INTRODUCTION
Allergic rhinitis (AR) is the most frequent chronic condition in
childhood and adolescence, its prevalence varies from 1.5% up to
42%,1,2reaching 8% in 6–8-year-old children and up
to 35% in 13–14 -year-old children, with a continuous increase in the
developed world.3-5
Pediatric AR may have a significant impact on global quality of life,
including school performance, sleep disorders, and emotional
health.2 Furthermore, over the years many authors
tried to correlate allergy with the onset of the most frequent upper
airway disorders in childrenand in particular of otitis media.It has
been estimated that more than 75% of AR children develop concomitant
conditions, including conjunctivitis, asthma, atopic dermatitis, upper
respiratory tract infections (URTI), rhinosinusitis, adeno-tonsillitis,
and otitis media, indicating that AR is not an isolated condition, but
it is part of a systemic disease,even though conflicting results are
frequently reached.6,7
AR is an inflammatory condition of the nasal mucosa provoked by
environmental allergens interacting with immunoglobulin (Ig)E in
sensitized subjects. Repeated exposure to allergens may lead to
long-term changes in systemic and local inflammation, including
up-regulation of nasal eosinophils and allergen-specific IgE, increased
levels of adhesion molecules in airway mucosa and
enhanced systemic response
to allergen challenge.8Consequently, it is not
surprising that AR has been historically associated with comorbid upper
airway diseases,among which otitis media.9
The association between AR and otitismedia isstill controversial.
However, AR can cause swelling of nasal mucosa resulting in Eustachian
tube (ET) dysfunction and subsequently otitis, in particular otitis
media with effusion (OME) characterized by inflammation of the mucous
membrane with fluid collection in the middle ear in the absence of acute
infection. If untreated, OME may be complicated with hearing loss
especially conductive type, poor school performance, behavioral
problems, and reduced the quality of life.10
The aim of the present systematic review was toevaluate clinical and
laboratory evidence,linking allergy to different phenotypes of otitis
media in children. Allergy in these conditions may be evocated not only
as risk, but also as a worsening factor. Poorly controlled AR might
exacerbate comorbidities, whereas early diagnosis and its adequate
treatment might improve these disorders having a substantial impact on
the quality of life of children.8