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The role of IgE-mediated hypersensitivity in the development of otitis media with effusion.
Otolaryngol Clin North Am. 1992 Feb; 25(1):197-211.OC

Abstract

The potential mechanisms of IgE-mediated hypersensitivity in OME have been reviewed. Two important questions were addressed at the beginning of this manuscript: (1) is OME an allergic disease, or (2) is OME a complication of an allergic disease in another part of the respiratory system? In regard to the first question, recurrent OME is associated with allergic rhinitis in about one-third of the studied population. However, of the patients who do have allergic rhinitis, in the great majority of children the middle ear mucosa is not the target organ. Rather, there appears to be increasing evidence that with both nasal provocation and natural antigen provocation in children during a normal allergen season, eustachian tube function is altered by nasal allergy. Whether this is truly physiologic or an artificial phenomenon cannot be determined at this time, as it is not absolutely clear whether the nine-step eustachian tube function test currently performed is really a measure of eustachian tube dysfunction, despite its forming the basis of all studies published so far, although one must conclude from current data that allergic rhinitis can produce eustachian tube dysfunction; there have been no cases in these studies in which allergic rhinitis produced otitis media. However, eustachian tube dysfunction is one of the major precursors in the development of OME. We believe that the anatomic part of the upper respiratory tract involved in the IgE-mediated hypersensitivity is most likely the mucosa of the nasopharyngeal portion of the eustachian tube. Inasmuch as total nasal obstruction, at least in adults, does not produce eustachian tube dysfunction in the great majority of cases, it is proposed that eustachian tube dysfunction that follows nasal provocation and occurs during the normal allergy season does so as a result of the transport of mediators of inflammation from inflammatory cells in the nasal mucosa via the nasal mucociliary system to the nasopharyngeal orifice of the eustachian tube. The role of food allergy is still problematic, but this author suggests that there is some supportive evidence that food immune complexes, particularly with dairy products, may play a role, especially in the otitis-prone child under the age of 2 years.(ABSTRACT TRUNCATED AT 400 WORDS)

Authors+Show Affiliations

Department of Otolaryngology, State University of New York, Buffalo.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

1549382

Citation

Bernstein, J M.. "The Role of IgE-mediated Hypersensitivity in the Development of Otitis Media With Effusion." Otolaryngologic Clinics of North America, vol. 25, no. 1, 1992, pp. 197-211.
Bernstein JM. The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. Otolaryngol Clin North Am. 1992;25(1):197-211.
Bernstein, J. M. (1992). The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. Otolaryngologic Clinics of North America, 25(1), 197-211.
Bernstein JM. The Role of IgE-mediated Hypersensitivity in the Development of Otitis Media With Effusion. Otolaryngol Clin North Am. 1992;25(1):197-211. PubMed PMID: 1549382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of IgE-mediated hypersensitivity in the development of otitis media with effusion. A1 - Bernstein,J M, PY - 1992/2/1/pubmed PY - 1992/2/1/medline PY - 1992/2/1/entrez SP - 197 EP - 211 JF - Otolaryngologic clinics of North America JO - Otolaryngol Clin North Am VL - 25 IS - 1 N2 - The potential mechanisms of IgE-mediated hypersensitivity in OME have been reviewed. Two important questions were addressed at the beginning of this manuscript: (1) is OME an allergic disease, or (2) is OME a complication of an allergic disease in another part of the respiratory system? In regard to the first question, recurrent OME is associated with allergic rhinitis in about one-third of the studied population. However, of the patients who do have allergic rhinitis, in the great majority of children the middle ear mucosa is not the target organ. Rather, there appears to be increasing evidence that with both nasal provocation and natural antigen provocation in children during a normal allergen season, eustachian tube function is altered by nasal allergy. Whether this is truly physiologic or an artificial phenomenon cannot be determined at this time, as it is not absolutely clear whether the nine-step eustachian tube function test currently performed is really a measure of eustachian tube dysfunction, despite its forming the basis of all studies published so far, although one must conclude from current data that allergic rhinitis can produce eustachian tube dysfunction; there have been no cases in these studies in which allergic rhinitis produced otitis media. However, eustachian tube dysfunction is one of the major precursors in the development of OME. We believe that the anatomic part of the upper respiratory tract involved in the IgE-mediated hypersensitivity is most likely the mucosa of the nasopharyngeal portion of the eustachian tube. Inasmuch as total nasal obstruction, at least in adults, does not produce eustachian tube dysfunction in the great majority of cases, it is proposed that eustachian tube dysfunction that follows nasal provocation and occurs during the normal allergy season does so as a result of the transport of mediators of inflammation from inflammatory cells in the nasal mucosa via the nasal mucociliary system to the nasopharyngeal orifice of the eustachian tube. The role of food allergy is still problematic, but this author suggests that there is some supportive evidence that food immune complexes, particularly with dairy products, may play a role, especially in the otitis-prone child under the age of 2 years.(ABSTRACT TRUNCATED AT 400 WORDS) SN - 0030-6665 UR - https://www.unboundmedicine.com/medline/citation/1549382/The_role_of_IgE_mediated_hypersensitivity_in_the_development_of_otitis_media_with_effusion_ L2 - https://medlineplus.gov/allergy.html DB - PRIME DP - Unbound Medicine ER -