The Influence of Age on the Relationship Between Allergic Rhinitis and Otitis Media

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J Allergy Clin Immunol. 2001;108:S2–8. • Fernandes SSC, Andrade CR, Alvim CG, Camargos PAM, Ibiapina CDC. Epidemiological trends of allergic diseases in adolescents. J Bras Pneumol. 2017;43:368–72. This cross-sectional analysis assessed prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in Brazil and compared these rates to studies performed 10 yrs earlier. It showed that more adolescents are now affected by allergic rhinitis than previously. Simon F, Haggard M, Rosenfeld RM, Jia H, Peer S, Calmels M-N, et al. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135:S33–9. Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. 1984;5:459–62. Shekelle P, Takata G, Chan L. Diagnosis, natural history, and late effects of otitis media with effusion. Rockville: Agency for Healthcare Research and Quality; 2003. • Zernotti ME, Pawankar R, Ansotegui I, et al. Otitis media with effusion and atopy: is there a causal relationship? World Allergy Organ J. 2017. https://doi.org/10.1186/s40413-017-0168-x. This paper evaluated the risk factors for OME, role of allergy in OME, impact of upper airway disease on OME and management of OME by reviewing the literature. Lewis ER. Otitis media and allergy. Ann Otol Rhinol Laryngol. 1929;38:185–8. Rezes S, Kesmarki K, Sipka S, Sziklai I. Characterization of otitis media with effusion based on the ratio of albumin and immunoglobulin G concentrations in the effusion. 2007;28:5. Skoner DP, Stillwagon PK, Casselbrandt ML, Tanner EP, Doyle WJ, Fireman P. Inflammatory mediators in chronic otitis media with effusion. Arch Otolaryngol Head Neck Surg. 1988;114:1131–3. Bluestone CD. Eustachian tube function: physiology, pathophysiology, and role of allergy in pathogenesis of otitis media. J Allergy Clin Immunol. 1983;72:242–51. Bernstein JM. The role of IgE-mediated hypersensitivity in the development of otitis media with effusion: a review. Otolaryngol Head Neck Surg. 1993;109:611–20. Yeo SG, Park DC, Eun YG, Cha CI. The role of allergic rhinitis in the development of otitis media with effusion: effect on eustachian tube function. Am J Otolaryngol. 2007;28:148–52. •• Roditi RE, Veling M, Shin JJ. Age: an effect modifier of the association between allergic rhinitis and otitis media with effusion: age is an effect modifier: allergy and OME. Laryngoscope. 2016;126:1687–92. This study used a large national database to evaluate the relationship of allergic rhinitis and OME. The authors found that age is an effect modifier of the association between AR and OME; with a significant relationship found in children 6 years of age and older, but no significant association was found in younger children. Luong A, Roland PS. The link between allergic rhinitis and chronic otitis media with effusion in atopic patients. Otolaryngol Clin N Am. 2008;41:311–23. Krouse JH. The unified airway—conceptual framework. Otolaryngol Clin N Am. 2008;41:257–66. Corren J. Allergic rhinitis and asthma: how important is the link? J Allergy Clin Immunol. 1997;99:S781–6. Lemanske RF, Busse WW. 6. Asthma. J Allergy Clin Immunol. 2003;111:S502–19. Nguyen LHP, Manoukian JJ, Sobol SE, Tewfik TL, Mazer BD, Schloss MD, et al. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol. 2004;114:1110–5. Hurst DS, Venge P. The presence of eosinophil cationic protein in middle ear effusion. Otolaryngol Head Neck Surg. 1993;108:711–22. Hurst DS, Venge P. Levels of eosinophil cationic protein and myeloperoxidase from chronic middle ear effusion in patients with allergy and/or acute infection. Otolaryngol Head Neck Surg. 1996;114:531–44. Quaranta N, Iannuzzi L, Gelardi M. Does the type of rhinitis influence development of otitis media with effusion in children? Curr Allergy Asthma Rep. 2014;14:472. Kreiner-Møller E, Chawes BLK, Caye-Thomasen P, Bønnelykke K, Bisgaard H. Allergic rhinitis is associated with otitis media with effusion: a birth cohort study. Clin Exp Allergy. 2012;42:1615–20. Kwon C, Lee HY, Kim MG, Boo SH, Yeo SG. Allergic diseases in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2013;77:158–61. Hardjojo A, Hadjojo A, Shek LP, van Bever HP, Lee BW. Rhinitis in children less than 6 years of age: current knowledge and challenges. Asia Pac Allergy. 2011;1:115–22. Usonis V, Jackowska T, Petraitiene S, Sapala A, Neculau A, Stryjewska I, et al. Incidence of acute otitis media in children below 6 years of age seen in medical practices in five East European countries. BMC Pediatr. 2016;16:108. https://doi.org/10.1186/s12887-016-0638-2. Passali D, Passali GC, Lauriello M, Romano A, Bellussi L, Passali FM. Nasal allergy and otitis media: a real correlation? Sultan Qaboos Univ Med J. 2014;14:e59–64. Oh J-H, Kim WJ. Interaction between allergy and middle ear infection. Curr Allergy Asthma Rep. 2016;16:66. •• Cheng X, Sheng H, Ma R, et al. Allergic rhinitis and allergy are risk factors for otitis media with effusion: a meta-analysis. Allergol Immunopathol. 2017;45:25–32. This meta-analysis of 7 studies evaluated the prevalence of allergic rhinitis in pediatric patients with OME and found that allergic rhinitis and allergy appear to be risk factors for otitis media with effusion. MacIntyre EA, Chen C-M, Herbarth O, Borte M, Schaaf B, Krämer U, et al. Early-life otitis media and incident atopic disease at school age in a birth cohort. Pediatr Infect Dis J. 2010;29:e96–9. MacIntyre EA, Heinrich J. Otitis media in infancy and the development of asthma and atopic disease. Curr Allergy Asthma Rep. 2012;12:547–50. Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2011. https://doi.org/10.1002/14651858.CD003423.pub3. Lack G, Caulfield H, Penagos M. The link between otitis media with effusion and allergy: a potential role for intranasal corticosteroids: OME and allergy. Pediatr Allergy Immunol. 2011;22:258–66. • Roditi RE, Rosenfeld RM, Shin JJ. Otitis media with effusion: our national practice. Otolaryngol Head Neck Surg. 2017;157:171–2. This paper evaluated national and current practice patterns related to OME management to identify adherence to national guideline recommendations. These results focused on pediatric patients. • Wang DE, Lam DJ, Bellmunt AM, Rosenfeld RM, Ikeda AK, Shin JJ. Intranasal steroid use for otitis media with effusion: ongoing opportunities for quality improvement. Otolaryngol Head Neck Surg. 2017;157:289–96. In this study, the authors evaluated patterns of intranasal steroid administration when OME was diagnosed in children. They found that despite randomized controlled trials showing a lack of efficacy for intranasal steroids for isolated OME, nasal steroids continue to be used to treat OME in children in the US. Martines F, Martinciglio G, Martines E, Bentivegna D. The role of atopy in otitis media with effusion among primary school children: audiological investigation. Eur Arch Otorhinolaryngol. 2010;267:1673–8. •• Pau BC, Ng DK. Prevalence of otitis media with effusion in children with allergic rhinitis, a cross sectional study. Int J Pediatr Otorhinolaryngol. 2016;84:156–60. In this study, the prevalence of OME in children 4 to 12 years of age with allergic rhinitis and non-allergic rhinitis was evaluated. 7.5% of the allergic rhinitis group were found to have OME compared with 1.6% of the non-allergic rhinitis group (p=0.016). This showed that in Hong Kong, OME was more likely to occur in children with allergic rhinitis. Mahdavinia M, Grammer LC. Chronic rhinosinusitis and age: is the pathogenesis different? Expert Rev Anti-Infect Ther. 2013;11:1029–40. Kurukulaaratchy RJ, Karmaus W, Raza A, Matthews S, Roberts G, Arshad SH. The influence of gender and atopy on the natural history of rhinitis in the first 18 years of life. Clin Exp Allergy. 2011;41:851–9. Almqvist C, Li Q, Britton WJ, Kemp AS, Xuan W, Tovey ER, Marks GB, CAPS team (2007) Early predictors for developing allergic disease and asthma: examining separate steps in the “allergic march.” Clin Exp Allergy 37:1296–1302. •• Warm K, Hedman L, Lindberg A, Lötvall J, Lundbäck B, Rönmark E. Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma. J Allergy Clin Immunol. 2015;136:1559–1565.e2. In this paper, allergic sensitization was shown to decrease with increasing age. In a multivariate model, allergic rhinitis was associated to sensitization to pollen and animal and this was more strongly associated in younger adults when compared to older adults. • Lambrecht BN, Hammad H. The immunology of the allergy epidemic and the hygiene hypothesis. Nat Immunol. 2017;18:1076–83. This paper evaluates the immunology of allergy and the hygiene hypothesis and evaluates the role of barrier tissues, environment, and the microbiome during early life to show how this affects immunoregulation in response to allergens. Sharma SK, Pichichero ME. Cellular immune response in young children accounts for recurrent acute otitis media. Curr Allergy Asthma Rep. 2013;13:495–500. •• Bowatte G, Tham R, Allen KJ, Tan DJ, Lau M, Dai X, et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015;104:85–95. This is a systematic review and meta-analysis that confirms that breastfeeding protects against AOM until 2 years of age. Exclusive breastfeeding during the first 6 months was associated with a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, there is no evidence that breast feeding is protective against AOM. Maw AR, Bawden R. The long term outcome of secretory otitis media in children and the effects of surgical treatment: a ten year study. Acta Otorhinolaryngol Belg. 1994;48:317–24. Kawano H, Paparella MM, Ho SB, Schachern PA, Morizono N, Le CT, et al. Identification of MUC5B mucin gene in human middle ear with chronic otitis media. Laryngoscope. 2000;110:668–73. •• Duah V, Huang Z, Val S, DeMason C, Poley M, Preciado D. Younger patients with COME are more likely to have mucoid middle ear fluid containing mucin MUC5B. Int J Pediatr Otorhinolaryngol. 2016;90:133–7. In this study, middle ear effusions from children receiving tympanostomy tubes were evaluated for the presence of 2 mucins (MUC5B and MUC5AC). MUC5B was more often detected in middle ear fluid compared to MUC5AC and was more common in mucoid effusions than serous effusions. The authors also found that patients with effusions positive for MUC5B were younger than those with effusions negative for MUC5B. Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C. Adenoid hypertrophy in adults: a case series. Indian J Otolaryngol Head Neck Surg. 2013;65:269–74. Quaranta N, Milella C, Iannuzzi L, Gelardi M. A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy. Int J Pediatr Otorhinolaryngol. 2013;77:1980–3. •• Yang B, Brook CD. The role of allergy in otologic disease. Otolaryngol Clin N Am. 2017;50:1091–101. In this article, the authors examined evidence for a relationship between allergic disease and several otologic conditions including OM, EOM, and Meniere's disease. Collins MP, Church MK, Bakhshi KN, Osborne J. Adenoid histamine and its possible relationship to secretory otitis media. J Laryngol Otol. 1985;99:685–91. Arnaoutakis D, Collins WO. Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children. Int J Pediatr Otorhinolaryngol. 2011;75:1318–21. Ulualp SO, Sahin D, Yilmaz N, Anadol V, Peker O, Gursan O. Increased adenoid mast cells in patients with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 1999;49:107–14. Caffarelli C, Cavagni G, Giordano S, Savini E, Piacentini G. Increased nasal eosinophils in children with otitis media with effusion. Otolaryngol Head Neck Surg. 1996;115:454–7. Iino Y, Nagamine H, Yabe T, Matsutani S. Eosinophils are activated in middle ear mucosa and middle ear effusion of patients with intractable otitis media associated with bronchial asthma. Clin Exp Allergy. 2001;31:1135–43. Iino Y, Tomioka-Matsutani S, Matsubara A, Nakagawa T, Nonaka M. Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx. 2011;38:456–61. Iino Y, Kakizaki K, Katano H, Saigusa H, Kanegasaki S. Eosinophil chemoattractants in the middle ear of patients with eosinophilic otitis media. Clin Exp Allergy. 2005;35:1370–6. Iino Y. Role of IgE in eosinophilic otitis media. Allergol Int. 2010;59:233–8. Kanazawa H, Yoshida N, Yamamoto H, Hara M, Hasegawa M, Matsuzawa S, et al. Risk factors associated with severity of eosinophilic otitis media. Auris Nasus Larynx. 2014;41:513–7. El-Qutob D. Off-label uses of omalizumab. Clin Rev Allergy Immunol. 2016;50:84–96. Okude A, Tagaya E, Kondo M, Nonaka M, Tamaoki J. A case of severe asthma with eosinophilic otitis media successfully treated with anti-IgE monoclonal antibody omalizumab. Case Rep Pulmonol. 2012;2012:1–5. Iino Y, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A, Kanazawa H, et al. Clinical efficacy of anti-IgE therapy for eosinophilic otitis media. Otol Neurotol. 2012;33:1218–24. Iino Y, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A, Kanazawa H, et al. Effect of omalizumab on biomarkers in middle ear effusion in patients with eosinophilic otitis media. Acta Otolaryngol. 2014;134:366–72. •• Kanazawa H, Yoshida N, Iino Y. New insights into eosinophilic otitis media. Curr Allergy Asthma Rep. 2015. https://doi.org/10.1007/s11882-015-0577-2. This paper reviews the latest information regarding the relatively new diagnosis of eosinophilic otitis media including the pathophysiology, differential diagnosis, effect of age, and treatment options. This disease is reported exclusively in adulthood. •• Nemati S, Jafari Shakib R, Shakiba M, Araghi N, Azimi SZ. Allergic rhinitis in adults with chronic suppurative otitis media. Iran J Otorhinolaryngol. 2015;27:261–6. This paper is one of the few studies in adult patients evaluating the correlation of allergic rhinitis and middle ear disease. This showed that patients with allergic rhinitis and non-allergic rhinitis had a 3.27 and 2.57 fold increased risk, respectively, of developing ear disease compared to healthy individuals (P=0.048). American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113:1412–29.