Role of type I hypersensitivity reaction in the development of overall and uncomplicated acute appendicitis: a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background This systematic review aimed to analyze the potential etiopathogenic role of a type I hypersensitivity reaction in the development of overall acute appendicitis (AA), non-complicated acute appendicitis (NCAA), and complicated acute appendicitis (CAA). Methods This review was prospectively registered in PROSPERO (CRD42024516547). We included both prospective and retrospective original clinical studies that examined the role of immunoallergic processes in the development of acute appendicitis (AA). A comprehensive search was conducted in PubMed, Web of Science, Scopus, and OVID, using the following search terms and keywords: (allergy OR allergic OR immunoallergy OR immunoallergic OR immunomediated) AND (appendicitis OR appendectomy) AND (IgE OR “IgE-mediated” OR hypersensitivity OR “type I”). Two independent reviewers meticulously selected the articles and extracted relevant data. The methodological quality of the studies was rigorously assessed using the Newcastle-Ottawa index. A synthesis of the results, a standardization of the metrics, and seven random-effect meta-analyses were performed. Results This review included nineteen studies. A random-effects meta-analysis including six articles (6370 patients with NCAA and 2000 patients with CAA) showed that patients with any documented history of IgE-mediated allergy had a lower risk of developing CAA (OR 0.52, 95%CI [0.38–0.72], p < 0.0001). The random-effect meta-analysis for serum Interleukin-9 (NCAA vs. CAA) included two articles (177 patients with NCAA and 101 patients with CAA) and resulted in a significant mean difference [95% CI] of -0.38 [-0.67,-0.08] pg/mL (p = 0.01). The random-effect meta-analysis for serum Interleukin-13 (NCAA vs. CAA) included two articles (177 patients with NCAA and 101 patients with CAA) and resulted in a significant mean difference [95% CI] of -11.32 [-13.90,-8.75] pg/mL (p = < 0.00001). The random-effect meta-analysis for total eosinophil count (NCAA vs. CAA) included three articles (455 NCAA and 303 CAA) and resulted in a significant mean difference [95% CI] of -0.06 [-0.09,-0.04] eosinophils x 109/L (p = < 0.00001). Conclusions The present study demonstrates an association between a type I hypersensitivity reaction and the development of NCAA. Additionally, our meta-analytic model shows significantly higher levels of eosinophils peripheral blood in patients with NCAA than in patients with CAA. These findings suggest a potential immunoallergic mediation in the development of NCAA. Future prospective studies must validate these findings since these patients may benefit from specific therapeutic targets. Registration: PROSPERO (CRD42024516547).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.016 | 0.039 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".