The role of IgE mediated hypersensitivity in recurrent otitis media with effusion

The term allergy has frequently been overused and abused. As our knowledge of specific immunologic reactivity has become sophisticated, it has become quite clear that many symptoms and signs attributed to the general term allergy are in fact due to nonimmunologic mechanisms. This is particularly true in the area of adverse food reactions, and food additive ingestions. It is emphasized in this article that we are specifically addressing the role of immunologic reactivity created by IgE mediated hypersensitivity. In our opinion, about two-thirds of patients with recurrent OME are not likely to have IgE mediated hypersensitivity in the upper respiratory tract. However, of the patients who do have allergic rhinitis, a small group of these patients (15 to 20 percent) may have the middle ear as a target organ. Furthermore, there is increasing evidence with more objective studies of eustachian tube function, that if allergen does reach the nasopharynx, it may produce eustachian tube edema and consequent eustachian tube dysfunction. Whether or not this is a truly physiologic phenomenon or whether only an artificial phenomenon produced by nasal provocation remains to be resolved. In this regard, it should be emphasized, that our observations in the Allergy Clinic at the Children's Hospital would not support the idea that during the ragweed season there is an increased incidence of eustachian tube dysfunction or otitis media with effusion. It is obvious that further studies of this kind, particularly in regard to evaluating eustachian tube function, must be performed in order to determine the exact role of IgE mediated hypersensitivity in the evolution of recurrent otitis media with effusion.