Allergy‐Related Sialodochitis: A Preliminary Cohort Study

Abstract

Objectives/Hypothesis To explore the clinically feasible diagnosis criteria and treatment outcomes of allergy‐related sialodochitis (ARS). Study Design Prospective Cohort Study. Methods Ninety‐six consecutive patients were enrolled by the following criteria: 1) recurrent swelling of ≥2 large salivary glands that lasted for ≥3 months; 2) with mucus plug exudations; 3) with atopic diseases; 4) ductal stenosis and/or ectasia. Sixty‐four patients with elevation of peripheral blood eosinophil (PBE) and/or serum IgE level comprised group A (highly‐suspected ARS group), while the remaining 32 comprised group B (patients without confirmed evidence of ARS). These patients were treated with interventional endoscopy. A chronic obstructive sialadenitis symptom (COSS) questionnaire was used to quantify the treatment outcomes. Results In group A, Serum IgE was elevated in 84.4% of patients and PBE was elevated in 34.4% of patients. Percentage of submandibular gland involvement was higher in group A than group B (48.4% vs. 18.8%). On sialograms, the snowflake changes of branch ducts were seen in higher percentage of group A compared with group B (59% vs. 35% for parotid glands, 27% vs. 8% for submandibular glands, respectively). Mucus plug smears showed abundant eosinophils in 14 group A patients. Biopsy of five group A patients revealed significant eosinophil infiltration around the main and interlobular ducts. During follow‐up, the COSS scores were significantly decreased in both groups, and group B was improved better than group A. Conclusion PBE and serum IgE are important diagnostic indexes of ARS. Mucus plug smear or histopathology verifies the diagnosis. Interventional endoscopy is helpful for ARS cases. Level of Evidence 3 Laryngoscope, 131:2030–2035, 2021

Eosinophilic sialodochitis: a case report of a rare disease

“…The etiology of ES is not well understood, although the most accepted hypothesis is that it is an allergic process [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Support for an allergic etiology is based on significant medical history of asthma and chronic rhino-conjunctivitis in some patients and a raised peripheral eosinophil count in affected patients [ 9 ].…”

Recurrent and Recalcitrant Salivary Gland Swelling in a Woman

“…Reports of the condition date back to 1879 under the names sialoadenitis fibrosa, allergic parotitis, or eosinophilic sialodochitis. 1 Patients with ES typically present with relapsing and remitting major salivary gland swelling with parotid and submandibular glands equally and often bilaterally affected. 2 Patients typically will pre- sent with pain and swelling of the affected gland, pruritus to the overlying skin, and stringlike mucous discharge from the salivary duct orifices.…”

“…Eosinophilic sialodochitis has also recently been referred to as allergy-related sialodochitis. 1 It is important to note, however, that despite serologic findings that suggest a robust allergic response, only 62% to 66% of patients with this diagnosis may experience comorbid atopy, 2,4 such as allergic rhinitis or asthma (88%), atopic dermatitis or urticaria (41%), and drug or food allergies (29%). 3 Imaging performed during workup will typically show diffusely enlarged glands without identifiable calculi, as were seen in this patient.…”

Symptom Outcomes After Sialendoscopy‐Assisted Salivary Duct Surgery: A Prospective 6‐Year Study

“…[1][2][3][4] Since then, this patient-reported outcome tool has been employed by others to study SASDS outcomes and to describe symptoms in differing etiologies of sialadenitis. [5][6][7] Evidence supports SASDS as a valuable intervention to treat chronic obstructive sialadenitis with a decreased need for gland excision and associated possible morbidities. 8 SASDS can be performed purely endoscopically with hydraulic and mechanical dilation of ductal stenosis and with basket or forceps retrieval of sialoliths or in a combined open-endoscopic surgical approach.…”

“…Over 8 years ago, our group developed the Chronic Obstructive Sialadenitis Symptoms (COSS) Questionnaire as a tool to assess patient‐reported sialadenitis‐specific symptom burden and post‐operative outcomes after sialendoscopy‐assisted salivary duct surgery (SASDS) 1–4 . Since then, this patient‐reported outcome tool has been employed by others to study SASDS outcomes and to describe symptoms in differing etiologies of sialadenitis 5–7 …”