Purpose of the Study. To determine the risk factor of adenoidal hypertrophy in patients with known allergic rhinitis (AR).
Study Population. Three hundred fifteen consecutive patients between the age of 1 and 18 years with a diagnosis of AR who were also found to have adenoid hypertrophy (AH). A control group of 315 similarly aged patients with AR and no evidence of AH were randomly selected.
Methods. This was a retrospective study reviewing patients seen in the allergy clinic at a University Medical Center in Florida over a 10-year period. AR was diagnosed by history, physical findings, and positive skin test results. AH was determined radiographically defined as a narrowing of the airway attributable to adenoid mass by as much as two thirds of the airway caliber (the distance between the posterior and anterior pharyngeal wall). Patients were divided into 4 groups by age—1 to 3 years, 4 to 6 years, 7 to 12 years, and 13 to 18 years. The frequency of the following clinical symptoms was compared between the groups with and without AH: 1) otitis media (>6 episodes per year defined clinically); 2) lower respiratory infections (>3 episodes a year defined clinically as bronchitis, croup, or pneumonia); 3) sinusitis (>5 episodes per year defined radiographically as complete opacity, air fluid level or >4 mm mucosal thickening); 4) exposure to cigarette smoking (>2 weeks per month); 5) sleep disorders (positive history confirmed by doctors); 6) use of antihistamines/decongestants (>2 weeks per month over the last 3 years); and 7) percutaneous allergy testing to dust mites, molds, animal danders, cockroach, and seasonal pollens.
Results. The frequency of otitis media was statistically significantly more frequent in patients with AH aged 1 to 4 and the 4 to 6 years. The frequency of lower respiratory tract infections was statistically significantly higher in all age groups. The frequency of sinusitis was higher in AH patients for ages 4 to 6 and 7 to 12. Exposure to cigarette smoking was higher in all age groups with AH, but only statistically significant for ages 4 to 6 years. Frequency of sleep disorders was higher in AH patients for all age groups studied. Use of antihistamines/decongestants was statistically significantly greater in all AH patients except for the youngest ones measured at 1 to 3 years. Allergy skin testing was similar in both groups for measurements to dust mites, animal danders, and seasonal allergens. All AH patients had highly statistically significantly greater skin test reactivity to molds.
Conclusions. In this study population, children with allergic rhinitis along with adenoidal hypertrophy had a greater frequency of lower respiratory tract infections, sleep disorders, and skin test reactivity to molds. Otitis media occurred more frequently in younger-aged children, sinusitis more frequently in children between the ages of 4 to 12. Antihistamine/decongestants were used more frequently in all children except the youngest age group.
Reviewer’s Comments. Although there are a number of weaknesses in this retrospective study, the association of AR and adenoid hypertrophy in children has not been well-characterized. This was a retrospective study of a large number of consecutively seen patients with AH, but the control patients were apparently selected randomly. AH was defined radiographically rather than by fiberoptic examination. The definition of the clinical parameters was apparently clinically arbitrary, ie, otitis media clinically defined, lower respiratory infection defined as bronchitis, croup, and pneumonia but no criteria were given, sleep disorders defined by history without polysomnogram and parameter of use of antihistamine/decongestants was not specified. Despite these critical problems, the study has some interesting findings. The frequency of lower respiratory infections was greater in the AH patients in addition to the expected increased frequency of sinusitis and otitis. Skin test reactivity was significantly greater only to molds. This may be representative of the geographic location of the study (Florida) with greater humidity and mold exposure, yet dust mite sensitivity was similar in both groups. Hopefully, additional prospective studies looking at this association will be forthcoming from other areas of the country looking at allergen sensitivity in children with AH.
- Copyright © 2002 by the American Academy of Pediatrics