the controls. Allergic children were divided into two groups, as children with and without AH, respectively. The groups did not differ statistically significantly by gender, age or familial history of atopic disease. However, cigarette smoke exposure at home and presence of allergic rhinitis was significantly more frequent in the group of patients with AH. In the logistic model investigating the effect of variables on AH presence (according to age, gender, cigarette smoke exposure, asthma, AR, AD presence, atopy presence, sensitivity to house dust, pollen, epithelium, Alternaria alternata and cockroach), AR presence and cigarette smoke exposure were statistically significant. CONLUSIONS AH frequency is higher in children with allergic disease compared to controls. The most common sensitivity to allergens among patients with AH was to house dust. Presence of allergic rhinitis and cigarette smoke exposure are risk factors for developing AH. Children with these risk factors should be questioned for AH during their routine examinations.
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Affiliation(s)
- Muhammed Fatih Evcimik
- Istanbul Medipol University, Faculty of Medicine, Department of Otorhinolaryngology - Head & Neck Surgery, Istanbul, Turkey.
| | - Mahmut Dogru
- Zeynep Kamil Woman's and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Ahmet Adnan Cirik
- Umraniye Training and Research Hospital, Department of Otorhinolaryngology - Head & Neck Surgery, Istanbul, Turkey
| | - Merve Iseri Nepesov
- Zeynep Kamil Woman's and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
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Quaranta N, Milella C, Iannuzzi L, Gelardi M. A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2013; 77:1980-3. [PMID: 24113158 DOI: 10.1016/j.ijporl.2013.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy. METHODS 81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation. RESULTS Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02). CONCLUSIONS A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.
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Affiliation(s)
- Nicola Quaranta
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy.
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Costa EC, Sabino HAC, Miura CS, de Azevedo CB, de Menezes UP, Valera FCP, Anselmo-Lima WT. Atopy and adenotonsillar hypertrophy in mouth breathers from a reference center. Braz J Otorhinolaryngol 2013; 79:663-7. [PMID: 24474475 PMCID: PMC9442386 DOI: 10.5935/1808-8694.20130123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/16/2013] [Indexed: 01/30/2023] Open
Abstract
Mouth breathers use the oral cavity as their principal breathing route. The main causes include: adenotonsillar hypertrophy and inflammatory diseases such as allergic rhinitis. Objective To look for atopy, the main allergens involved and to check for atopy as a comorbidity with the degree of hypertrophy of the tonsils and adenoids in mouth breathers. Method A historical cohort study with cross-sectional review of 308 medical charts of patients treated at a mouth breather care center of a tertiary hospital in the period of 2008–2010. We collected data on the mouth breather's clinical history and we ran otolaryngological exams, flexible nasal endoscopy and skin prick test to aeroallergens. Results Of 308 patients, 36% were positive on allergy testing, with 95 % of atopic patients being positive for mites. Among all patients, 46% had adenoid hypertrophy; of these, 37% were atopic and 47% had tonsillar hypertrophy, and among these, 33% were atopic. Conclusion We found no direct correlation between atopy and the degree of tonsils and adenoid hypertrophy observed among the mouth-breathing patients assessed. si.
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Affiliation(s)
- Emanuel Capistrano Costa
- MD; Resident Physician, University Hospital, School of Medicine of Ribeirão Preto, University of Sãc Paulo
| | | | - Carolina Sponchiado Miura
- MD; Resident Physician, University Hospital, School of Medicine of Ribeirão Preto, University of Sãc Paulo
| | - Carolina Brotto de Azevedo
- MD; Resident Physician, University Hospital, School of Medicine of Ribeirão Preto, University of Sãc Paulo
| | - Ullissis Pádua de Menezes
- MD; Resident Physician, University Hospital, School of Medicine of Ribeirão Preto, University of Sãc Paulo
| | | | - Wilma Terezinha Anselmo-Lima
- Senior Associate Professor; Associate Professor, School of Medicine of Ribeirão Preto, University of São Paulo
- Send correspondence to: Wilma Terezinha Anselmo-Lima. Av. Bandeirantes, n 3900. Vila Monte Alegre. Ribeirão Preto - SP. Brasil. CEP: 14049-900. Tel: +55 (016) 3602-2862. Fax: +55 (016) 3602-2860
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Zhang X, Sun B, Li S, Jin H, Zhong N, Zeng G. Local atopy is more relevant than serum sIgE in reflecting allergy in childhood adenotonsillar hypertrophy. Pediatr Allergy Immunol 2013; 24:422-6. [PMID: 23724785 DOI: 10.1111/pai.12089] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND There was a lack of convincing evidence supporting the influence of allergy on the adenotonsillar hypertrophy (ATH). We investigated the presence of specific IgE (sIgE) in the serum and adenotonsillar tissues in children with ATH. METHODS A Pharmacia ImmunoCAP system was used to test sIgE against 31 allergens in the serum in 83 children with ATH before adenotonsillectomy. sIgE against 15 representative allergens were detected in adenotonsillar tissues from 20 of those children. RESULTS A total of 51 (61.45%) children had positive serum sIgE. 20 children with ATH had positive sIgE to more than two allergens at both tonsils and adenoids, although half of them were serum sIgE negative. The percentage of subjects with positive sIgE expression in adenoids and tonsils was 50.0% and 42.9%, respectively, among the subjects with positive serum sIgE expression. Of subjects with negative serum sIgE expression, local sIgE was detected in 36.0% of adenoids and 43.8% of tonsils, respectively. The rate of sIgE presence in local tissue (adenoids or tonsils) was significantly higher than that seen in the serum. CONCLUSION This study provided evidence that there was an important role for allergic inflammation in the ATH. The inconsistency in sIgE expression between adenotonsillar and serum suggests a role of local atopy in childhood ATH.
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Affiliation(s)
- Xiaowen Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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Bohne S, Siggel R, Sachse S, Kiehntopf M, Bauer M, Straube E, Guntinas-Lichius O. Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis. J Negat Results Biomed 2013; 12:11. [PMID: 23816317 PMCID: PMC3701599 DOI: 10.1186/1477-5751-12-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 05/29/2013] [Indexed: 01/20/2023] Open
Abstract
Background The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis. Methods A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). Correlation analyses between CHT and PTA group as well as between the different time points within each group concerning the serological parameters and the outcome parameters were performed. Results At T-1, patients in the CHT group presented with significantly higher lymphocytes counts (relative and absolute), basophils (relative and absolute) and eosinophils but less white-cells, monocytes, neutrophils (absolute and relative), alpha-1, alpha-2, beta globulins, immunoglobulin and lower C-reactive protein and procalcitonin values than patients in the PTA group (all p < 0.05, respectively). Within each group, different significant changes of the serum parameters (often in opposite direction) were observed between T-1 and T5. SBTI scores at T-1 were significantly lower in the CHT group. In contrast, most GBI scores at T180 were significantly higher in the CHT group. Between T-1 and T180 the SBTI scores improved in three quarters of the CHT patients but only in three fifths of the PTA patients. Higher eosinophil counts and immunoglobulin E levels at T-1 predicted higher GBI scores at T180 in the CHT group. Conclusions This pilot study showed a specific serological pattern for patients with chronic tonsillitis with a specific pattern of changes after tonsillectomy. But there is no established role for biomarkers currently used in clinical practice to predict the outcome of tonsillectomy for chronic tonsillitis.
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Lin SY, Melvin TAN, Boss EF, Ishman SL. The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review. Int Forum Allergy Rhinol 2013; 3:504-9. [PMID: 23307785 DOI: 10.1002/alr.21123] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/11/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this work was to systematically review existing literature on the association between allergic rhinitis (AR) and sleep-disordered breathing (SDB) in children. METHODS We performed a literature search encompassing the last 25 years in PubMed, EMBASE, and Cochrane CENTRAL. Inclusion criteria included English-language papers containing original human data, number of subjects ≥7, and age <18 years old. Data was systematically collected on study design, patient demographics, clinical characteristics/outcomes, and level-of-evidence. Two investigators independently reviewed all articles. RESULTS The initial search yielded 433 abstracts, of which 18 articles were included. Twelve (67%) of the 18 articles showed a statistically significant association between AR and SDB. All articles were either case-series or case-control studies. Based on the Newcastle-Ottawa scale, the quality of the articles was determined to be fair to good. For characterizing AR, 7 (39%) studies included skin-prick testing and/or in vitro testing. For determining presence of SDB, 7 (39%) of the studies used polysomnographic data, of which 1 study incorporated data from a home polysomnogram. Habitual snoring was the most common form of SDB studied, in 10 (56%) of the articles. Obstructive sleep apnea was studied in 6 (33%) articles. CONCLUSION Although the majority of the studies included in this review showed a significant association between AR and SDB, all of the studies were evidence level 3b and 4, for an overall grade of B- evidence (Oxford Evidence-Based Medicine Center). Further higher-quality studies should be performed in the future to better evaluate the relationship between AR and SDB in children.
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Affiliation(s)
- Sandra Y Lin
- Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD 21287, USA.
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Ishman SL, Smith DF, Benke JR, Nguyen MT, Lin SY. The prevalence of sleepiness and the risk of sleep-disordered breathing in children with positive allergy test. Int Forum Allergy Rhinol 2011; 2:139-43. [PMID: 22162486 DOI: 10.1002/alr.20104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/28/2011] [Accepted: 10/02/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Eryaman E, Ozkul A, Ozker BY. Skin prick test and tonsil size in children: any relation? Indian J Otolaryngol Head Neck Surg 2011; 65:371-4. [PMID: 24427602 DOI: 10.1007/s12070-011-0296-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 08/12/2011] [Indexed: 11/25/2022] Open
Abstract
We hypothesized, allergic reactions of the tonsillar mucosa may cause secondary lymphoid hypertrophy in children. To evaluate this, we compared tonsil sizes and skin prick test results. Children of ages 6-12 years were divided into two groups according to the results of the skin prick tests (SPT), as atopic and non-atopic groups. All tonsil sizes were evaluated by the same observer using the Brodsky L. Scala. No statistically meaningful difference was found between the tonsil sizes of the atopic and the non-atopic groups of children. No statistically meaningful correlation was found between tonsil sizes and allergen sensitivity degrees. Even though some highly allergic children were observed to have large tonsils, it was not statistically meaningful. Since no correlation is found between SPT and tonsil sizes, allergy may not be an etiologic factor of tonsillar hypertrophy in children.
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Affiliation(s)
- E Eryaman
- Department of Otorhinolaryngology and Head and Neck Surgery, Baskent Universitesi Istanbul Saglik Uygulama ve, Arastirma Merkezi Hastanesi, KBB Hastaliklari AD, Mahir Iz cad., No. 43, 34662 Altunizade, Istanbul Turkey
| | - A Ozkul
- Department of Pediatry, Baskent University School of Medicine, Bahcelievler, Ankara Turkey
| | - B Y Ozker
- Department of Otorhinolaryngology and Head and Neck Surgery, Baskent Universitesi Istanbul Saglik Uygulama ve, Arastirma Merkezi Hastanesi, KBB Hastaliklari AD, Mahir Iz cad., No. 43, 34662 Altunizade, Istanbul Turkey
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