The role of allergy in pediatric rhinosinusitis

Veling, Maria C.

doi:10.1097/moo.0b013e32835fb399

Cited by 10 publications

(7 citation statements)

References 52 publications

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“…In fact, nasal blockage may occur in AR children, due to edematous mucosa, neurogenic and vascular responses, over-production of secretions, and impaired mucociliary clearance leading to congestion of the ostia and symptoms simulating rhinosinusitis. On the other hand, the blockage leads to stagnant debris and acidotic environment that might stimulate bacteria overgrowth [ 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…In fact, nasal blockage may occur in AR children, due to edematous mucosa, neurogenic and vascular responses, overproduction of secretions, and impaired mucociliary clearance leading to congestion of the ostia and symptoms simulating rhinosinusitis. On the other hand, the blockage leads to stagnant debris and acidotic environment that might stimulate bacteria overgrowth [34,35]. Histopathological analysis [36,37] demonstrated that pediatric CRS is quite different from the adult form, showing greater inflammatory cellularity, higher density of submucosal lymphocytes, less eosinophilic inflammation, basement membrane thickening, and mucous gland hyperplasia, suggesting a different pathway compared with the adult CRS pattern, which is predominantly characterized by a Th2-oriented response with polypoid changes.…”

Section: Allergy and Chronic Rhinosinusitis (Crs) In Childrenmentioning

confidence: 99%

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Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

Corso

Lucidi

Cantone³

et al. 2020

Curr Allergy Asthma Rep

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Purpose of the Review We provide a systematic review of experimental and clinical evidences linking allergy to acute, including common cold, and chronic rhinosinusitis in children. Furthermore, we questioned if anti-allergy treatment may prevent the occurrence of rhinosinusitis or improve outcomes of its specific management. Recent Findings Allergic rhinitis is a common childhood disease in industrialized countries that is responsible for a major impact on quality of life and healthcare resources. Over the years many authors tried to correlate allergy with comorbidities and in particular to the onset of rhinosinusitis including common cold, even though conflicting results are frequently reached. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 7103 that were finally screened. This resulted in 25 publications of which the full texts were assessed and included in a qualitative analysis per different phenotypes of rhinosinusitis. Summary The evidence suggests that allergy may lead to overall impairment of mechanical and immunological defense function of the nasal mucosa against viruses and that anti-allergy treatment may significantly decrease the number and severity of upper respiratory tract infections including common colds in children. It was not possible to perform the analysis for allergy and postviral acute rhinosinusitis, bacterial acute rhinosinusitis, and recurrent acute rhinosinusitis because of paucity and heterogeneity of data. Although there is no definitive proof of causation linking allergy to chronic rhinosinusitis, studies lead to suppose that antiallergy treatment may improve outcomes of specific CRS treatments.

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Section: Resultsmentioning

confidence: 99%

Section: Allergy and Chronic Rhinosinusitis (Crs) In Childrenmentioning

confidence: 99%

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

Corso

Lucidi

Cantone³

et al. 2020

Curr Allergy Asthma Rep

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“…Another study reported that atopic asthmatics suffer from more frequent lower-respiratory-tract infections and have more severe and persistent lower-respiratory-tract symptoms than normal subjects [ 18 ]. Thus, a relevant link between RI and AR exists as underlined by several studies [ 19 20 21 22 23 24 25 26 ]…”

Section: Discussionmentioning

confidence: 99%

Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite

Barberi

Ciprandi

Verduci

et al. 2015

Asia Pacific Allergy

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BackgroundAllergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity.ObjectiveThis study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children.MethodsGlobally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground.ResultsSLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group.ConclusionThis preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.

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“…Moreover, the pediatric form is characterized by greater cellularity of chronic inflammatory cell infiltrate, whereas the adult form is characterized by both polypoid changes with edema of the lamina propria and glandular hyperplasia. The population of eosinophils and the proportion of complete epithelial denudation are also different, with a significantly greater extent found in the adult CRS specimens (16). Such differences have led researches to distinguish studies on the role of allergy on CRS between adults and children and to conclude that in adults, the evidence favoring a role for AR in the etiology of the typical case of CRS is weak, whereas in children, causal relationship between allergens and CRS is probably nonexistent (7).…”

Section: Mechanistic Evidencementioning

confidence: 99%

“…And even some specific gene polymorphisms present in CRS have also been found in asthma (14). Several reviews on the role of allergy in CRS, in both adults (11,15) and children (16), can be found in the recent English literature, where epidemiological and experimental studies are mentioned. However, a logical structure for investigating and defining causality in epidemiological studies, such as Bradford-Hill criteria for causation, has not been applied so far.…”

mentioning

confidence: 99%

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

Georgalas

Vlastos

Picavet

et al. 2014

Allergy

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The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health (1-5). Some review articles on chronic rhinosinusitis (CRS) have suggested that atopy predisposes to its development (6), because allergic rhinitis (AR) is a common coexisting disease in pediatric and adult patients with CRS (7).Despite the fact that acute and CRS have been shown to occur frequently in AR patients, a sound pathophysiologic mechanism has not been proven, and thus, the association between rhinosinusitis and AR remains controversial (8, 9). The hallmark of AR is an IgE-mediated (type I) hypersensitivity reaction to an inciting inhaled antigen (10) and, in some cases, an ingested food that causes a cross-reaction because of antigenic similarities between the inhalant and the food (11). On the other hand, the pathophysiology of CRS is more obscure. Although the clinical presentation and symptoms of CRSwNP and CRSsNP overlap, it appears that they are underlined by distinct pathophysiological mechanisms.For example, nasal polyps (NP) have significantly higher levels of eosinophil markers, while CRSsNP is characterized by a Th1 polarization with high levels of interferon-gamma (IFN-c) and transforming growth factor-beta (TGF-b). On the other hand, CRSwNP showed a Th2 polarization with high IL-5 and immunoglobulin (Ig) E concentration (12). One step further is to assess whether the Th2 phenotype in CRSwNP is the result of the atopic status, the presence of AR, or (allergic) asthma. We know that there are many parallels between NP and asthma (13). And even some specific gene polymorphisms present in CRS have also been found in asthma (14). Several reviews on the role of allergy in CRS, in both adults (11,15) and children (16), can be found in the recent English literature, where epidemiological and experimental studies are mentioned. However, a logical structure for investigating and defining causality in epidemiological studies, such as Bradford-Hill criteria for causation, has not been Allergy 69 (2014) 828-833

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The role of allergy in pediatric rhinosinusitis

Cited by 10 publications

References 52 publications

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

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