Modrzynski Marek, Zawisza Edward
The Regional Allergology Outpatient Euromedica, 86-300 Grudziadz, Legionow 71, Poland.
Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1017-23. doi: 10.1016/j.ijporl.2007.02.018. Epub 2007 May 4.
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 used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got anti-allergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group, we examined the influence of specific nasal provocation test on the adenoid size too.
In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p>0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r=0.18).
The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.
气道的过敏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。在人类中，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。
我们使用声反射鼻测量法和鼻内镜检查来评估桦树授粉对67名5至12岁儿童腺样体大小的影响。对四组不同的儿童进行了检查。研究组由28名对树花粉过敏且患有季节性过敏性鼻炎的儿童组成（通过访谈、皮肤点刺试验阳性结果、血清中存在特异性免疫球蛋白E以及用桦树花粉过敏原进行鼻激发试验阳性来确定）。第一对照组由14名对益母草花粉过敏的特应性儿童组成。第二对照组由15名非特应性儿童组成。第三对照组由10名对树花粉过敏的儿童组成，他们在桦树授粉前一周接受了抗过敏治疗（局部鼻用类固醇和抗组胺药）。在所有组中，在桦树授粉前、授粉期间和授粉后都对腺样体大小进行了检查。在研究组中，我们还检查了特异性鼻激发试验对腺样体大小的影响。
在研究组的大多数儿童（71.4%）中，我们观察到在桦树授粉期间，鼻内镜检查显示腺样体大小显著增加，声反射鼻测量法显示鼻咽腔体积减小（92.9%）。在大多数儿童（90%）中，授粉期过后这些变化恢复。在第一和第二对照组中几乎未观察到变化（p>0.05）。第三对照组使用的药物治疗避免了桦树授粉季节期间腺样体大小的增加。在研究组中，授粉期鼻咽体积的变化与鼻激发试验结果之间没有统计学上的显著相关性（r = 0.18）。
我们的研究结果表明，对于患有季节性过敏性鼻炎的儿童，接触过敏原可能会影响腺样体大小。标准剂量的鼻用糖皮质激素与抗组胺药联合正确使用可能会避免这种影响。
