Nasal congestion in children with allergic rhinitis can be confounded by adenoidal hypertrophy. This retrospective Turkish study examines this association in more detail. The sample studied was 566 children (age 2-18) that were diagnosed (based on ARIA guidelines) and treated for allergic rhinitis. All children had skin prick tests for common allergens including house dust mite, pollens, cat/dog dander, mould and cockroach! Adenoidal tissue hypertrophy was diagnosed either by endoscopic examination or lateral nasopharyngeal X-ray. Interestingly, adenoidal hypertrophy was detected in 118 (21.2%) children. Sociodemographic characteristics evaluated in the two groups (with and without adenoidal hypertrophy) included age, gender, familial atopy and passive smoking. Other factors examined between groups included severity/duration of rhinitis, symptomology and presence of asthma/eczema.

Statistically significant associations with adenoidal hypertrophy in children with allergic rhinitis were a more prolonged and severe rhinitis, nasal congestion and a sensitivity to mould (Alternaria alternate).

A negative relationship with adenoidal hypertrophy was seen in asthmatic children and patients with an ‘itchy nose’. The authors concluded adenoidal hypertrophy should be considered in non-asthmatic children with severe nasal congestion and mould sensitivity. Following on from this work, it would be clinically useful to see what proportion had an improvement in their adenoidal hypertrophy with medical treatment of their allergic rhinitis and what proportion went on to have surgery in the form of adenoidectomy and/or turbinate reduction.

Does adenoid hypertrophy affect disease severity in children with allergic rhinitis?
Dogru M, Evcimik M, Calim O.
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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