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.