Similar Allergic Inflammation in Middle Ear and Upper Airway
Notice bibliographique
Résumé
Source: Nguyen LHP, Manoukian JJ, Sobol SE, 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;114:1110–1115Children with otitis media with effusion have an increased prevalence of atopic diseases.1 Airways in children with allergic rhinitis and those with asthma demonstrate similar inflammatory markers,2 suggesting that these 2 conditions represent different manifestations of a single inflammatory airway disease. Researchers from McGill University in Montreal and the University of Pennsylvania compared the cellular and cytokine profiles of the nasopharynx and middle ear effusion (MEE) in atopic and non-atopic children.Forty-five consecutive children (age 2–18 years) who required myringotomy, tympanostomy tube placement, and adenoidectomy were enrolled in the study. All had MEE persisting for at least 3 months and symptomatic nasal obstruction from adenoidal hypertrophy. Children using corticosteroids within the previous 6 weeks and those with acute otitis media within 3 weeks were excluded, as were those found to have pus in the nasopharynx at the time of the procedure. Atopy was defined as a positive skin prick test to at least 1 of 12 common aeroallergens. Samples of the MEE, adenoid tissue, and biopsy specimens of the ipsilateral torus tubaris (nasopharyngeal mucosa near the Eustachian tube opening) were collected from study patients and evaluated for cellularity (eosinophils, T lymphocytes, and neutrophils) and the presence of messenger RNA for interleukin (IL)-4, IL-5, and interferon (IFN)-γ.Eleven of 45 children enrolled were atopic; the remainder served as non-atopic controls. The atopic group tended to be older (mean age 6.5 vs 5.3 years) and had a lower female-tomale ratio (1:2.7 vs 1:1). The MEE from atopic children had significantly more eosinophils and T cells than did the MEE of non-atopic controls. Similarly, the MEE of atopic patients had a higher percentage of IL-4 mRNA+ cells and IL-5 mRNA+ cells than did that of controls. Conversely, atopic children had significantly fewer neutrophils and fewer IFN-γ+ cells in their MEE than the non-atopic subjects. Compared to that of non-atopic controls, the adenoid tissue of atopic children contained significantly more eosinophils, more IL-4 and IL-5 mRNA+ cells, and fewer neutrophils and IFN-γ+ cells. There was no difference in the number of T cells between groups. Finally, when biopsies of the torus tubaris were examined, a similar pattern was observed. Atopic children had significantly more eosinophils, T cells, IL-4 mRNA+ cells, and IL-5 mRNA+ cells, with significantly fewer neutrophils than the controls. These findings establish that in atopic patients allergic inflammation is manifest in both the middle ear effusions and the tissues of the nasopharynx.Dr. Lester has disclosed no financial relationships relevant to this commentary.Every part of the airway is connected, at least indirectly, to every other part, leading to the concept of a “united airway.” Sinusitis, otitis, and asthma are co-morbid conditions of allergic rhinitis.1 Furthermore, control of allergic rhinitis can lead to improved control of recurrent upper airway bacterial infections3 and asthma.4 Eustachian tube dysfunction can be treated with an application of topical corticosteroid to the Eustachian orifice,5 suggesting an element of eosinophilic inflammation at the site in some patients.This study is the first to demonstrate the simultaneous presence of allergic inflammation at both ends of the Eustachian tube in allergic patients: in the middle ear and in the nasopharynx. The study demonstrates that the various conditions attributable to “allergic airways disease” cannot be fully understood by study of its manifestation in a single anatomic location.The results of this study demonstrate that an allergic response occurs in the middle ear of atopic children with MEE. The clinical implications of this finding are unclear; however, it may be that more aggressive treatment of allergic symptoms might reduce MEE, both by aiding in Eustachian tube dysfunction through treatment of allergic rhinitis as well as by reducing the allergic response in the middle ear itself. As the authors point out, if these results are validated in clinical trials, careful attention to the treatment of allergic conditions might obviate the need for surgery in many children with MEE.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».