Abstract
Atopy in its most common forms (asthma, allergic rhinitis, and atopic dermatitis) has a significant impact on society in terms of health care costs and quality of life. Aside from having significant morbidity from these diseases, patients with atopy have also been noted to have a high incidence of comorbidities, including bacterial infections such as otitis media and sinusitis. In this paper, current evidence is reviewed that supports the close associations among allergic rhinitis and the two commonly diagnosed bacterial diseases, otitis media and sinusitis.
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References and Recommended Reading
Ray NF, Baraniuk JN, Thamer M, et al.: Direct expenditures for the treatment of rhinoconjunctivitis in 1996, including the contributions of related airway illnesses. J Allergy Clin Immunol 1999, 103:401–407.
Stempel DA, Woolf R: The cost of treating allergic rhinitis. Curr Allergy Asthma Rep 2002, 2:223–230.
Gwaltney JM, Phillips CD, Miller RD, Riker DK: Computed tomographic study of the common cold. N Engl J Med 1994, 330:25–30.
Skoner DP: Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001, 108:S2-S8.
Sly RM: Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol 1999, 82:233–248.
Caffarelli C, Savini E, Giordano S, et al.: Atopy in children with otitis media with effusion. Clin Exper Allergy 1998, 28:591–596.
Juntti H, Tikkanen S, Kokkonen J, et al.: Cow’s milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol 1999, 119:867–873.
Tainio V-M, Savilahti E, Salmenpera L, et al.: Risk factors for infantile recurrent otitis media: atopy but not type of feeding. Pediatr Res 1988, 23:509–512.
Skoner DP, Doyle WJ, Fireman P: Eustachian tube obstruction (ETO) after histamine nasal provocation: a double-blind dose-response study. J allergy Clin Immunol 1987, 79:27–31.
Ojala K, Sipila P, Sorri M, Karma P: Role of atopic allergy in chronic otitis media. Acta Otolaryngol 1982, 93:55–60.
Caffarelli C, Cavagni G, Giordano S, et al.: Increased nasal eosinophils in children with otitis media with effusion. Otolaryngol Head Neck Surg 1996, 115:454–457.
Alles R, Parikh A, Hawk L, et al.: The prevalence of atopic disorders in children with chronic otitis media with effusion. Pediatr Allergy Immunol 2001, 12:102–106. In this study, 209 children with chronic OME were evaluated for presence of AR, eczema, and asthma. There was a very high prevalence of AR in this group (89%), suggesting that testing children with refractory OME and treating those with AR might help resolve the OME.
Yung MW, Arasaratnam R: Adult-onset otitis media with effusion: results following ventilation tube insertion. J Larnygol Otol 2001, 115:874–878.
Hurst DS, Venge P: Evidence of eosinophil, neutrophil, and mast-cell mediators in the effusion of OME patients with and without atopy. Allergy 2000, 55:435–441.
Benninger MS: Rhinitis, sinusitis, and their relationships to allergies. Am J Rhinol 1992, 6:37–43.
Emanuel IA, Shah SB: Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngol Head Neck Surg 2000, 123:687–691.
Rachelefsky GS: Chronic sinusitis: the disease of all ages. Am J Dis Child 1989, 143:886–868.
Rachelefsky G, Goldberg M, Kutz R, et al.: Sinus disease in children with respiratory allergy. J Allergy Clin Immunol 1978, 61:310–314.
Shapiro G: Role of allergy in sinusitis. Pediatr Infect Dis 1985, 4:555–558.
Huang S-W: The risk of sinusitis in children with allergic rhinitis. Allergy Asthma Proc 2000, 21:85–88. In this study, 215 children with PAR and 198 children with SAR were evaluated for frequency of sinusitis. Patients with PAR, especially mold allergy, had a significantly higher prevalence of sinusitis than nonmold PAR and SAR patients (relative risk, 2.49). Treatment of mold allergies may reduce the frequency of sinusitis in these patients.
Naclerio RM, deTineo ML, Baroody FM: Ragweed allergic rhinitis and the paranasal sinuses. Arch Otolaryngol Head Neck Surg 1997, 123:193–196.
Ramadan HH, Fornelli R, Ortiz AO, Rodman S: Correlation of allergy and severity of sinus disease. Am J Rhinol 1999, 13:345–347.
Hoover GE, Newman LJ, Platts-Mills TAE, et al.: Chronic sinusitis: risk factors for extensive disease. J Allergy Clin Immunol 1997, 100:185–191.
Krouse JH: Computed tomography stage, allergy testing, and quality of life in patients with sinusitis. Otolaryngol Head Neck Surg 2000, 123:389–392.
Stewart MG, Sicard MW, Piccirillo JF: Severity staging in chronic sinusitis: Are CT scan findings related to patient symptoms? Am J Rhinol 1999, 13:161–167.
Baroody FM, Naclerio RM: Allergic rhinitis. In Clinical Immunology Principles and Practice. Edited by Rich RR, Fleisher T, Shearer WT, et al. London: Mosby; 2001:48.1–48.13.
Durham SR, Ying S, Varner VA, et al.: Cytokine messenger RNA expression for IL-3, IL-4, IL-5, and granulocyte/macrophagecolony-stimulating factor in the nasal mucosa after local allergen challenge provocation: relationship to tissue eosinophilia. J Immunol 1992, 148:2390–2394.
Amin K, Hurst DS, Roomans GM, et al.: Eosinophils and neutrophils in biopsies from the middle ear of atopic children with otitis media with effusion. Inflamm Res 1999, 48:626–631.
Raisanen S, Stenfors LE: Bacterial quantification: a necessary complement for the comprehension of middle ear inflammations. Int J Pediatr Otorhinolaryngol 1992, 23:117–124.
Giebink GS, Carlson BA, Hetherington SV, et al.: Bacterial and polymorphonuclear leukocyte contribution to middle ear inflammation in chronic otitis media with effusion. Ann Otol Rhinol Laryngol 1985, 94:398–402.
Hurst DS, Amin K, Seveus L, Venge P: Evidence of mast cell activity in the middle ears of children with otitis media with effusion. Laryngoscope 1999, 109:471–477.
Sobol SE, Taha R, Schloss MD, et al.: Th2 cytokine expression in atopic children with otitis media with effusion. J Allergy Clin Immunol 2002, 110:125–130. In this study, 26 children with OME had skin testing for atopy and their effusions were collected at the time of myringotomy and tube placement. Thirty percent were atopic and found to have higher levels of eosinophils, T lymphocytes, IL-4, and IL-5 in their effusions than nonatopic patients, whereas nonatopic patients had higher percentages of neutrophils in their effusions. The differences were significant, but the sample size was small, with only eight atopic patients.
Wright ED, Hurst D, Miotto D, et al.: Increased expression of major basic protein (MBP) and interleukin-5 (IL-5) in middle ear biopsy specimens from atopic patients with persistent otitis media with effusion. Otolaryngol Head Neck Surg 2000, 123:533–538.
Baroody FM, Hughes CA, McDowekk P, et al.: Eosinophilia in chronic childhood sinusitis. Arch Otolaryngol Head Neck Surg 1995, 121:1396–1402.
Harlin SL, Anssel DG, Lane SR, et al.: A clinical and pathologic study of chronic sinusitis: the role of the eosinophil. J Allergy Clin Immunol 1988, 81:867–875.
Suzuki M, Watanabe T, Suko T, Mogi G: Comparison of sinusitis with and without allergic rhinitis: characteristics of paranasal sinus effusion and mucosa. Am J Otolaryngol 1999, 20:143–150. Paranasal sinus effusion and mucosa were examined in 31 patients with allergic chronic sinusitis and 48 patients with nonallergic chronic sinusitis. In the sinus effusions, there were higher numbers of eosinophils, activated eosinophils, neutrophils, and higher levels of IL-5 in allergic sinusitis patients. In the mucosa, more eosinophils and activated eosinophils were present in patients with allergic sinusitis. This study supports the role of AR in the chronic inflammation seen in chronic sinusitis patients.
Kramer MF, Ostertag P, Pfrogner E, Rasp G: Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis. Laryngoscope 2000, 110:1056–1062.
Hamilos DL, Leung DYM, Wood R, et al.: Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis. J Allergy Clin Immunol 1995, 96:537–544.
Kotsimbos TC, Ghamdi KA, Small P, et al.: Upregulation of Th2 cytokine receptors in atopy- and nonatopy-associated chronic sinusitis. J Otolaryngol 1996, 25:317–321.
Lavigne F, Nguyen CT, Cameron L, et al.: Prognosis and prediction of response to surgery in allergic patients with chronic sinusitis. J Allergy Clin Immunol 2000, 105:746–751. In this study, 15 atopic patients with CS underwent ethmoidectomy and middle meatotomy when indicated. In 24 months of follow-up, seven were responders and eight were nonresponders. The only significant difference between the groups was a higher level of IL-5 (+) cells in the ethmoid sinus biopsies of the nonresponders, which could potentially be used as a marker to predict patient response to surgery.
Bomer K, Brichta A, Baroody F, et al.: A mouse model of acute bacterial rhinosinusitis. Arch Otolaryngol Head Neck Surg 1998, 124:1227–1232.
Blair C, Nelson M, Thompson K, et al.: Allergic inflammation enhances bacterial sinusitis in mice. J Allergy Clin Immunol 2001, 108:424–429. Ovalbumin-sensitized BALB/c mice that were then challenged with ovalbumin and nonsensitized mice were inoculated with Streptococcus pneumoniae and sacrificed at day 5. Allergic mice that received a nasal challenge with allergen had a more rigorous infection in response to S. pneumoniae compared with nonallergic infected controls. This model demonstrated that an ongoing allergic inflammation augments bacterial infection in these mice.
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Mucha, S.M., Baroody, F.M. Relationships between atopy and bacterial infections. Curr Allergy Asthma Rep 3, 232–237 (2003). https://doi.org/10.1007/s11882-003-0045-2
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DOI: https://doi.org/10.1007/s11882-003-0045-2