Interaction Between Allergy and Middle Ear Infection

Abstract

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.

Phenotype Profiling and Allergy in Otitis-Prone Children

“…Allergy and atopy have been previously investigated as possible risk factors for AOM and OME (18, 29–37). However, although there is clinical, mechanical and therapeutic evidence supporting their possible effect on the pathogenesis of recurrent or chronic middle ear inflammation, there is still a lack of strong epidemiological evidence, and the results obtained in previously published studies are conflicting.…”

“…Finally, a record was made of the factors known to influence the development of RAOM (including a family history of allergy, little or no breast-feeding, the use of a pacifier or push-and-pull plastic bottle caps, parental smoking, pneumococcal conjugate and influenza vaccination, day-care attendance, and the presence and number of older siblings) (2, 13, 16–18).…”

“…There are a number of known risk factors for the development of chronic or recurrent middle ear inflammation, such as a genetic predisposition, a young age, male gender, little or no breastfeeding, parental smoking, the use of a pacifier or push-and-pull plastic bottle caps, day-care attendance, allergy, nasopharyngeal bacterial biofilm, and the presence of an older sibling (2, 13–18), but no dedicated epidemiological models have been developed to explain the clinical heterogeneity of this subset of diseases, and there is no unanimous consensus about the best individual approach to the single phenotypes. Moreover, although various interventions have been proposed as a means of reducing the risk of new infectious exacerbations in otitis-prone children (2, 3, 19–22), none of these is completely effective, and their benefits in terms of preventing RAOM have not been precisely quantified (2).…”

Evaluation of the Relationships between Intestinal Regional Lymph Nodes and Immune Responses in Viral Infections in Children

“…It is known that aberrations of the immune system, such as allergies, occur in childhood [ 1 , 2 , 3 ] and are presumed to involve the disruption of mucosal homeostasis. This is attributed to stimulation by foreign antigens of lymph nodes in the respiratory or gastrointestinal systems in childhood [ 4 , 5 , 6 ]. Particularly, viral infections and aberrations of the immune system, such as allergies, have recently been gaining attention.…”

The Atopy Index Inventory: A Brief and Simple Tool to Identify Atopic Patients

“…As a consequence, atopy produces allergy with the typical symptoms of asthma, rhino conjunctivitis, or eczema. Atopy has been associated with several ear, nose, and throat (ENT) disorders, such as otitis media with effusion [1][2][3][4], adenoid hypertrophy [5][6][7], rhinitis and sinusitis [8,9], Ménière disease [10][11][12], and Reinke edema [13]. When a patient is referred for one of these common diseases, ENT specialists usually address the existence of an allergic substrate by means of a direct, time-consuming interview or empiric treatments [14].…”