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Liang J, Huang Y, Yin L, Sadeghi F, Yang Y, Xiao X, Adami HO, Ye W, Zhang Z, Fang F. Cancer risk following surgical removal of tonsils and adenoids - a population-based, sibling-controlled cohort study in Sweden. BMC Med 2023; 21:194. [PMID: 37226237 DOI: 10.1186/s12916-023-02902-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Removal of tonsils and adenoids is among the most common surgical procedures worldwide. Evidence of increased risk of cancer following such surgery is, however, inconclusive. METHODS We conducted a population-based, sibling-controlled cohort study of 4,953,583 individuals in Sweden with a follow-up during 1980-2016. History of tonsillectomy, adenotonsillectomy, and adenoidectomy was identified from the Swedish Patient Register whereas incident cases of cancer during follow-up were identified from the Swedish Cancer Register. We used Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) of cancer in both a population and a sibling comparison. The sibling comparison was used to assess the potential impact of familial confounding, due to shared genetic or non-genetic factors within a family. RESULTS We found a modestly increased risk for any cancer following tonsillectomy, adenoidectomy, or adenotonsillectomy in both the population (HR 1.10; 95%CI 1.07-1.12) and sibling (HR 1.15; 95%CI 1.10-1.20) comparisons. The association did not differ greatly by type of surgery, age at surgery, or potential indication for surgery, and persisted more than two decades after surgery. An excess risk was consistently observed for cancer of the breast, prostate, thyroid, and for lymphoma in both population and sibling comparisons. A positive association was observed for pancreatic cancer, kidney cancer, and leukemia in the population comparison whereas a positive association was observed for esophageal cancer in the sibling comparison. CONCLUSIONS Surgical removal of tonsils and adenoids is associated with a modestly increased risk of cancer during the decades following the surgery. The association is unlikely attributed to confounding due to shared genetic or non-genetic factors with a family.
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Affiliation(s)
- Jinfeng Liang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Yi Huang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fatemeh Sadeghi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yanping Yang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Xiao
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), Ministry of Education, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Nanning, Guangxi, China
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zhe Zhang
- Department of Otolaryngology-Head & Neck Surgery, First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Guangxi, 530021, Nanning, China.
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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de Souza JNR, de Castro FDOF, de Souza CL, El Cheikh MR, Ramos HVL, da Fonseca SG, Costa CC. Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy? Int Arch Otorhinolaryngol 2021; 26:e208-e212. [PMID: 35602273 PMCID: PMC9122772 DOI: 10.1055/s-0041-1730301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction
Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system.
Objective
To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy.
Methods
Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis.
Results
The plasma level of IL-6 was higher in the RT (
p
= 0.0394) and TH (
p
= 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (
p
= 0.039). The IL-6/IL-10 ratio was higher in the RT (
p
= 0.029) and TH (
p
= 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (
p
= 0.0091).
Conclusion
Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.
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Affiliation(s)
| | | | - Camila Lemes de Souza
- Institute of Tropical Pathology and Public Health, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Hugo Valter Lisboa Ramos
- Otorhinolaryngology, Centro de Reabilitação e Readaptação Dr. Henrique Santilo (CRER), Goiânia, GO, Brazil
| | | | - Claudiney Candido Costa
- Otorhinolaryngology, Centro de Reabilitação e Readaptação Dr. Henrique Santilo (CRER), Goiânia, GO, Brazil
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He JW, Zhou XJ, Lv JC, Zhang H. Perspectives on how mucosal immune responses, infections and gut microbiome shape IgA nephropathy and future therapies. Am J Cancer Res 2020; 10:11462-11478. [PMID: 33052226 PMCID: PMC7545987 DOI: 10.7150/thno.49778] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023] Open
Abstract
Infections have been considered to play a critical role in the pathogenesis of IgA nephropathy (IgAN) because synpharyngitic hematuria is a common feature in IgAN. However, how infections participate in this process is still debated. More recent studies have also revealed that the alteration of the gut microbiome exerts a profound effect on host immune responses, contributing to the etiology or progression of autoimmunity. Considering IgA as the first line of defense against bacterial and viral antigens, this review evaluates the relationships among intestinal infections, gut microbiome, and IgA for a better understanding of the pathogenesis of IgAN. Moreover, as a prototype of IgA immunity, we provide detailed clarification of IgAN pathogenesis to shed light on other diseases in which IgA plays a role. Finally, we discuss potential therapies focusing on microbes and mucosal immune responses in IgAN.
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Radman M, Ferdousi A, Khorramdelazad H, Jalali P. Long-term impacts of tonsillectomy on children's immune functions. J Family Med Prim Care 2020; 9:1483-1487. [PMID: 32509637 PMCID: PMC7266207 DOI: 10.4103/jfmpc.jfmpc_935_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/20/2023] Open
Abstract
Background There exist a wide level of discrepancy regarding the role of tonsils and its indication among pediatricians and ENT specialists. This fact sometimes causes confusion and delay in making the right decisions by parents and specialists for appropriate treatment of patients. Objectives Thus, the aim of this study was to investigate the effects of long-term tonsillectomy on the immune system of patients. Methods In this case-control study we measured the status of immune system in 34 children (aged 9-15 years) following 4 to 6 years of tonsillectomy. We have also enrolled 30 healthy children with similar age group. Venous blood samples were taken and the serum levels of IgG, IgA, and IgM were detected along with expression of CD4, CD8, CD10 and CD56. Data were analyzed by SPSS version 18 software and a P < 0.05 was considered as significant. Results We found that the mean serum levels IgM, IgA, and IgG in the case group was significantly (P < 0.0001) lower than the control group. Whereby, the CD4, CD8 and CD56 expressions was examined, there was no significant difference in both groups while only CD10 expression was lower in tonssiloctomized patients (P = 0.108). Conclusion Overall, according to these findings, CD10 as a marker of B lymphocytes in children undergoing tonsillectomy was significantly less than those healthy children. This may indicate a decrease in B cells and further reduced antibody production in these patients.
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Affiliation(s)
- Masoud Radman
- Clinical Research Development Unit (CRDU), Moradi Hospital, Rafsanjan, Iran
| | - Asiyeh Ferdousi
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Khorramdelazad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan, Iran
| | - Pooneh Jalali
- Family Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Altwairqi RG, Aljuaid SM, Alqahtani AS. Effect of tonsillectomy on humeral and cellular immunity: a systematic review of published studies from 2009 to 2019. Eur Arch Otorhinolaryngol 2019; 277:1-7. [PMID: 31664514 DOI: 10.1007/s00405-019-05672-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although tonsillectomy is the most commonly performed surgical operation for children, its postoperative effect on the immune response was a source of debate among physicians. PURPOSE The aim of this systemic review was study the effect of tonsillectomy on children immune response. DATA SOURCES PubMed, Medline, Embase and Cochrane Library. REVIEW METHODS All relevant articles published English language addressing the effect of tonsillectomy on the immune system were included. One investigators extracted data regarding: year of the study, sample size, study design, sample size, timing of analysis, studied immune factors, result and conclusion were identified. Another investigator independently reviewed data accuracy. RESULTS Ten articles published between from January 2009 to January 2019 in about this issue that included 404 children were reviewed. All reviewed studies showed a non-significant difference between levels of indicators of the humeral immunity (IgA, IgG, IgM, C3 and C4) pre- and postoperatively. Studies that measured these indicators only after surgery, showed a non-significant difference in their levels between patients and healthy controls. Levels of indicators of cellular immunity (CD4+ , CD3+ , CD8+ , CD19+ , CD25+ , CD16+ , CD+ 56) showed slight reduction or increase in some studies but without a significant difference compared to their levels preoperatively, postoperatively at different intervals or with healthy controls. Other studies found no changes in these indicators postoperatively. CONCLUSION There was enough evidence to conclude that tonsillectomy has no negative affect on both humeral and cellular immunity of children.
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Affiliation(s)
- R G Altwairqi
- Medical Intern, College of Medicine, Taif University, Taif City, Saudi Arabia.
| | - S M Aljuaid
- Senior Registrar ORL Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia
| | - A S Alqahtani
- Senior Registrar ORL Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia
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Yan Y, Song Y, Liu Y, Su J, Cui L, Wang J, Geng J, Liu X, Shi Y, Quan S, Hang A, Zuo L. Short- and long-term impacts of adenoidectomy with/without tonsillectomy on immune function of young children <3 years of age: A cohort study. Medicine (Baltimore) 2019; 98:e15530. [PMID: 31083200 PMCID: PMC6531274 DOI: 10.1097/md.0000000000015530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To investigate the short- and long-term impacts of adenoidectomy with/without tonsillectomy on the immune functions of young children < 3 years of age.This longitudinal prospective study included 40 pediatric patients (age <3 y) undergoing adenoidectomy with/without tonsillectomy for snoring and sleep apnea. Serum immunoglobulin IgA, IgG, IgM, complement C3, and C4 levels were measured for the status of humoral immunity; CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were measured for the status of cellular immunity. Blood samples were taken at 3 time points: before surgery, 1 month after surgery (short-term), and 3 months after surgery (long-term). All patients were assessed for short-term outcome at 1-month postoperation, but only 30 patients were followed at 3 months after surgery. The incidence of recurrent respiratory tract infections and other immune-related conditions were recorded at each follow-up.The levels of IgA significantly decreased from the preoperative level at 1-month follow-up (P < .05), but still within normal range. No significant changes were found in the levels of IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cell at 3-month follow-up in comparison with preoperative levels. There was also no episode of recurrent respiratory tract infection and other immune-deficiency conditions.Adenoidectomy with/without tonsillectomy may result in a reduction in individual antibodies in children <3 years of age, but did not show negative impacts on their immune functions. Also, the surgery does not lead to the increased risk of upper respiratory tract infection in these children.
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Yan Y, Song Y, Liu Y, Su J, Cui L, Wang J, Geng J, Liu X, Shi Y, Quan S, Zuo L. Early Stage Impacts of Adenoidectomy With/Without Tonsillectomy on Immune Functions of Children Aged Less Than Three Years. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:18-22. [PMID: 31508251 DOI: 10.1089/ped.2018.0964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Objective: To evaluate the early stage effects of adenoidectomy with/without tonsillectomy on immune functions in children aged <3 years. Methods: Twenty-four children aged <3 years underwent adenoidectomy with/without tonsillectomy were included. The levels of IgG, IgA, IgM, C3, and C4 were measured for humoral immunity, and the levels of CD3+, CD4+, CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were measured for cellular immunity before and 2 weeks after the operation. Results: The postoperative levels of IgA, IgG, IgM, C3, and C4 were significantly increased compared with the preoperative levels (P < 0.05). The levels of CD3+, CD4+, CD8+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were increased, while the level of CD19+ was decreased in postoperative period compared with preoperative period. Compared with those in the control group, the preoperative levels of IgA, IgG, and CD3+CD4+CD8+ T cells were significantly increased (P < 0.05), while the levels of IgM, C3, C4 and CD3+, CD4+, CD8+, CD56+, and CD3+CD4-CD8- T cells were not significantly changed. The postoperative levels of IgA, IgG, C3, C4, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were significantly increased (P < 0.05), while the levels of IgM, CD3+, CD4+, CD8+, and CD56+ T cells were not significantly changed compared with those in the control group. Conclusion: Adenoidectomy with/without tonsillectomy could stimulate the immune responses, which could avoid significant immune deficiency in a short period of time in children aged <3 years.
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Affiliation(s)
- Yuyan Yan
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yingluan Song
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yingying Liu
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jinzhu Su
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Li Cui
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Jiangqiao Geng
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Xiaofeng Liu
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Yanan Shi
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Shan Quan
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Lujie Zuo
- Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Shijiazhuang, China
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Yurtsever N, Soyyigit S, Sozener ZC, Mungan D, Kose SK, Misirligil Z. Is Adenoidectomy and/or Tonsillectomy a Risk Factor for Allergic Diseases and Asthma in Adulthood? Eurasian J Med 2018; 50:152-155. [PMID: 30515033 DOI: 10.5152/eurasianjmed.2018.17182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To determine the relationship between adenoidectomy and/or tonsillectomy in childhood and allergic diseases in adulthood. Materials and Methods A survey investigating the history of adenoidectomy and/or tonsillectomy was administered to patients that were followed-up by our department between January and June 2014 with the diagnosis of asthma, allergic rhinitis, urticaria-angioedema, drug allergy, food allergy, and venom allergy; patients willing to participate were included in the study. The relationship and risk ratios were analyzed. Results Totally, 510 (female/male: 379/131) patients were included in the study: 248 with asthma, 205 with rhinitis, 82 with drug allergy, 73 with urticaria, 24 with food allergy, and 14 with venom allergy. Of these, 65 (12.7%) had undergone adenoidectomy and/or tonsillectomy. Of these 65 patients, 41 had asthma, 33 had allergic rhinitis, and 28 had other allergic diseases. No relation between the history of atopy and adenoidectomy and/or tonsillectomy (p=0.129) was detected; however, there was a positive correlation between asthma and patients aged <15 years having a history of tonsillectomy and/or adenoidectomy (p=0.020). The risk of asthma was determined to be increased by 1.96 fold among the patients, provided the patient had undergone adenoidectomy and/or tonsillectomy (confidence interval [CI]:1.14-3.36). No connection was observed between atopic and non-atopic asthmatic patients in relation to adenoidectomy and/or tonsillectomy (p=0.46). No relationship was observed between allergic rhinitis and adenoidectomy and/or tonsillectomy. Conclusion Adenoidectomy and/or tonsillectomy in childhood increase the risk of asthma in adulthood, whereas it does not increase the risk of atopy. This result signifies the criticality of adenoidectomy or tonsillectomy in the pathogenesis of asthma.
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Affiliation(s)
- Nalan Yurtsever
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Sadan Soyyigit
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsad Mungan
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - S Kenan Kose
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Misirligil
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Bitar MA, Rameh C, Ataya NF, Najarian A, Chakhtoura M, Abdelnoor A. Alterations in Humoral Immunity After Partial Versus Total Tonsillectomy: A Pilot Study and Systematic Review of Literature. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-6214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bitar MA, Dowli A, Mourad M. The effect of tonsillectomy on the immune system: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2015; 79:1184-91. [PMID: 26055199 DOI: 10.1016/j.ijporl.2015.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/12/2015] [Accepted: 05/16/2015] [Indexed: 11/28/2022]
Abstract
IMPORTANCE The immunological sequelae of tonsillectomy in children have been a source of debate among physicians and a continuous concern for parents. Contradictory pertinent results exist in the literature. OBJECTIVE To understand the real effect of tonsillectomy on the immune system. DATA SOURCES MEDLINE, EMBASE and COCHRANE. STUDY SELECTION Articles addressing the effect of tonsillectomy on the immune system, up to Dec 2014. Related keywords and medical subject headings were used during the search. The abstracts were reviewed to determine suitability for inclusion based on a set of criteria. Manual crosscheck of references was performed. DATA EXTRACTION We checked the tests results and the conclusion of each study to classify it as supporting or refuting the hypothesis of a negative effect of tonsillectomy on the immune system. RESULTS We reviewed 35 articles, published between 1971 and 2014, including 1997 patients. Only Four studies (11.4%), including 406 patients (20.3%) found that tonsillectomy negatively affects the immune system. We performed a separate meta-analysis on various reviewed humoral and cellular immunological parameters (e.g. total and specific serum Ig's, SecIgA, cellular immunity, and Ag specific Ig). There is more evidence to suggest that tonsillectomy has no negative clinical or immunological sequalae on the immune system. Study limitations included heterogeneity in the diagnostic tools, timing of testing, indication for tonsillectomy and patients' age. CONCLUSION It is reasonable to say that there is enough evidence to conclude that tonsillectomy has no clinically significant negative effect on the immune system. It will be important for future studies to uniformly use both preoperative and control laboratory tests' levels to compare the postoperative levels with, to have short and long term follow-up levels, and to include both humoral and cellular immunity in their measurements. RELEVANCE The results should reassure both surgeons and parents that tonsillectomy has no proven clinical sequalae. If more research is to be done in the future, it should be performed in a standardized way to avoid the heterogeneity seen in the literature.
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Affiliation(s)
- Mohamad A Bitar
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Department of Pediatrics & Adolescent Medicine, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Department of ENT Surgery, The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Alexander Dowli
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon; Maine Medical Center, Portland, ME, USA
| | - Marc Mourad
- Department of Otolaryngology Head & Neck Surgery, American University of Beirut Faculty of Medicine & Medical Center, Beirut, Lebanon
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Lee J, Chang DY, Kim SW, Choi YS, Jeon SY, Racanelli V, Kim DW, Shin EC. Age-related differences in human palatine tonsillar B cell subsets and immunoglobulin isotypes. Clin Exp Med 2015; 16:81-7. [PMID: 25618165 DOI: 10.1007/s10238-015-0338-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/08/2015] [Indexed: 11/27/2022]
Abstract
The tonsils provide defense of the upper aerodigestive tract against pathogens. Although long known to undergo functional changes with age, the precise changes occurring within tonsillar B cell populations remain undefined. In the present study, we investigated age-related changes in palatine tonsillar B cell subsets and immunoglobulin (Ig) isotypes. Palatine tonsils were obtained from forty-two tonsillectomy patients without tonsillitis who were divided into three groups: young children (4-9 years), adolescents (10-19 years), and adults (20-60 years). Tonsillar B cells were then analyzed by flow cytometry. Using expression of CD38 and IgD to define B cell subsets, we found that the frequency of germinal center (GC) B cells in the tonsils was significantly higher, and the frequency of memory B cells lower, in young children as compared to adolescents and adults. Within the GC B cell subsets, adults had a higher frequency of IgA(+) cells and a lower frequency of IgM(+) cells as compared to individuals in the younger age groups. Moreover, young children had a higher frequency of IgG(+) cells in the GC B cell subsets than did individuals in the older age groups. We also observed an abundance of IgM(+) cells among memory B cells and plasmablasts in young children and IgA(+) cells in adults. In summary, the proportion of GC B cells in palatine tonsillar B cells decreases with age, while the proportion of memory B cells increases with age. In addition, Ig isotypes in tonsils preferentially switch from IgM to IgA as individuals age.
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Affiliation(s)
- Jino Lee
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 305-701, Republic of Korea
| | - Dong-Yeop Chang
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 305-701, Republic of Korea.,Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, 660-702, Republic of Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, 660-702, Republic of Korea
| | - Yoon Seok Choi
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 305-701, Republic of Korea
| | - Sea-Yuong Jeon
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, 660-702, Republic of Korea
| | - Vito Racanelli
- Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, 156-707, Republic of Korea.
| | - Eui-Cheol Shin
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 305-701, Republic of Korea.
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Refaat M, Ashour ZA, Farres MN, Eissa AM, Elsayed MM. Effect of tonsillectomy on the efficacy of house dust mite sublingual immunotherapy. Allergol Immunopathol (Madr) 2015; 43:108-11. [PMID: 24388811 DOI: 10.1016/j.aller.2013.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/24/2013] [Accepted: 09/14/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M Refaat
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z A Ashour
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M N Farres
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - A M Eissa
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M M Elsayed
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus. Pediatr Infect Dis J 2013; 32:834-8. [PMID: 23518825 PMCID: PMC3740796 DOI: 10.1097/inf.0b013e31829062e2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In children presenting with obsessive compulsive disorder (OCD) and/or tics, especially those with a temporal association with streptococcal pharyngitis (eg, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), there is speculation about whether tonsillectomy/adenoidectomy might improve the child's neuropsychiatric course. Our objective was to examine whether removal of the tonsils and/or adenoids impacted streptococcal antibody titers, the timing of onset of OCD and/or tics and the clinical severity of these symptoms. METHODS Study participants (N = 112; average age = 9.2 ± 2.4; 44 women) were recruited as part of a prospective investigation of neuropsychiatric phenomena with temporal association to streptococcal pharyngitis and examined by family history, diagnostic interview, physical examination, medical record review, psychological testing and streptococcal antibodies and divided into surgical or nonsurgical groups. The surgical group consisted of children having previously had a tonsillectomy and/or adenoidectomy (n = 32). The remaining children were categorized as nonsurgical group (n = 76). Measures of OCD and tic severity, streptococcal antibody titers and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification were compared between both groups. RESULTS There were no significant differences as determined by streptococcal antibody titers, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification and OCD or tic severity between the surgical and nonsurgical groups. Most participants had surgery before the onset of neuropsychiatric symptoms and surgery did not affect symptomology. CONCLUSIONS Streptococcal antibodies and neuropsychiatric symptom severity did not differ on the basis of surgical status. From these data, we cannot infer that tonsillectomy and adenoidectomy are likely to impact positively the course of OCD/tics or streptococcal antibody concentrations.
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Santos FP, Weber R, Fortes BC, Pignatari SSN. Short and long term impact of adenotonsillectomy on the immune system. Braz J Otorhinolaryngol 2013; 79:28-34. [PMID: 23503904 PMCID: PMC9450877 DOI: 10.5935/1808-8694.20130006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 10/13/2012] [Indexed: 11/29/2022] Open
Abstract
Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. Objective To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. Method This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). Results TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. Conclusion This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.
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Bitar MA, Mahfoud L, Nassar J, Dana R. Exploring the characteristics of children with obstructive adenoid responding to mometasone fuorate monohydrate: preliminary results. Eur Arch Otorhinolaryngol 2012; 270:931-7. [DOI: 10.1007/s00405-012-2155-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/06/2012] [Indexed: 11/30/2022]
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Meng H, Ohtake H, Ishida A, Ohta N, Kakehata S, Yamakawa M. IgA Production and Tonsillar Focal Infection in IgA Nephropathy. J Clin Exp Hematop 2012; 52:161-70. [DOI: 10.3960/jslrt.52.161] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Schwab B, Raynor E. The role of adenotonsillectomy in graft-versus-host disease. Int J Pediatr Otorhinolaryngol 2012; 76:57-60. [PMID: 22018926 DOI: 10.1016/j.ijporl.2011.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to better characterize the impact of pre-transplant adenotonsillectomy in the development of graft-versus-host disease in pediatric patients undergoing allogeneic stem cell transplantation. METHODS This retrospective study involved 211 children undergoing stem cell transplantation at Duke University. Patients who had undergone transplant were characterized by age at transplant, age at adenotonsillectomy (if applicable), age at graft-versus-host disease (if applicable), average length of follow up and other factors. Statistical analyses were performed to determine the relative risks associated with each variable. RESULTS A total of 136 patients developed graft-versus-host disease and 75 did not. Average length of follow up was 2 years for GVHD and 1.7 years for non-GVHD patients. The relative risk (RR) of graft-versus-host disease was significantly increased under univariate analysis if the donor and recipient were unrelated (RR=2.1, p<0.0001) and if the HLA match was not identical (RR=1.6, p<0.001). A history of adenotonsillectomy prior to transplant did not affect the risk of developing graft-versus-host disease (RR=1.1, p=0.70). CONCLUSIONS Adenotonsillectomy prior to bone marrow transplant has no significant impact either protectively or adversely on the risk of developing graft-versus-host disease after transplantation in pediatric patients. Future studies are needed to further examine the impact of otolaryngologic surgery on pediatric patients in terms of immune system modification. Research should specifically focus on the immunological effects of surgery on patients who will be undergoing bone marrow transplant.
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Affiliation(s)
- Brian Schwab
- Duke University, DUMC 3805, Durham, NC 27710, United States.
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Serpero LD, Kheirandish-Gozal L, Dayyat E, Goldman JL, Kim J, Gozal D. A mixed cell culture model for assessment of proliferation in tonsillar tissues from children with obstructive sleep apnea or recurrent tonsillitis. Laryngoscope 2009; 119:1005-10. [PMID: 19266584 DOI: 10.1002/lary.20147] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recurrent infective tonsillitis (RI) and obstructive sleep apnea (OSA) are the major indications for adenotonsillectomy (T&A) in children. However, little is known on the determinants of lymphadenoid tissue proliferation in the pediatric upper airway. OBJECTIVES To develop an in vitro culture system allowing for assessment of tonsillar or adenoidal proliferation under basal or stimulated conditions. METHODS Tonsils surgically removed from pediatric patients with obstructive sleep apnea and recurrent tonsillitis during T&A, were dissociated using standard methods. Whole cell tonsillar cultures were either maintained in normal medium or stimulated with lipopolysaccharide (25 microg/mL) and concanavalin A (10 microg/mL) for 24 hours (stimulated conditions [STIM]). Cellular proliferation was evaluated by [3H]thymidine incorporation. In parallel, supernatants were collected after 48 hours, and concentration of cytokines was measured using standard enzyme-linked immunosorbent assay procedures. RESULTS Basal proliferative rates were increased in the OSA group (305.2 +/- 40.6 cpm; n = 31) compared to RI group (232.8 +/- 31.9 cpm; n = 26; P < .001). No significant differences in proliferative rates emerged after STIM between OSA and RI. Furthermore, basal TNF-alpha, IL-6, and IL-8 concentrations in the supernatant were increased in OSA-derived cultures compared to RI, but IL-8 was higher after STIM in RI, while IL-6 remained increased in OSA. CONCLUSIONS The proliferative rates and concentrations of inflammatory mediators in tonsillar cell cultures from children with OSA and RI suggest that lymphadenoid tissue proliferation in these two conditions may be regulated by different mechanisms. This novel method may allow for future development of specific therapeutic interventions aimed at curtailing and reversing tonsillar and adenoidal hypertrophy in children in a disease-specific manner.
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Affiliation(s)
- Laura D Serpero
- Division of Sleep Medicine, Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
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Kaygusuz I, Alpay HC, Gödekmerdan A, Karlidag T, Keles E, Yalcin S, Demir N. Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study. Int J Pediatr Otorhinolaryngol 2009; 73:445-9. [PMID: 19150575 DOI: 10.1016/j.ijporl.2008.11.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/26/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this follow-up study was to investigate the long-term effects of tonsillectomy in comparison with their short-term results. PATIENTS AND METHODS We successfully retrieved 20 out of our previously reported 37 patients who underwent tonsillectomy in our clinic 54 months ago. The blood levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16++56+ (cellular immunity), and IgG, IgA, IgM, C3 and C4 (humoral immunity) were determined and compared with their previously reported short-term respective values. RESULTS There were no statistically significant differences between the short-term (1 month) and long-term (54 months) values of IgA, IgG, IgM and C4 levels of the patients (P>0.05). There was a slight but statistically significant decrease in complement factor C3 value compared to its the early-stage value (P<0.05) but this was not significantly different from age-matched healthy controls (P>0.05). The levels of CD4+ and CD19+ were higher and the levels of CD16++56+ and CD25+ were lower in the late-stage (54 months) compared to their early-stage values (P<0.05). When the long-term immune parameters of the tonsillectomized patients were compared with aged-match healthy controls, there were no significant differences between the levels of immunoglobulins, complements and lymphocytes (IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD19+, CD25+, CD16++56+) (P>0.05). CONCLUSION The results of this long-term follow-up study indicate that tonsillectomy do not compromise the immune functions of children as humoral and cellular immunity of patients recovered compared to their early-stage immune status (1 month), as they have similar immune capacity compared to their age-matched healthy controls at both early- and late-stages. Although a small sample of patients enrolled, our results are of importance with respect to the reassuring in settling the widely held urban myth that tonsillectomy compromises life long immunity.
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Affiliation(s)
- Irfan Kaygusuz
- Department of Otorhinolaryngology, Firat University Medical Faculty, 23119 Elazig, Turkey
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Binding of complement regulators factor H and C4b binding protein to group A streptococcal strains isolated from tonsillar tissue and blood. Microbes Infect 2008; 10:757-63. [PMID: 18538613 DOI: 10.1016/j.micinf.2008.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 11/20/2022]
Abstract
Group A streptococcus (GAS) is the most common pathogen causing bacterial pharyngitis. We isolated streptococcal strains from tonsils removed from patients with tonsillar disease (n=202) and studied their ability to bind the complement regulators factor H (FH) and C4b binding protein (C4BP) using 125 I-labeled proteins. Blood isolates of GAS (n=10) were obtained from patients with bacteraemia. Streptococci were isolated from 21% of the tonsillitis patients. The emm and T types of the GAS strains were determined. Of the 26 GAS strains studied, only six could bind FH and/or C4BP above the threshold levels. The fraction of the offered radioactive protein bound ranged between 6-12% for FH and 19-56% for C4BP. The clinical course of the tonsillar disease was not related to the binding of FH or C4BP by GAS. The binding strains were mostly of the T4M4 or T28M28 type. From the invasive strains (n=10), three bound FH (binding level: 8-11%) and two C4BP (36-39%). The binding correlated only partially to M-protein (emm) type suggesting that the binding was not exclusively due to M-protein. The results indicate that complement regulator binding by GAS is only partially related to pathogenicity and not a universal property of all group A streptococci.
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Distribution of dipeptidyl peptidase IV in patients with chronic tonsillitis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:794-8. [PMID: 18385458 DOI: 10.1128/cvi.00054-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the pathogeneses of recurrent tonsillitis (RT) and tonsillar hypertrophy (TH), different immunological mechanisms are involved. Dipeptidyl peptidase IV (DPP IV) and aminopeptidase N (APN) participate in the regulation of the immune response during inflammation. In this study, the localization of DPP IV and the enzymatic activities of DPP IV and APN in 32 patients, 13 with RT and 19 with TH, who underwent tonsillectomy were investigated. The localization of DPP IV in tonsils was studied using histochemical and immunohistochemical methods. The enzymatic activities of DPP IV and APN in tonsillar lymphocytes and the patients' sera were determined kinetically at 37 degrees C using Gly-Pro-p-nitroanilide (for DPP IV) and Ala-p-nitroanilide (for APN) as chromogenic substrates. In samples from both RT and TH patients, DPP IV was found to localize mainly in extrafollicular areas of tonsillar tissue in a pattern corresponding to the T-cell distribution. Significantly higher (P < 0.001) levels of DPP IV and APN activities in sera from patients with TH than in sera from patients with RT were found. A correlation of DPP IV activities in sera and tonsillar lymphocytes from patients with TH was also found (r = 0.518; P < 0.05). Moreover, the results show that DPP IV and APN activities in sera decreased significantly with age. Tonsillar lymphocytes demonstrated a wide range of DPP IV and APN activities, without significant differences between the investigated groups. The results of this study show that the localization of DPP IV does not depend on the type of tonsillitis, whereas the variety in levels of DPP IV and APN activities in sera of patients with TH and RT suggests different patterns of participation of antigen-stimulated tonsils in the immune system.
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Andreu-Ballester JC, Pérez-Griera J, Ballester F, Colomer-Rubio E, Ortiz-Tarín I, Peñarroja Otero C. Secretory immunoglobulin A (sIgA) deficiency in serum of patients with GALTectomy (appendectomy and tonsillectomy). Clin Immunol 2007; 123:289-97. [PMID: 17449327 DOI: 10.1016/j.clim.2007.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 01/25/2007] [Accepted: 02/12/2007] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In adult human beings, 80-85% of the immune cells are located in the digestive tract mucosa; hence the importance of the Gut Associated Lymphoid Tissue (GALT) in host defence. We studied the influence of the surgical removal of two important parts of the gut associated with lymphoid tissue (tonsillectomy and appendectomy) on immune parameters. METHODS One hundred and sixty patients were enrolled in this study. They were divided into four groups of forty patients each and matched for gender and age: group 1, appendectomized and tonsillectomized; group 2, only appendectomized; group 3, only tonsillectomized; and group 4, control group, neither tonsillectomized nor appendectomized. We analysed in blood: hemogram, protein electrophoresis, lymphocytic populations (T4 cells, T8 cells, NK cells), IgG, IgM, IgA immunoglobulin, and their fractions IgA1, IgA2, and secretory IgA. RESULTS Levels of secretory IgA in serum of patients in group 1 were significantly lower than in the other three groups (1.89 mg/dl, group 1; 2.32 mg/dl, group 2; 2.19 mg/dl, group 3 and 4.97 mg/dl, group 4; p<0.0001). Also, the values found in the two groups that had undergone only one of the operations were clearly lower than in control patients (p<0.0001). In this study, the reduction was sustained for a period of between 3 months and 3 years in appendectomized patients, and more than 20 years in tonsillectomized patients. IN SUMMARY GALTectomy (appendectomy and tonsillectomy) significantly decreases secretory IgA levels in serum. The decrease is more intense when both operations have been done.
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Affiliation(s)
- Juan Carlos Andreu-Ballester
- Emergency Department, and Clinical Analysis Laboratory, Arnau de Vilanova Hospital, c/ San Clemente 12, 46015, and Unit of Epidemiology and Statistics, Valencian School of Studies for Health, Valencia, Spain.
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van den Akker EH, Sanders EAM, van Staaij BK, Rijkers GT, Rovers MM, Hoes AW, Schilder AGM. Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial. Ann Allergy Asthma Immunol 2006; 97:251-6. [PMID: 16937760 DOI: 10.1016/s1081-1206(10)60022-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It remains controversial whether pediatric adenotonsillectomy ultimately results in decreased serum immunoglobulin levels and if so whether such a decrease is associated with increased susceptibility to upper respiratory tract infections (URIs). OBJECTIVE To evaluate changes in serum immunoglobulin levels in relation to occurrence of URIs in children participating in a randomized controlled trial on the effectiveness of adenotonsillectomy. METHODS A total of 300 children aged 2 to 8 years, with symptoms of recurrent throat infections or tonsillar hypertrophy, were randomly assigned to either adenotonsillectomy or watchful waiting (WW). Serum samples were collected at baseline and at 1-year follow-up. Occurrence of throat infections and other URIs during first-year follow-up was recorded in a diary by the child's parents. RESULTS Paired serum samples were available for 123 children (63 in the adenotonsillectomy group and 60 in the WW group). IgG1 and IgG2 levels decreased but remained within the reference range for age in both study arms. IgM and IgA levels decreased as well but remained elevated. The IgA level in the adenotonsillectomy group decreased in significantly greater degree compared with the WW group, but this difference disappeared in cases where children experienced frequent URIs. In general, no relation between immunoglobulin levels and the number of throat infections or URIs at 1-year follow-up was found. CONCLUSIONS Immunoglobulin levels of children undergoing adenotonsillectomy decreased from elevated to slightly elevated or reference values for age during 1-year follow-up irrespective of treatment (adenotonsillectomy or WW). IgA showed a greater decrease in the adenotonsillectomy group but rose to levels comparable with the WW group in cases of frequent URIs. This finding indicates that the remaining mucosa-associated lymphoid tissue can compensate for the loss of tonsil and adenoid tissue.
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Affiliation(s)
- Emma H van den Akker
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
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Lesmeister MJ, Bothwell MR, Misfeldt ML. Toll-like receptor expression in the human nasopharyngeal tonsil (adenoid) and palantine tonsils: a preliminary report. Int J Pediatr Otorhinolaryngol 2006; 70:987-92. [PMID: 16325925 DOI: 10.1016/j.ijporl.2005.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 10/12/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Waldeyer's ring, comprised of the nasopharyngeal tonsil (adenoid), the paired tubal tonsils, the paired palantine tonsils, and the lingual tonsil, is arranged in a circular orientation around the wall of the throat. This orientation allows direct contact between the tissues of the Waldeyer's ring and inhaled or ingested material, which may contain potential antigenic substances. Previous studies involving the tissues of the Waldeyer's ring have been focused on the adaptive immune system, with little consideration toward the innate immune system. Since studies have demonstrated that the adenoids and tonsils are capable of producing proinflammatory cytokines, we postulate that toll-like receptors (TLRs), which recognize components of pathogenic organisms, may be involved in the immune response in these tissues. TLRs are innate pattern recognition receptors, which produce proinflammatory cytokines and chemokines upon ligation. In this pilot study, we address expression of TLRs, which are vital components of the innate immune system, in adenoid and tonsil tissue. METHODS To determine whether TLRs are expressed in the human adenoid and palantine tonsils, we utilized endpoint RT-PCR and real time RT-PCR. Endpoint PCR was performed on all tissue obtained from adenotonsillectomy patients. Real time RT-PCR was performed only on adenoid tissue. RESULTS All of the ten TLRs examined are expressed in the adenoid and tonsil tissue with varying band intensities. TLR3, TLR7, TLR8, and TLR9 expression is highly variable between patients. CONCLUSIONS TLRs are expressed in human adenoid and tonsil tissue, and may play a vital role in the immunological outcomes of these tissues.
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Affiliation(s)
- Margaret J Lesmeister
- Department of Molecular Microbiology and Immunology, University of Missouri-Columbia, School of Medicine, 1 Hospital Drive, M616 Medical Sciences Building, Columbia, MO 65212, USA
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van Hattum ES, Balemans WAF, Rovers MM, Zielhuis GA, Schilder AGM, van der Ent CK. Adenoidectomy and/or tonsillectomy in childhood is not associated with atopic disease later in life. Clin Exp Allergy 2006; 36:40-3. [PMID: 16393264 DOI: 10.1111/j.1365-2222.2005.02416.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the association between adenoidectomy and/or tonsillectomy in childhood and asthma, allergic rhinitis (AR), and eczema in adolescence. METHODS Longitudinal birth cohort study of 1328 members born in the city of Nijmegen. Information on ear-nose-throat surgery was documented at 2, 4, and 8 years of age. In 1055 cohort members the incidence of asthma, AR, and eczema at 21 years of age was determined using the International Study of Asthma and Allergic disease in Childhood Core Questionnaire. To analyse the association between adenoidectomy and/or tonsillectomy in childhood and asthma, AR, and eczema at age 21 years, relative risks (RR) were calculated. RESULTS Six hundred and ninety-three (66%) members completed the questionnaire at age 21 years, of whom 104 (15%) had undergone adenoidectomy and/or tonsillectomy and 262 (38%) reported atopic disease. Children who underwent adenoidectomy and/or tonsillectomy before the age of 8 years were not more likely to develop asthma, AR, or eczema at the age of 21 years than children who did not; RR 0.93 (95% confidence limits (CL) 0.52-1.64), RR 0.94 (CL 0.68-1.30), and RR 1.00 (CL 0.59-1.68), respectively. CONCLUSIONS Our data show no association between adenoidectomy and/or tonsillectomy in childhood and the incidence of atopic disease in young adults.
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Affiliation(s)
- E S van Hattum
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Weil-Olivier C, Sterkers G, François M, Garnier JM, Reinert P, Cohen R. [Tonsillectomy in 2005]. Arch Pediatr 2005; 13:168-74. [PMID: 16386410 DOI: 10.1016/j.arcped.2005.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 10/18/2005] [Indexed: 11/28/2022]
Abstract
During the past years, the number of tonsillectomies (only palatine tonsils are taken off) has decreased, indications for surgery have changed. A multi-disciplinal group of paediatricians tried to elaborate the state of the art in the field. Tonsils are the first line defense of high respiratory tract. The immune functions of their lymphoid tissue are multiple: mucosal antigens capture, presentation to lymphocytes, antigens specific proliferation of lymphocytes T and B, differentiation of lymphocytes in effectors lymphocytes and immune lymphocytes. Epithelial cells on the tonsils' surface express non-specific defense. These facts explain partly tonsils' hypertrophy. Tonsillectomy has no general immune consequences. In 2002, in France, 75,000 tonsillectomies were realized, of which 90% were in children. Tonsil's hypertrophy is the major indication, mandatory when sleep apnoeas exist. The main historical tonsillectomy indication for recurrent tonsillitis should decrease due to a more precise diagnostic (rapid test at bed site), an efficient antibiotics therapy and better care for pain. Other indications are scarce. Surgery, feasible from 9 months of age, requires a brief general anaesthesia and has very few contra-indications. The technique, operator dependent, relies on his experience. The only potentially severe complication is an haemorrhage due to scab fall between the eighth and twelfth days. It requires explanation and a written note given to parents. The possibility of lack of feeding and voice modification, usually transitory, should be known. Multiple consequences of tonsillectomy especially allergy have been alleged. Since the years 1980, it is well established that pre-existing allergy or asthma are not a contraindication. More, its deleterious impact on allergic children has not been demonstrated. Last, a gain of weight post-tonsillectomy is possible and could become a risk if excessive.
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Affiliation(s)
- C Weil-Olivier
- Service de Pédiatrie Générale, Hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 178, rue des Renouillers, 92700 Colombes, France.
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Xie Y, Chen X, Nishi S, Narita I, Gejyo F. Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy. Kidney Int 2004; 65:1135-44. [PMID: 15086452 DOI: 10.1111/j.1523-1755.2004.00486.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although there are many papers about IgA nephropathy (IgAN) and tonsils, respectively, reviews about the relationship between tonsils, tonsillitis, tonsillectomy, and IgAN are limited. In this review, we introduced the structure, development, and function of tonsils, difference of tonsils with and without IgAN, consistency of both tonsillar IgA and glomerular IgA, the effect of tonsil stimulation, tonsil infection, and tonsillectomy on IgAN showed some evidences in which tonsils were closely related to IgAN and polymeric IgA1 deposited in glomerular mesangium were at least in part of tonsillar origin. Tonsillectomy can improve the urinary findings, keep stable renal function, improve mesangial proliferation and IgA deposit, have a favorable effect on long-tern renal survival in some IgAN patients, and do not cause significant immune deficiency and do not increase incidence of the upper respiratory tract infections, and can be used as a potentially effective treatment. The indications of tonsillectomy in patients with IgAN include mainly the deterioration of urinary findings after tonsillar infection, mild or moderate renal damage. However, tonsillectomy may not be enough and may not change the prognosis in IgAN patients with marked renal damage.
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Affiliation(s)
- Yuansheng Xie
- Kidney Center of PLA, Department of Nephrology, Chinese General Hospital of PLA, Beijing, China
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Amorós Sebastiá LI, Ferrer Ramírez MJ, López Mollá C, Carrasco Llatas M, Plá Mochilí A, Díaz Ruiz M, Estellés Ferriol JE, López Martínez R. Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2004; 55:404-8. [PMID: 15605804 DOI: 10.1016/s0001-6519(04)78544-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.
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