Modrzyński Marek, Zawisza Edward, Mazurek Henryk
Poradnia Alergologiczna NZOZ Euromedica w Grudziadzu.
Otolaryngol Pol. 2006;60(4):543-50.
Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy.
We examined changes in clinical symptoms score, and used acoustic rhinometry and endoscopy to evaluate the influence of three months anti-allergic treatment (topical nasal steroid and antihistaminic) on the adenoid size in children with adenoid hypertrophy. Three separate groups of children were examined. The study group consisted of 31 children with adenoid hypertrophy and perennial allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with dust allergens). The first control group consisted of 23 atopic children hypersensitive to dust allergens (positive skin-prick test results, presence of sIgE in the serum) with adenoid hypertrophy but without signs of perennial allergic rhinitis and with negative nasal provocation test. This group was not treated. The second control group consisted of 20 non-allergic children with adenoid hypertrophy. The children were treated similar to the children from the study group.
In children from the study group we observed the most significant decrease of clinical symptoms and endoscopic adenoid size and increase of nasopharyngeal cavity in acoustics rhinometry after the treatment. In the first control group there were almost no changes and in the second control group, the improvement concern only 25% of children. The medical treatment had however no statistical important influence on the tympanometry results in all the examined groups.
Properly administered nasal glucocorticoid spray together with antihistaminic in standard doses can significantly reduce adenoidal hypertrophy and considerably eliminate airway obstructive symptoms in children with allergic rhinitis. Likely only in this children the antiallergic treatment can be a useful alternative to surgery.
气道的过敏性致敏不仅发生在休克器官的黏膜，也发生在引流这些结构的淋巴站点。人类中最接近鼻黏膜的淋巴结构是腺样体。许多研究表明，在部分儿童中，过敏性鼻炎可能是腺样体肥大的一个危险因素。
我们检查了临床症状评分的变化，并使用鼻声反射和内窥镜检查来评估为期三个月的抗过敏治疗（局部鼻用类固醇和抗组胺药）对腺样体肥大儿童腺样体大小的影响。对三组不同的儿童进行了检查。研究组由31名患有腺样体肥大和常年性过敏性鼻炎的儿童组成（通过访谈、皮肤点刺试验结果阳性、血清中存在特异性免疫球蛋白E以及对粉尘过敏原的鼻激发试验阳性）。第一对照组由23名对粉尘过敏原过敏的特应性儿童组成（皮肤点刺试验结果阳性、血清中存在特异性免疫球蛋白E），他们患有腺样体肥大但无常年性过敏性鼻炎体征且鼻激发试验阴性。该组未接受治疗。第二对照组由20名患有腺样体肥大的非过敏性儿童组成。这些儿童接受了与研究组儿童相似的治疗。
在研究组儿童中，我们观察到治疗后临床症状和内窥镜下腺样体大小显著降低，鼻声反射测量中鼻咽腔增大。在第一对照组中几乎没有变化，而在第二对照组中，只有25%的儿童有所改善。然而，药物治疗对所有检查组的鼓室导抗图结果没有统计学上的重要影响。
标准剂量的鼻用糖皮质激素喷雾剂与抗组胺药联合使用，可显著减轻过敏性鼻炎儿童的腺样体肥大，并大大消除气道阻塞症状。可能只有在这些儿童中，抗过敏治疗才是手术的有效替代方法。
