IgE sensitization, respiratory allergy symptoms, and heritability independently increase the risk of otitis media with effusion

Comparative study on adhesive otitis media and pars tensa cholesteatoma in children

OBJECTIVE

Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma.

METHODS

Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography.

RESULTS

Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834-264.184), total adhesion (OR, 28.550; 95% CI, 0.962-847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022-366.589) were related to pars tensa cholesteatoma.

CONCLUSION

Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.

IL-17 is a Potential Therapeutic Target in a Rodent Model of Otitis Media with Effusion

Background

Otitis media with effusion (OME) is a non-suppurative inflammation of the middle ear that is characterized by middle ear effusion and hearing loss. However, the mechanisms of OME are not fully understood. The aim of this study was to determine the function and the mechanism of the IL-17 cytokine in the pathogenesis of OME and to investigate IL-17 as a potential strategy for the treatment of OME.

Methods

In this study, the OME rat model was induced by ovalbumin (OVA) as previously described. The severity of OME was determined with an oto-endoscope, by histochemical analysis, and by acoustic immittance. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of RNA-sequencing (RNA-seq) data was carried out to analyze the signaling pathways related to the pathogenesis of OME, which indicated that IL-17 is involved in OME. The anti-IL-17A monoclonal antibody was administrated by nasal drip to block IL-17 to treat OME in the rat model. The rats were finally injected intraperitoneally with the inhibitor of Notch signaling pathway to study the mechanisms of IL-17-induced inflammation. Serum and lavage fluid were collected for the detection of related cytokines, and middle ear tissue was collected for Western blot, quantitative real-time PCR (qRT-PCR), and immunohistochemical and immunofluorescence analysis.

Results

KEGG analysis of RNA-seq data suggested that the IL-17 signaling pathway might be involved in the onset of OME. IL-17 expression was confirmed to be increased in both the serum and the middle ear of the rat model. The monoclonal antibody against IL-17 neutralized IL-17, inhibited the inflammation in the middle ear, and reduced the overall severity of OME in vivo. Furthermore, the Notch signaling pathway was activated upon IL-17 upregulation in OME and was suppressed by IL-17 blockage. However, there was no change in IL-17 expression after Notch inhibitor treatment, which reduced the severity of OME in the rat middle ear.

Conclusion

IL-17 plays a key role in the pathogenesis of the OVA-induced OME rat model. IL-17 induced inflammatory responses via the Notch signaling pathway and targeting IL-17 might be an effective approach for OME therapy.

Nasal epithelium: new insights and differences of the cytokine profile between normal subjects and subjects with allergic rhinitis

Background: The role of the nasal epithelium in the induction of a proper cytokine response in normal subjects and subjects with allergic rhinitis is still not completely elucidated. Methodology: We aimed to compare nasal epithelial immune responses in allergic rhinitis patients of different ages compared to healthy volunteers. Primary nasal epithelial cells from 47 subjects (33 normal and 17 with allergic rhinitis) were collected and cultured. Their unstimulated supernatants were analysed for 21 cytokines and chemokines. Statistical analysis was performed with the R statistical software and the RStudio interface. Results: Differences of the spontaneous release of epithelial cytokines and chemokines were noticed between the two study groups. The levels of GMCSF, MIP1A, MIP1B, IL28A, TNFA, CCL5 were significantly lower in the allergic rhinitis group compared to healthy volunteers’ group, independent of age. Most differences were noticed in the younger allergic rhinitis group (0-12 years old). Conclusions: Despite the cross-sectional nature of the study and the limited number of subjects, allergic rhinitis appears to be associated with dysfunction of cytokine and chemokine spontaneous release from nasal epithelial cells which may represent an abnormal innate immunity maturation pattern.

Early-Life Respiratory Infections in Infants with Cow's Milk Allergy: An Expert Opinion on the Available Evidence and Recommendations for Future Research

Acute respiratory infections are a common cause of morbidity in infants and young children. This high rate of respiratory infections in early life has a major impact on healthcare resources and antibiotic use, with the associated risk of increasing antibiotic resistance, changes in intestinal microbiota composition and activity and, consequently, on the future health of children. An international group of clinicians and researchers working in infant nutrition and cow's milk allergy (CMA) met to review the available evidence on the prevalence of infections in healthy infants and in those with allergies, particularly CMA; the factors that influence susceptibility to infection in early life; links between infant feeding, CMA and infection risk; and potential strategies to modulate the gut microbiota and infection outcomes. The increased susceptibility of infants with CMA to infections, and the reported potential benefits with prebiotics, probiotics and synbiotics with regard to improving infection outcomes and reducing antibiotic usage in infants with CMA, makes this a clinically important issue that merits further research.

Structural Phylogeny of Different Allergens May Reveal Common Epitopic Footprint

BACKGROUND

The incidence of allergy is increasing at an alarming rate for the last few decades.

OBJECTIVE

Our present study is focused on finding out the structurally homologous motifs present in different proteinaceous allergens Methods: Significant number of protein sequences and their corresponding structures of various pollen, fungal, bacterial, and food allergens were retrieved, and the sequence and structural identity were analyzed.

RESULTS

Intra- and inter-sequence and their structural analysis of the proteinaceous allergens, resulted in no significant relationships among them. A few, but not negligible number of high structural similarities were observed within different groups of allergens from fungus, angiosperms, and animals (Aves and Mammalia).

CONCLUSION

Our in silico study on thirty-six different allergens showed a significant level of structural similarities among themselves, regardless of their sequences.

Bidirectional association between asthma and otitis media in children

BACKGROUND

This study explored the reciprocal association between otitis media and asthma in children.

METHODS

The 2002-2013 Korean Health Insurance Review and Assessment Service-National Sample Cohort participants < 15 years old were used. In study I, 14,665 asthma patients from 2002 through 2005 were selected. The asthma patients were matched 1:1 with the control I group, and the occurrence of otitis media was followed until 2013. In study II, 27,043 otitis media patients from 2002 through 2005 were selected. The otitis media patients were matched 1:1 with the control II group, and the occurrence of asthma was followed until 2013. Stratified Cox proportional hazard models were used to analyze the hazard ratio (HRs) of asthma for otitis media (study I) and otitis media for asthma (study II).

RESULTS

The HR for otitis media was 1.46 in asthma patients (95% confidence interval [CI] = 1.40-1.52, P < 0.001). The HR for asthma was 1.43 in otitis media patients (95% confidence interval [CI] = 1.36-1.50, P < 0.001).

CONCLUSION

Asthma and otitis media have a bidirectional association in children.

Risk Factors for Otitis Media in Children Referred to Abuzar Hospital in Ahvaz: A Case-Control Study

Introduction

Otitis media is one of the most common causes of infection in preschool children. The most damaging complication of otitis media is temporary or permanent hearing loss. This study aimed to determine the important risk factors for otitis media.

Methods

In this case-control study, 625 children aged six months to seven years were examined from winter to spring 2020, and 53 children with otitis media were allocated to the case group and the same number to the control group. The chi-square test was used to identify the risk factors affecting otitis media, and the risk factors were compared between the case and control groups. Logistic regression was used to investigate the relationship between the incidence of otitis media and risk factors.

Results

Bivariate analysis revealed the following primary risk factors for otitis media: using pacifiers or bottle feeding, working mother, seasonal rhinitis, allergic rhinitis, tonsillopharyngitis, rhinorrhea, and adenoid hypertrophy (P<0.05). In logistic regression analysis, using pacifiers or bottle feeding (odds ratio [OR]=0.156, P=0.000), working mother (OR=0.226, P=0.000), seasonal rhinitis (OR=0.175, P=0.000), allergic rhinitis (OR=5.20, P=0.000) and adenoid hypertrophy (OR=1.57, P=0.000) were identified as the most important risk factors.

Conclusion

Adenoid hypertrophy and allergic rhinitis increased the risk of otitis media more than the other risk factors. Therefore, pediatricians should increase their awareness of the existence of these risk factors in a patient, and take the appropriate diagnostic steps and implement therapeutic care to prevent language and speech complications.

Differentiating Rhinitis in the Paediatric Population by Giving Focus on Medical History and Clinical Examination

Chronic rhinitis is defined as an inflammation of the nasal epithelium, and is characterized by the presence of two or more specific nasal symptoms including obstruction, rhinorrhea, sneezing, and/or itching for at least 12 weeks. In childhood, this clinical entity is very common and carries a significant socioeconomic burden. The impact on the physical, social, and psychological well-being of family cannot be underestimated. Rhinitis is an umbrella term which includes different phenotypes of rhinitis with distinct underlying pathophysiologic mechanisms. In most cases the diagnosis of rhinitis is rather straightforward; however, sometimes when based on clinical symptomatology, characterization may be challenging. Herein, we provide guidance for getting all the data needed for the differential diagnosis of rhinitis based on medical history and clinical examination.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

BACKGROUND

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

METHODS

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

RESULTS

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

CONCLUSION

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Otitis media with effusion and atopy: is there a causal relationship?

Otitis Media with Effusion (OME) is an inflammatory condition of the middle ear cleft, acute or chronic, with collection of fluid in the middle ear with an intact tympanic membrane. It is a very common disease in childhood, the most frequent cause of hearing loss in childhood and often requiring surgery. OME is called chronic when the fluid in the middle ear persists for more than three months or when the episodes recur six or more times in one year. The current article covers various aspects of OME including definition, epidemiology. Pathomechanisms, risk factors, role of allergy in OME, impact of upper airway disease on OME, eosinophilic otitis media and management of OME.

The Role of Allergy in Otologic Disease

Allergy is commonly associated with conditions such as rhinitis, sinusitis, and asthma, but the relationship between allergy and otologic diseases is less clear. This article examines the evidence for a relationship between allergic disease and several common otologic conditions, including otitis media with effusion, eosinophilic otitis media, and Ménière's disease.

Interaction Between Allergy and Middle Ear Infection

PURPOSE OF REVIEW

Recent studies have attempted to identify interactions among the causes of otitis media with effusion (OME). This review discusses the interaction between allergy and infection with regard to host and environmental factors in terms of the development of OME.

RECENT FINDINGS

Protection of the upper airway against microbial invasion requires active interaction between the defense mechanisms of the respiratory epithelium, including innate and adaptive immunity, and mechanical factors. The impairment of these defenses due to allergy and/or increased bacterial resistance may lead to increased susceptibility to infectious organisms in the respiratory tract and middle ear mucosa. Recent genetic studies have provided valuable information about the association of Toll-like receptor signaling variations with clinical phenotypes and the risk of infection in the middle ear. Among the causal factors of OME, allergy not only induces an inflammatory reaction in the middle ear cavity but also facilitates the invasion of infectious pathogens. There is also evidence that allergy can affect the susceptibility of patients to infection of the upper respiratory tract, including the middle ear cavity.

What Role Does Allergy Play in Chronic Ear Disease and Laryngitis?

IgE-mediated allergy plays a well-established role in both nasal and pulmonary diseases due to the common epithelium and shared mediator responses of the upper and lower airways. This "unified airway" concept has also been described in other sites within the head and neck that contain similar respiratory mucosa: the middle ear and the larynx. This review will highlight the data suggesting a role for IgE-mediated allergic disease in chronic laryngopharyngeal and middle ear disease and the role for allergy testing to aid in diagnosis and treatment of these disorders.

Allergic rhinitis and allergy are risk factors for otitis media with effusion: A meta-analysis

OBJECTIVE/HYPOTHESIS

We systematically reviewed the associations between allergic rhinitis or allergy and otitis media with effusion, by reference to published data.

STUDY DESIGN

A meta-analysis of case-controlled studies.

DATA SOURCE

Five databases (Pubmed, Highwire, Medline, Wanfang, and China National Knowledge Infrastructure) were searched for relevant studies in the English language published prior to November 12, 2015.

STUDIES CHOSEN

Studies with clearly defined experimental and control groups, in which the experimental groups had otitis media with effusion together with allergic rhinitis or allergy, were selected.

METHODS

We performed a meta-analysis on data from the identified cross-sectional and case-controlled studies using fixed- or random-effects models (depending on heterogeneity). We used Reviewer Manager 5.3 software to this end.

RESULTS

Seven studies met the inclusion criteria. The prevalence of allergic rhinitis in patients with otitis media with effusion and the control groups differed significantly in three studies (P<0.00001), as did the prevalence of allergy (in six studies; P=0.003).

CONCLUSION

Allergic rhinitis and allergy appear to be risk factors for otitis media with effusion.

Detection of bacteria in middle ear effusions based on the presence of allergy: does allergy augment bacterial infection in the middle ear?

Background

Bacterial infection, Eustachian tube dysfunction, allergies, and immunologic factors are major causes of otitis media with effusion (OME). However, the exact pathogenesis of OME is still unclear. This study evaluated whether allergy influences bacterial growth in middle ear effusions.

Materials

Fifty-four samples were obtained from OME patients 3–10 years of age who underwent ventilation tube insertion and were divided into two groups based on the presence of allergy as determined using the multiple allergosorbent test (MAST). Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis bacterial DNA in the middle ear effusions was analyzed using polymerase chain reaction. Overall detection rates and those for each species were compared between the two groups.

Results

Of the 54 middle ear effusion samples, 38 (70.4 %) contained bacterial DNA and 14 (36.8 %) of these contained DNA from multiple species. S. pneumoniae was detected in 27 samples (50 %), H. influenzae in 17 samples (31.4 %), and M. catarrhalis in 9 samples (16.6 %). There was no significant difference in the bacterial detection rates between the middle ear effusions of the MAST-positive and MAST-negative groups.

Conclusion

The rate of bacteria detection in middle ear effusions did not differ between allergic and non-allergic children.

Predisposition to Childhood Otitis Media and Genetic Polymorphisms within the Toll-Like Receptor 4 (TLR4) Locus

Background

Predisposition to childhood otitis media (OM) has a strong genetic component, with polymorphisms in innate immunity genes suspected to contribute to risk. Studies on several genes have been conducted, but most associations have failed to replicate in independent cohorts.

Methods

We investigated 53 gene polymorphisms in a Finnish cohort of 624 cases and 778 controls. A positive association signal was followed up in a tagging approach and tested in an independent Finnish cohort of 205 cases, in a British cohort of 1269 trios, as well as in two cohorts from the United States (US); one with 403 families and the other with 100 cases and 104 controls.

Results

In the initial Finnish cohort, the SNP rs5030717 in the TLR4 gene region showed significant association (OR 1.33, P = .003) to OM. Tagging SNP analysis of the gene found rs1329060 (OR 1.33, P = .002) and rs1329057 (OR 1.29, P = .003) also to be associated. In the more severe phenotype the association was stronger. This finding was supported by an independent Finnish case cohort, but the associations failed to replicate in the British and US cohorts. In studies on TLR4 signaling in 20 study subjects, the three-marker risk haplotype correlated with a decreased TNFα secretion in myeloid dendritic cells.

Conclusions

The TLR4 gene locus, regulating the innate immune response, influences the genetic predisposition to childhood OM in a subpopulation of patients. Environmental factors likely modulate the genetic components contributing to the risk of OM.

What does tympanostomy tube placement in children teach us about the association between atopic conditions and otitis media?

Otitis media is the most common infection second only to viral upper respiratory infection in the outpatient setting. Tympanostomy tube insertion (TTI) is the most common ambulatory surgical procedure in the USA. While many risk factors for otitis media have been identified, atopic conditions have been underrecognized as risk factors for recurrent and persistent otitis media. Given that asthma and other atopic conditions are the most common chronic conditions during childhood, it is worth examining the association between atopic conditions and risk of otitis media, which can provide insight into how atopic conditions influence the risk of microbial infections. This paper focuses its discussion on otitis media; however, it is important that the association between atopic conditions and risk of otitis media be interpreted in the context of the association of atopic conditions with increased risks of various microbial infections.

Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology

Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence-based recommendations for the diagnosis and therapy of paediatric rhinitis. Rhinitis is characterized by at least two nasal symptoms: rhinorrhoea, blockage, sneezing or itching. It is classified as allergic rhinitis, infectious rhinitis and nonallergic, noninfectious rhinitis. Similar symptoms may occur with other conditions such as adenoidal hypertrophy, septal deviation and nasal polyps. Examination by anterior rhinoscopy and allergy tests may help to substantiate a diagnosis of allergic rhinitis. Avoidance of relevant allergens may be helpful for allergic rhinitis (AR). Oral and intranasal antihistamines and nasal corticosteroids are both appropriate for first-line AR treatment although the latter are more effective. Once-daily forms of corticosteroids are preferred given their improved safety profile. Potentially useful add-on therapies for AR include oral leukotriene receptor antagonists, short bursts of a nasal decongestant, saline douches and nasal anticholinergics. Allergen-specific immunotherapy is helpful in IgE-mediated AR and may prevent the progression of allergic disease. There are still a number of areas that need to be clarified in the management of rhinitis in children and adolescents.

Current and future directions in pediatric allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications.

OBJECTIVE

The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR.

METHODS

Literature reviews in each of these areas were conducted, and the results were incorporated.

RESULTS

The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy.

CONCLUSIONS

In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.

Current knowledge of the genetics of otitis media

Otitis media is one of the most common childhood infections leading to doctor's visits and a leading cause of antibiotic prescriptions in children. Twin and family studies have confirmed that the predisposition of developing a bacterial middle ear infection is genetically determined. Several case-control studies have been performed to analyze genes involved in inflammatory processes in search of potential associations. Modern genome-wide association approaches that require no prior assumptions of the involvement of a given gene locus in the risk of otitis media are currently being used to identify otitis media genes, and will hopefully give more detailed information on the pathogenesis of childhood otitis media. That information could be used in finding the high-risk patient, in the prevention of the disease, and in the design of new treatments.

Associations between symptoms, clinical findings and the short-term prognosis among children with otitis media: a cohort study

OBJECTIVE

Otitis media (OM) is a common childhood disease and a frequent reason for seeking medical care in general practice. Only few studies have focused on what happens after diagnosis and initial treatment of OM. In particular, there is a lack of research on how different patient- and disease-related factors influence the course of OM. The aim of this study was to analyze to what extent symptoms at the time of initial diagnosis are associated with the short-term course of otitis media.

METHODS

Cohort study in general practice comprising 747 children between 0 and 7 years with a new ear symptom. At the first consultation the GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. The children were followed up four weeks later.

RESULTS

Sleep problems at inclusion are statistically significant associated with having one or more symptom after four weeks in children between 0 and 2 years (OR: 2.02 (95% confidence interval (CI): 1.24-3.31)). If the result of tympanometry is a flat curve, the OR for being referred is 3.24 (CI: 1.61-6.55) in children between 0 and 2 years compared to children without a flat curve. The OR for being referred in children between 2 and 7 years with a flat curve is 8.94 (CI: 4.18-19.11) when compared to children without a flat curve.

CONCLUSION

Sleep problems at inclusion were the only symptom statistically significant associated with having one or more symptoms after four weeks in children between 0 and 2 years.

Allergic diseases in children with otitis media with effusion

OBJECTIVES

Recent studies have shown that allergic diseases may be associated with the pathogenesis of recurrent otitis media with effusion (OME). We aimed to assess the relationship between OME and allergic diseases and other types of disease in children with OME. We also evaluated the between group differences in the characteristics of middle ear effusion.

MATERIALS AND METHODS

We evaluated 370 patients diagnosed with OME between January 2007 and December 2012 and, as a control group, 100 children with no medical history of OME but who had undergone blood tests and MAST-CLA (multiple allergosorbent test - chemiluminescent assay) were selected.

RESULT

Among the allergic diseases, the incidence of allergic rhinitis alone was significantly higher in children with OME (33.8%) than without OME (16.0%) (p<0.05). The rate of adenoid, but not tonsil, hypertrophy was significantly greater in patients with than without OME also (p<0.05). When we evaluated the characteristics of middle ear effusion (MEE) in patients with OME, we found that 186 had serous, 129 had mucous and 55 had purulent MEE. Of these patients, 75 (40.3%), 36 (27.9%) and 14 (25.5%), respectively, had allergic rhinitis and the rates of allergic rhinitis and asthma were significantly higher in the serous group than in the mucous group (p<0.05).

CONCLUSION

Allergic rhinitis was significantly more frequent among pediatric patients with than without OME, although the rates of other allergic diseases did not differ in these two groups. The likelihoods of allergic rhinitis and asthma were higher in patients with serous than with mucous MEE.

Assessment of the association between atopic conditions and tympanostomy tube placement in children

This study assesses the relationship between otitis media and atopic conditions in children by comparing the incidence of tympanostomy tube placement between children with and without atopic conditions: asthma, allergic rhinitis, and atopic dermatitis. Study subjects were a cohort of 323 healthy children who participated in a study of vaccine response. All episodes of tympanostomy tube placement and physician diagnoses of allergic rhinitis and atopic dermatitis were collected through comprehensive medical record review. Asthma status was ascertained through application of established criteria. We compared incidence rates of tympanostomy tube placement between children with and without atopic conditions. We fitted data to a Poisson regression model to calculate relative risk ratios (RRs) and their corresponding 95% confidence intervals (95% CI). Three subjects were excluded who did not have parental authorization for using records for research. Of the remaining 320 subjects, 170 (53%) were male subjects, 268 (94%) were white, 124 (39%) were asthmatic patients, and 20 (6%) had tympanostomy tube placement. Children with asthma before the index date of tympanostomy tube placement were more likely to have tympanostomy tube placement compared with those without asthma (RR, 19.33; 95% CI, 11.41; 32.75; p < 0.001). We found a similar association between asthma ever (before or after index date) and the incidence of tympanostomy tube placement (RR, 1.53; 95% CI, 0.93-2.53; p = 0.095). This was true for children with allergic rhinitis compared with those without allergic rhinitis (RR, 1.70; 95% CI, 1.01-2.86; p = 0.007). Atopic dermatitis was not associated with the incidence of tympanostomy tube placement. Asthma or allergic rhinitis may be unrecognized risk factors for recurrent or persistent otitis media. However, given the small sample size of the study, a cohort study with a larger sample size is necessary.

The role of allergy in otitis media with effusion

The role of allergy in chronic otitis media with effusion (OME) is controversial. New evidence from cellular biology and immunology explain the basics of allergic reactions and allow more accurate diagnosis of allergies and inflammatory disease throughout the unified airway. This article examines the epidemiologic, methodological, and immunologic studies of allergic causes of OME, including (1) evidence for and against OME as an allergic disease, (2) allergy as a cause for eustachian tube obstruction, (3) examination of the most sensitive diagnostic tests for allergy, and (4) the effect of treatment of underlying allergies in improving and resolving middle ear disease.

Early-life otitis media and incident atopic disease at school age in a birth cohort

BACKGROUND

Otitis media is a common and costly disease that peaks in early childhood. Recent reviews concluded that the relationship between otitis media and atopy is not well understood, and that further research is warranted.

METHODS

Logistic regression was used to analyze data from a German Birth Cohort (n = 1690; born 1997–1999). Parental questionnaires were used to assess children for physician-diagnosed otitis media throughout the first 2 years of life and for incident atopic disease (asthma, allergic rhinitis, and eczema) during the sixth year of life. Odds ratios were adjusted for gender, older siblings, city, parental education, breast-feeding, and daycare. Parallel analyses were completed for the full birth cohort and for a population subset with atopic mothers.

RESULTS

The adjusted odds of asthma were elevated for children with early-life otitis media, but were statistically significant only for those children with at least 3 episodes (adjusted odds ratio: 4.26 [95% confidence interval: 1.34–13.6]). Associations between early-life otitis media and allergic rhinitis were largely inconsistent. There was a positive association between early-life otitis media and late-onset allergic eczema (≥2 episodes: 2.68 [1.35–5.33], ≥3 episodes: 3.84 [1.80–8.18]). Similar results were found for the maternal atopy subgroup but with greater effect estimates.

CONCLUSIONS

Children diagnosed with otitis media during infancy were at greater risk for developing late-onset allergic eczema and asthma during school age, and associations were stronger for frequent otitis. These results indicate that frequent otitis media during infancy may predispose children to atopic disease in later life.

The association between symptomatic asthma and neurobehavioral comorbidities among children

BACKGROUND

Asthma affects millions of children in the United States. The extent to which asthma and other medical conditions coexist, however, is largely unknown.

OBJECTIVE

This study aimed to determine associations between symptomatic asthma and neurobehavioral comorbidities among children in rural United States.

METHODS

This cross-sectional study used data from 406 parents/caregivers of children aged 16 or younger, who completed survey questionnaires assessing their child's health status. Symptomatic asthma was defined as parents'/caregivers' report of physician diagnosed asthma and presence of night-time asthma symptoms in their children. The dependent variables were parents'/caregivers' reported comorbidities in children.

RESULTS

Symptomatic asthma was present in 9% of the sample. Approximately 26% parents/caregivers reported their child had one or more mental health problems and 13% reported one or more neurological problems. In multivariable logistic regression analyses, a statistically nonsignificant 50% elevated odds of one or more mental health problems were observed for children with symptomatic asthma (adjusted odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.6-3.5). Of the individual comorbidities included in the mental health construct, more than 2-fold elevated odds of anxiety problems (adjusted OR = 2.6, 95% CI = 0.8-8.6) and attentional problems (adjusted OR = 2.4, 95% CI = 1.0-5.8) were observed for symptomatic asthma. The odds of reporting one or more neurological problems were 4-fold elevated (adjusted OR = 4.0, 95% CI = 1.6-10.0) for symptomatic asthma. Of the individual comorbidities included in the neurological construct a significantly elevated odds of hearing impairment or deafness was observed among children with symptomatic asthma (adjusted OR = 8.2, 95% CI = 1.5-45.3) as compared to the no asthma/no symptoms reference group.

CONCLUSION

These data suggest significant associations between symptomatic asthma and neurological comorbidities.

New visions in respiratory allergy (asthma and allergic rhinitis): an iPAC summary and future trends

In many aspects, respiratory allergies, i.e., allergic asthma and rhinitis, represent the hallmarks of allergy. Epidemiologic data highlight their large prevalence of most parts of the world, socioeconomic analysis reveal their large impact on global health and the large number of scientific publications in this field regularly brings to light many new aspects of these diseases. However, the current understanding of respiratory allergies, in particular in children remains scarce. How can we efficiently prevent respiratory allergies in allergy-prone infants? How can we prevent the progression of the disease? What therapeutic strategies could efficiently address efficient immunomodulation? the international Pediatric Allergy and Asthma Consortium, addressed these issues by a thorough review of the literature providing a state-of-the-art current knowledge in respiratory allergy, and identified a series of needs to be addressed in future studies.

Efficacy of allergy immunotherapy as a treatment for patients with chronic otitis media with effusion

OBJECTIVE

Controversy persists over the significance of allergy as it might relate to chronic middle-ear disease as no controlled study of the efficacy of allergy immunotherapy has been published. The aim of this study was (1) to evaluate the atopic status of patients with intractable chronic otitis media with effusion or drainage from their middle ear and (2) to determine in this select population the efficacy of specific allergy immunotherapy in preventing or limiting the duration of their chronic middle-ear disease.

METHODS

This was a prospective, cohort study of patients cared for in a private community practice. History, examination, audiogram, tympanometry and recurrence of effusion/infection were recorded on 89 patients (52 children <15 years old, 37 adults) referred with (1) effusion found to warrant myringotomy and ventilation tubes, or (2) chronic drainage from a perforation or tube. All were evaluated for allergy by intradermal skin testing according to criteria of the American Academy of Otolaryngic Allergy. A control cohort of 21 patients who refused therapy was included. Intervention consisted of immunotherapy for dust, pollen, and molds. Recurrence or persistence of fluid or drainage following 2-8 years of therapy was compared to the patient's pretreatment status.

RESULTS

All 89 OME patients proved to be atopic. Most were allergic to dust (94%), animals (44%) and molds (88%) while 9% were allergic only to seasonal pollens. Associated allergic diseases included asthma (21%) and allergic rhinitis/sinusitis (63%). Otitis was the sole symptom among 37%. Immunotherapy provided complete resolution of effusion or drainage in 85% of 127 ears.

CONCLUSION

Intradermal testing proved all 89 patients with intractable middle-ear disease in this study who presented with chronic effusion or chronic draining perforations or tubes to be atopic. Specific allergy immunotherapy significantly improved 5.5% and completely resolved 85% of chronic otitis media with effusion in these ears. None of the controls resolved spontaneously (p<0.001). This supports the hypothesis that in many, otitis media with effusion is an immune mediated allergic disease and suggests that these patients deserve consideration for aggressive evaluation and allergy treatment, as most respond to immunotherapy.

Increased risk of otitis media with effusion in allergic children presenting with adenoiditis

Objective

Otitis media with effusion (OME) is a common disorder in childhood. The aim of the study was to assess the association of atopy and endoscopic features with the presence of OME.

Subjects and Methods

This cross-sectional study evaluated 287 children presenting with acute upper-airway infections persistent for at least ten days and tested through nasal endoscopy and skin-prick test.

Results

Fifty-three patients had a diagnosis of OME; out of them, 23 showed acute rhinosinusitis, ten adenoiditis, and 20 both features. OME was diagnosed in 26 atopic children and in 27 nonatopic ones. On a multivariable analysis, allergic rhinitis, endoscopic pattern of adenoiditis, and younger age were all shown to be independently associated with a diagnosis of OME.

Conclusions

This study suggests that allergic rhinitis and adenoiditis are significant risk factors to OME development and that the risk becomes higher when these two conditions are con-comitantly present.

Induction of high-affinity IgE receptor on lung dendritic cells during viral infection leads to mucous cell metaplasia

Respiratory viral infections are associated with an increased risk of asthma, but how acute Th1 antiviral immune responses lead to chronic inflammatory Th2 disease remains undefined. We define a novel pathway that links transient viral infection to chronic lung disease with dendritic cell (DC) expression of the high-affinity IgE receptor (FcepsilonRIalpha). In a mouse model of virus-induced chronic lung disease, in which Sendai virus triggered a switch to persistent mucous cell metaplasia and airway hyperreactivity after clearance of replicating virus, we found that FceRIa(-/-) mice no longer developed mucous cell metaplasia. Viral infection induced IgE-independent, type I IFN receptor-dependent expression of FcepsilonRIalpha on mouse lung DCs. Cross-linking DC FcepsilonRIalpha resulted in the production of the T cell chemoattractant CCL28. FceRIa(-/-) mice had decreased CCL28 and recruitment of IL-13-producing CD4(+) T cells to the lung after viral infection. Transfer of wild-type DCs to FceRIa(-/-) mice restored these events, whereas blockade of CCL28 inhibited mucous cell metaplasia. Therefore, lung DC expression of FcepsilonRIalpha is part of the antiviral response that recruits CD4(+) T cells and drives mucous cell metaplasia, thus linking antiviral responses to allergic/asthmatic Th2 responses.