Conclusions
AR is a common disease in childhood in industrialized countries and has a major impact on quality of life and health care resources. Recent studies pointed out main differences between allergic children and adults. For instance, AR in children seems to be more intermittent and severe than in adults, with less symptoms but with a higher number of comorbidities.52Furthermore, children suffering from AR often present additional conditions that may decrease response to medical treatment, worsening QoL. So, AR in children should be considered a disease with a high multimorbidity.
Experimental and clinical evidence strongly supports the existence of an association between allergy and OME, although clear evidence is still debated. Otherwise, the evidence linking atopy or allergy to AOM/RAOM or CSOM is poor and contradictory. Further studies are needed, paying particular attention to the inclusion criteria, the methodology of research and, above all, the accurate phenotyping of otitis media.
From a clinical point of view, children with persistent moderate to severe AR should be screened for otitis media and in particular, OME.We summarized in a practical algorithm our conclusions per phenotype of otitis in order to elucidate when prompt accurate diagnosis and treatment of allergy is recommended (Fig. 2). Reviewing the data about allergy and middle ear inflammation, we concluded that a clear link exists to some phenotypes of middle ear otitis, and in particular OME and acute re-exacerbation in patients with middle ear effusion.