An analysis of the incidence of adenoid hypertrophy in allergic children

INTRODUCTION: The adenoidectomy is the most often made operation in small children but the reasons of adenoid hypertrophy are not completely explained. Some researches show that in part of children, allergy can be a risk factor for adenoid hypertrophy. The main aim of this study was the analysis of adenoid hypertrophy in children with different allergic diseases. MATERIAL AND METHODS: Two separate groups of children were examined. The study group consisted of 436 children between 4 and 9 years old with allergic rhinitis and/or bronchial asthma and/or atopic dermatitis hypersensitive to house dust mites (interview, positive skin-prick test results). The control group consisted of 229 non-atopic children (negative interview and skin-prick tests) in the similar age. In the both groups we examined the incidence of adenoid hypertrophy and its dependence of the kind of allergic disease, age, sex, infections, results of skin-prick test and other sensitization. RESULTS: The probability of adenoid hypertrophy was statistically more significant (logistic regression analysis) only in children from the study group with allergic rhinitis. There were no differences in adenoid hypertrophy incidence between children with other allergic diseases and the control group. The children from the study group with adenoid hypertrophy were more often hypersensitive to pollen and moulds allergens than the children without adenoid hypertrophy (chi square test). But there were no differences in the incidence of infection, age, sex and results of skin-prick tests. CONCLUSION: The result of our study suggests that the chance of adenoid hypertrophy in allergic children hypersensitive to dust mites is greater only in them with allergic rhinitis.     

The influence of birch pollination on the adenoid size in children with intermittent allergic rhinitis

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.     

影响儿童慢性鼻窦炎非手术疗效的多因素分析

目的：探讨影响儿童慢性鼻窦炎非手术治疗效果的各种因素，以期提高非手术治疗的疗效。方法：回顾分析58例采用非手术治疗的慢性鼻窦炎患儿的临床资料，采用Logistic回归法分析了性别、年龄、病程、鼻窦炎分期、病变鼻窦数、伴发腺样体肥大、伴发变应性鼻炎、上颌窦穿刺、疗程等因素对疗效的影响。结果：患儿病史长短、治疗的疗程以及是否伴发腺样体肥大及变应性鼻炎是影响非手术疗效的重要因素。结论：对于儿童鼻窦炎应予以足量疗程的药物综合治疗，并积极处理腺样体肥大及变应性鼻炎。     

腺样体肥大儿童伴变应性鼻炎与分泌性中耳炎的相关性分析

目的 分析腺样体肥大儿童伴分泌性中耳炎(ＯＭＥ)与变应性鼻炎(ＡＲ)发病的相关性。方法 回顾性分析12岁以下870例腺样体肥大患儿的病史,分析AR、咽鼓管功能不良及OME的相关性。结果 本组腺样体肥大患儿中AR发病率为30.11%,AR在不同年龄组中的发病率差异有统计学意义,随着年龄增加,发病率逐渐升高(P<0.01)。6岁以内发生咽鼓管功能障碍及OME的概率高,其中1~3岁组发生分泌性中耳炎的概率最大(P<0.01)。春季OME发病率高(P<0.001)。与不伴AR患者相比,伴有AR患儿患咽鼓管功能不良的概率增加了0.4倍(P=0.042);但患有OME的检出率减少了32%(P=0.0472)。结论 在腺样体肥大患儿中,多种因素使咽鼓管功能不良乃至OME高发。其中咽鼓管及其周围结构生理、病理、发育特点是最主要的因素,变态反应是次要影响因素。随着年龄增长,前者因逐渐发育完善,致病性降低,后者致病性增高,但总的发病率是逐渐降低的。     

儿童OSAHS和变应性鼻炎的关系探讨

目的:探讨儿童OSAHS和变应性鼻炎的关系;方法:①通过病史、体征、变应原检测、鼻内镜检查、多导睡眠监测,对我科诊治的574例OSAHS患儿中变应性鼻炎的发病率进行了调查;②对78例接受正规抗过敏治疗3周以上的OSAHS伴变应性鼻炎患儿进行回顾性分析,总结疗效。结果:①574例OSAHS患儿中,258例(44.9%)被诊断为变应性鼻炎,占同期所有变应性鼻炎患儿的50.4%(258/512)。258例中,以持续性变应性鼻炎为主223例(86.4%);变应原以真菌属为主187例(72.5%),与其他组相比差异有统计学意义(P<0.05)。②接受正规抗过敏治疗3周以上的40例轻、中度OSAHS伴变应性鼻炎患儿,睡眠呼吸暂停现象消失,血氧饱和度达到92%以上,继续药物治疗维持疗效,有效率达100%。38例经正规抗过敏治疗的重度OSAHS伴变应性鼻炎患儿中,3例用药后有效,继续药物治疗维持疗效,其余患儿症状虽然有所减轻,睡眠中仍有呼吸暂停或低通气现象,LSaO2<92%,均行等离子系统腺样体切除,扁桃体部分切除加消融手术或扁桃体消融手术。结论:变应性鼻炎与儿童OSAHS存在密切关系,其中以持续性变应性鼻炎占大多数。变应原以真菌占首位,粉尘螨、屋尘螨为其次。对于轻、中度伴变应性鼻炎的OSAHS患儿,可以坚持抗过敏药物治疗,避免手术。对于重度患儿可以先抗过敏药物治疗,疗效不好再行手术。腺样体、扁桃体切除术后常规抗过敏治疗,方可预防变应性鼻炎所致的下鼻甲肥大或圆枕淋巴组织增生再次引起睡眠时低通气。     

广州地区2136例变应性鼻炎儿童吸入性变应原皮肤点刺试验结果分析

目的分析广州地区变应性鼻炎（AR）儿童吸入性变应原皮肤点刺试验（skin prick test,SPT）结果,了解常见变应原的分布。方法对AR患儿进行SPT,描述变应原的分布特征,根据年龄和季节分层分析,同时对尘螨阳性率进行分析。结果 74.67%患儿对2～4种变应原过敏。阳性率前三位的变应原分别是屋尘螨（93.16%）、粉尘螨（86.23%）、热带螨（40.73%）。屋尘螨、猫毛和德国小蠊在学龄组和学龄前组的阳性率差异有统计学意义。德国小蠊在春、夏、秋、冬的阳性率无明显差异。尘螨强阳性率在学龄组、学龄前组及春、夏、秋、冬季无明显差异性。结论尘螨是广州地区AR患儿的主要变应原。屋尘螨、猫毛和德国小镰在学龄组阳性率较高。德国小蠊为常年致敏变应原。尘螨过敏有强阳性倾向。     

鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大疗效分析

目的 探讨儿童变应性鼻炎(AR)与腺样体肥大的关系, 评价鼻用类固醇治疗儿童变应性鼻炎伴腺样体肥大的疗效。方法 对照组为单纯腺样体生长儿童261例, 其中腺样体肥大190例(72.7%)。观察组为变应性鼻炎伴腺样体生长儿童162例, 其中腺样体肥大110例(67.2%)。两组均给予鼻用类固醇(丙酸氟替卡松喷剂)持续喷鼻3个月后于鼻内镜下复查。结果 对照组并发腺样体肥大构成比为72.7%,观察组并发腺样体肥大构成比为67.2%, 差异无统计学意义(χ²=1.16, P>0.05)。对照组采用鼻用类固醇治疗后有效腺样体体积减少112例(58.9%),观察组有效腺样体体积减小89例(80.9%)(χ²=19.04, P<0.01)。结论 经鼻用类固醇治疗, 变应性鼻炎伴腺样体肥大患儿腺样体体积减小程度较单纯腺样体肥大患儿明显。对变应性鼻炎合并腺样体肥大者可优先考虑应用鼻用类固醇激素。     

儿童腺样体肥大和变应性鼻炎关系的临床研究

目的探讨儿童腺样体肥大与合并变应性鼻炎的相关性。方法抽选2017年10月至2018年10月间收治的60例儿童腺样体肥大患者,均对患儿进行鼻咽侧位像DR扫描,测定腺样体/鼻咽腔比率(A/N比值)来评定腺样体的大小,采用视觉模拟量表(VAS)供患者对疾病程度和生活质量所受的影响程度进行自我评估,依据症状发作的频度,持续时间,对睡眠、学习及工作的影响程度评分。应用Spearman秩相关对二者相关性进行分析。结果60例腺样体肥大患儿中,合并变应性鼻炎20例,占33.3%。腺样体肥大1级患儿4例,视觉模拟量表(VAS)评分为1-4分;2级6例,视觉模拟量表(VAS)评分2-7分;3级10例,视觉模拟量表(VAS)评分4-10分。腺样体肥大等级越高,视觉模拟量表(VAS)评分也越高。腺样体肥大与合并变应性鼻炎呈正相关。结论儿童腺样体肥大和变应性鼻炎具有显著相关性,腺样体肥大也是造成变应性鼻炎患病的因素之一。儿童变应性鼻炎的临床治疗,明确主要病因与腺样体肥大有关时,可采用对腺样体肥大的专业治疗,可有效消除变应性鼻炎的病源,改善患儿变应性鼻炎的症状,提升患儿的生活质量。     

舌下含服粉尘螨滴剂治疗儿童变应性鼻炎合并腺样体肥大的疗效观察

目的 探讨舌下特异性免疫治疗对儿童变应性鼻炎及腺样体肥大的治疗效果。方法 将诊断为变应性鼻炎合并腺样体肥大的92例患儿随机分为两组,研究组应用舌下含服粉尘螨滴剂治疗,对照组采用常规抗过敏药物治疗,研究组观察3、6个月,对照组观察3个月,采用VAS评分记录患者鼻过敏和睡眠打鼾症状的变化,采用鼻内镜检查及鼻咽侧位片A/N比检测患儿腺样体大小的改变。结果 ①两组患者治疗后鼻过敏症状、睡眠打鼾症状VAS评分均低于治疗前;②常规抗过敏药物治疗组睡眠打鼾症状VAS评分低于舌下含服组,差异均有显著性统计学意义;③两组治疗后腺样体A/N比率均小于治疗前,且常规抗过敏药物治疗组小于舌下含服组（P<0.05）。结论 舌下特异性免疫治疗可有效控制儿童变应性鼻炎合并腺样体肥大患儿的过敏症状、睡眠打鼾症状及腺样体大小,可作为非手术干预治疗变应性鼻炎伴腺样体肥大的有效方法。     

小儿变应性鼻炎症状与尘螨特异性IgE及家居环境尘螨变应原含量相关性分析

目的　探究学龄前儿童变应性鼻炎症状与家居环境尘螨及尘螨特异性IgE（specific IgE,sIgE）相关性,为小儿过敏性疾病防治工作提供理论依据。方法　出生于芜 湖市第二人民医院,3～4周岁时,对患有变应性鼻炎儿童进行家庭内随访,评估患儿变应性鼻炎症状积分,采集患儿家居环境灰尘样本,应用酶联免疫吸附法测定尘样中屋尘螨第1组分变应原（Der p1）和粉尘螨第1组分变应原（Der f1）含量,并对患儿进行血清尘螨sIgE水平检测。结果　对采集的64份尘螨样本进行相关性分析,小儿变应性鼻炎症状与屋尘螨sIgE和粉尘螨sIgE之间有正相关性（P <0.05）;小儿变应性鼻炎症状与Der p1 和Der f1 之间有正相关性（P <0.05）。患儿居室内Der p1 和Der f1 暴露水平与屋尘螨sIgE及粉尘螨sIgE相互之间没有统计学意义上的相关性（P >0.05）。结论　小儿变应性鼻炎症状与家居环境尘螨含量及尘螨sIgE呈正相关,给临床科研提供了一个研究方向,提示可通过检测sIgE水平初步预测变应性鼻炎症状严重性,通过加强尘螨健康教育及降低居室环境尘螨含量来防治过敏性疾病和改善生活质量。     

变应性鼻炎和哮喘是一种疾病的临床调查研究

目的从临床流行病学角度探讨变应性鼻炎和哮喘的相关性,进一步论证二者是一种疾病的概念。方法在3210例哮喘患者进行变应性鼻炎和哮喘的相关性调查,其中1960例患者中进行变应原皮内试验,1250例患者进行点刺试验。结果哮喘患者中伴有变应性鼻炎者2684例（83.61%）,2402例先发生或同时发生变应性鼻炎（74.83%）。大部分变应性鼻炎患者在发病后的1～10年内发生哮喘。尘螨（屋尘螨和粉尘螨）是哮喘和变应性鼻炎最常见的变应原。结论调查结论支持变应性鼻炎和哮喘是一种疾病的观点,其诊断和防治也应结合起来进行考虑。     

糠酸莫米松鼻喷剂和孟鲁司特钠联合治疗儿童腺样体肥大的疗效观察

目的：探讨儿童腺样体肥大的非手术治疗方法及其疗效。方法联合使用糠酸莫米松鼻喷剂和孟鲁司特钠治疗儿童腺样体肥大30例,按照腺样体大小分为轻度12例、中度11例、重度7例三组,同时按照有无变应性鼻炎分为伴变应性鼻炎组19例和不伴变应性鼻炎组11例。患者的症状评分根据Carlos O’Connor-Reina的家长调查问卷获得。结果轻度组中有效率91.7%（11/12）,中度组有效率63.6%（7/11）,重度组有效率14.3%（1/7）。伴变应性鼻炎组有效率73.7%（14/19）,不伴变应性鼻炎组有效率36.4%（4/11）。结论糠酸莫米松鼻喷剂联合孟鲁司特钠是非手术治疗腺样体肥大一个较好的方法,但各组效果不一。轻度腺样体肥大效果较好,重度腺样体肥大效果较差。对于伴有变应性鼻炎的腺样体肥大治疗效果明显优于不伴有变应性鼻炎的。     

四川宜宾、云南昭通及部分长江上游地区变应性鼻炎患者的变应原分布特点及结果分析

目的：通过对四川宜宾、云南昭通及部分长江上游地区变应性鼻炎患者行变应原检测及分析,筛查本地区常见变应原,了解常见吸入性变应原的分布情况,为临床诊断和治疗变应性鼻炎提供参考。方法采集2013年3月～2015年6月于四川省宜宾市第一人民医院就诊的661例经皮肤点刺试验（skin prick test,SPT）诊断明确的常年性变应性鼻炎患者的资料,对所测定的致敏变应原进行统计分析。结果在661例患者的SPT中,阳性率最高前5位为粉尘螨（76.55%）、屋尘螨（72.01%）、蟑螂（35.85%）、猫毛（11.35%）、狗毛（8.62%）;不同季节变应原阳性率差异无统计学意义（χ2=4.568,P=0.206）;随着年龄的增加,变应性鼻炎患者变应原阳性率呈下降趋势。结论四川宜宾、云南昭通及部分长江上游地区中导致变应性鼻炎的变应原占主导地位的为粉尘螨、屋尘螨、蟑螂,对于儿童的变应性鼻炎防控应尤为重视。     

Is there any correlation between allergy and adenotonsillar tissue hypertrophy?

Objectives

Tonsil and adenoid are part of waldeyers ring;the basic function of which are antibody formation,which later react against a grat variety of antigens,The Adenotonsillectomy is the most common operation in small children but the exact reasons of adenotonsillar hypertrophy remains unknown,some researches have shown that allergy may be at risk factor for adenotonsillar hypertrophy.

Methods

Thorough one year two separated groups of children at the ENT and allergy ward of childrens hospital was enrolled in the study.The study group consisted of 117 children between 1 and 14 years old(with average of 6) who had adenotonsillar hypertrophy.The control group consisted of 100 children in the similar age that had not adenotonsillar hypertrophy.both groups were examined for the incidence of allergic disease,results of skin prick test, serum IgE levels and close contact to smoke.

Results

In the study group .70.3% of children with adenotonsillar hypertrophy had positive skin prick test.But only 10% of children in control group had positive skin prick test.Increased serum total IgE level was confirmed in 48% of children with positive skin prick test in study group were in close contact with smoker parents.

Conclusion

Allergy and sensitivity to different kinds of allergens are important risk factors for adenotonsillar hypertrophy in children.Allergy control may have role in reducing the rate of adenotonsillectomy in children suffering allergic reactions with adenotonsillar hypertrophy.     

Pre- and postoperative evaluation by acoustic rhinometry of children submitted to adenoidectomy or adenotonsillectomy

INTRODUCTION: Nasal obstruction is a common symptom in children and its etiology includes septal deviation, choanal atresia, allergic rhinitis and hypertrophy of the adenoids. Hypertrophy of the adenoids and hypertrophic rhinitis are the most frequent causes of nasal obstruction in the pediatric population, with adenoidectomy being the main surgery carried out during childhood. OBJECTIVE: To analyze the rhinograms of children with nasal obstruction before and after surgery and to compare them with those obtained for children without respiratory complaints. STUDY DESIGN: A clinical prospective study. METHODS: Thirty-five patients with adenoid or adenotonsillar hypertrophy were submitted to otolaryngologic examination and acoustic rhinometry before and 30-60 days after surgery. The control group consisted of 18 children without nasal complaints. RESULTS: Significant differences in the rhinograms were observed before and after surgery, but not between patients and the control group. CONCLUSION: We conclude that acoustic rhinometry is well tolerated by children, and is a rapid and noninvasive method. The technique is valuable for interindividual comparisons, but not for the assessment of different groups.     

尘螨变应原皮肤点刺试验结果与其血清sIgE及年龄的相关性

目的 探讨尘螨变应原皮肤点刺试验(skin pricktest,SPT)结果与血清特异性IgE(specificIgE,sIgE)检测结果及年龄的相关性。方法 选取160例尘螨变应原皮肤点刺试验阳性患者,测定血清sIgE水平,对SPT结果及血清sIgE及年龄分别行相关性分析。结果 尘螨变应原SPT阳性结果与其相应的血清sIgE检测结果存在显著差异,随着尘螨类变应原阳性级别的升高,其血清sIgE的阳性率也随之升高,与血清sIgE的分级呈正相关,与年龄的增长呈负相关。结论 尘螨变应原SPT结果与血清sIgE检测结果及年龄存在相关性。     

变应性鼻炎患者4637例变应原特点分析

目的 了解上海地区近5年来变应性鼻炎(allergic rhinitis,AR)患者的变应原分布状况,为AR的防治提供临床参考.方法 2005年6月至2010年5月间,针对有AR症状的患者行变应原皮肤点刺试验(skin prick test,SPT),分析各种变应原的致敏阳性率,以及致敏患者在年龄、性别、检测时间等方面的差异.结果 全部4637例患者中SPT阳性率为62.84％,屋尘螨、粉尘螨为主要变应原;不同季节变应原阳性率差异有统计学意义(x2 =93.581,P＜0.01),其中秋季最高,春季最低;各月份变应原检出阳性率差异有统计学意义(x2 =112.001,P＜0.01),其中10月份阳性率最高;变应原阳性率与年龄呈负相关(r=-0.792,P＜0.01),屋尘螨和粉尘螨的反应强度均随着年龄增大而减弱(x2 =122.513,P＜0.01;x2=138.475,P＜0.01).结论 尘螨为近5年来上海地区AR患者的主要变应原,年龄较小者变应原阳性率及阳性反应强度均较高.尘螨阳性率在季节分布方面存在差异.     

舌下含服粉尘螨滴剂治疗多种变应原过敏的变应性鼻炎儿童的疗效与安全性评估

目的:比较舌下含服标准化粉尘螨滴剂对治疗尘螨过敏和尘螨合并多种变应原过敏的变应性鼻炎患儿的疗效。方法:157例尘螨过敏的患儿,按变应原种类分为尘螨过敏组92例[患儿只对屋尘螨或(和)粉尘螨过敏]和多种变应原过敏组65例(患儿同时对尘螨和其他变应原过敏)。采用标准化粉尘螨滴剂进行舌下特异性免疫治疗(SLIT)1年。记录和比较两组治疗前和治疗1年后的症状评分和药物评分,同时比较两组间的疗效差异。应用SPSS 17.0软件对数据进行统计学分析。结果:125例患儿完成1年SLIT,两组患儿治疗前后症状评分均得到明显改善,尘螨过敏组治疗前后分别为(11.42±1.60)分和(3.55±1.57)分,多种变应原过敏组分别为(11.54±1.55)分和(3.23±1.56)分,组内比较差异均有统计学意义(t值分别为30.03、27.76,均P<0.01);但两组之间症状评分的改善无明显差异,尘螨过敏组为(7.94±2.24)分,多种变应原过敏组为(8.32±2.18)分,P>0.05。同样,两组患儿治疗前后药物评分均得到明显改善,尘螨过敏组治疗前后分别为(1.62±0.44)分和(0.56±0.37)分,多种变应原过敏组分别为(1.63±0.43)分和(0.50±0.40)分,组内差异均有统计学意义(t值分别为15.01、13.49,均P<0.01);但两组之间药物评分的改善无明显差异,尘螨过敏组为(1.03±0.58)分,多种变应原过敏组为(1.13±0.61)分,P>0.05。结论:舌下含服标准化粉尘螨滴剂可以明显改善对尘螨合并多种变应原过敏的变应性鼻炎患儿的鼻部症状,减少对症药物应用,其疗效与治疗单纯尘螨(不合并其他过敏原)过敏的患儿相当。因此,舌下含服标准化粉尘螨滴剂可以用于治疗尘螨合并多种变应原过敏的变应性鼻炎患儿。     

宁波地区1268例变应性鼻炎吸入性变应原调查分析

目的调查宁波地区引发变应性鼻炎的主要吸入性变应原种类。方法采用23种标准化变应原对宁波地区1268例变应性鼻炎患者进行皮肤点刺试验，筛选致敏变应原。调查对象中，少年组370例（6～18岁），成人组898例（18岁以上），分析两组间的变应原差异。结果变应原皮肤试验阳性者844例，总阳性率66.56%；其中少年组292例（78.92%），成人组552例（61.47%）。成人组变应原阳性率居前5位的是粉尘螨、屋尘螨、干草尘埃、胶乳、狗上皮，少年组为粉尘螨、屋尘螨、狗上皮、猫上皮、动物毛Ⅰ；少年组粉尘螨、屋尘螨阳性率高于成人组。结论尘螨是宁波地区最重要的吸入性变应原，尤以儿童患者为最。     

屋尘螨变应原制剂治疗变应性鼻炎的临床疗效观察

目的:评价屋尘螨变应原制剂治疗变应性鼻炎(AR)的临床疗效。方法:采用病例自身对照的方法,通过比较55例AR患者在接受2年的屋尘螨变应原制剂特异性免疫治疗前后的症状、体征积分,观察该制剂的临床疗效。结果:55例患者在完成特异性免疫治疗后的症状、体征积分较治疗前均明显减少,差异具有统计学意义(P<0.01)。结论:屋尘螨变应原制剂是治疗尘螨引起的AR的一种有效治疗方法。