The prevalence of atopic disorders in children with chronic otitis media with effusion

Abstract

We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…It remains difficult to interpret epidemiologic data. The enhanced prevalence of allergy in OME patients reported by some authors (2139,2140) may represent a true finding or may reflect a referral bias.…”

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

“…In a case series of 93 children aged 2-10 years referred to a sleep laboratory for polysomnography, sleep apnoea-hypopnoea syndrome was strongly associated with the clinical history of nasal obstruction and AR (32). Chronic middle ear effusion and eustachian tube dysfunction, potentially causing hearing impairment, are associated with rhinitis (33)(34)(35). Local production of nonspecific and specific IgE against both environmental allergens and staphylococcal enterotoxin antigens may be involved in ongoing allergic inflammation observed in the adenoidal lymphatic tissue from atopic children (12,36).…”

The Role of Allergic Rhinitis in the Development of Otitis Media With Effusion

“…Numerous epidemiologic studies have identified allergy as a risk factor for otitis media with effusion [OME]. Alles et al [5] reported an 89% prevalence of allergic rhinitis among OME patients which was significantly higher than the reported prevalence of allergic rhinitis in the general population [6,7]. In other study, otologic symptoms were reported in 32.8% of the children with allergic rhinitis.…”