Colavita L, Miraglia Del Giudice M, Stroscio G, Visalli C, Alterio T, Pidone C, Pizzino M R, Arrigo T, Chimenz R, Salpietro C, Cuppari C
1 Department of Pediatrics, Unit of Genetics and Pediatric Immunology, University of Messina, Policlinico G. Martino, Messina, Italy.
Department Donna del Bambino e di Chirurgia Generale e Specialistica, Seconda Università di Napoli, Italy.
J Biol Regul Homeost Agents. 2015 Apr-Jun;29(2 Suppl 1):58-63.
Allergic rhinitis (AR) and adenoid hypertrophy (AH) are common in children and are often associated with each other. Recent studies have shown improvement of respiratory symptoms and reduction in the adenoid volume after anti-allergic medical therapy (intranasal corticosteroids, antihistamines). The aim of our retrospective study is to evaluate the effectiveness of adenoidectomy on respiratory symptoms in pediatric patients with AR. We recruited 404 pediatric patients with AR, and we divided them into 4 groups (1. intermittent-mild rhinitis; 2. intermittent-moderate/severe rhinitis; 3. persistent-mild rhinitis; 4. persistent-moderate/severe rhinitis), using ARIA classification. For each patient we evaluated: age at onset of AR; family history of allergy; the presence of other allergic diseases; serum total IgE values; skin prick test (SPT) results; presence of AH evaluated by rhino-laringeal fibroscopy; adenoidectomy and its efficacy on respiratory symptoms. Our data show an association between AR and AH: 90 of 404 (22%) children with AR had AH of a degree greater than 2nd. A significant percentage (80%) of children suffering from AR did not present satisfactory benefits from adenoidectomy. They reported persistence or recurrence of rhinitic symptoms after surgery or only partial benefits, especially of recurrent respiratory tract infections and nasal obstruction. The local allergic persistent inflammation on nasal mucosa and adenoid tissue is probably the cause of the unsatisfactory results of adenoidectomy, therefore surgery cannot be the first therapeutic step for these children. It is important to extinguish the local inflammation by medical anti-allergic therapy to obtain improvements of nasal symptoms and to prevent adenoid regrowth.
变应性鼻炎（AR）和腺样体肥大（AH）在儿童中很常见，且常相互关联。最近的研究表明，抗过敏药物治疗（鼻内用糖皮质激素、抗组胺药）后，呼吸道症状有所改善，腺样体体积减小。我们这项回顾性研究的目的是评估腺样体切除术对小儿AR患者呼吸道症状的疗效。我们招募了404例小儿AR患者，并根据ARIA分类将他们分为4组（1. 间歇性轻度鼻炎；2. 间歇性中度/重度鼻炎；3. 持续性轻度鼻炎；4. 持续性中度/重度鼻炎）。对于每位患者，我们评估了：AR发病年龄；过敏家族史；其他过敏性疾病的存在情况；血清总IgE值；皮肤点刺试验（SPT）结果；通过鼻咽喉纤维镜检查评估的AH情况；腺样体切除术及其对呼吸道症状的疗效。我们的数据显示AR与AH之间存在关联：404例AR患儿中有90例（22%）的AH程度大于2级。相当比例（80%）的AR患儿未从腺样体切除术中获得满意疗效。他们报告术后鼻炎症状持续或复发，或仅获得部分改善，尤其是复发性呼吸道感染和鼻塞方面。鼻黏膜和腺样体组织上的局部变应性持续性炎症可能是腺样体切除术效果不理想的原因，因此手术不能作为这些患儿的首要治疗步骤。通过抗过敏药物治疗消除局部炎症以改善鼻部症状并防止腺样体再生很重要。
