Research Letter
Effect of tonsillectomy on the efficacy of house dust mite sublingual immunotherapy
M. Refaat, Z.A. Ashour, M.N. Farres
, A.M. Eissa, M.M. Elsayed
Corresponding author
Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Read
2652
Timeswas read the article
668
Total PDF
1984
Total HTML
Share statistics
array:22 [ "pii" => "S0301054613002796" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.09.007" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "569" "copyright" => "SEICAP" "copyrightAnyo" => "2013" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2015;43:108-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 675 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 460 "PDF" => 209 ] ] "itemSiguiente" => array:17 [ "pii" => "S030105461400024X" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.10.004" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "588" "copyright" => "SEICAP" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2015;43:111-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 827 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 527 "PDF" => 292 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Adolescent form of sporadic lymphangioleiomyomatosis (S-LAM)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "111" "paginaFinal" => "114" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 743 "Ancho" => 1000 "Tamanyo" => 170611 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Surgical lung biopsy showing spindle cells in the wall of a cystic space stain for HMB-45; 400×.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.M. Restrepo-Gualteros, C.E. Rodriguez-Martinez, L.E. Jaramillo-Barberi, A.F. Lopez-Cadena, G. Nino" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S.M." "apellidos" => "Restrepo-Gualteros" ] 1 => array:2 [ "nombre" => "C.E." "apellidos" => "Rodriguez-Martinez" ] 2 => array:2 [ "nombre" => "L.E." "apellidos" => "Jaramillo-Barberi" ] 3 => array:2 [ "nombre" => "A.F." "apellidos" => "Lopez-Cadena" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Nino" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461400024X?idApp=UINPBA00004N" "url" => "/03010546/0000004300000001/v1_201501250943/S030105461400024X/v1_201501250943/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0301054614000238" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.10.003" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "587" "copyright" => "SEICAP" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2015;43:106-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 951 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 567 "PDF" => 373 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Sodium metabisulphite allergy with multiple food and drug hypersensitivities in a five-year-old child: A case report and literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "106" "paginaFinal" => "108" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Vitaliti, F. Guglielmo, L. Giunta, P. Pavone, R. Falsaperla" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Vitaliti" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Guglielmo" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Giunta" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Pavone" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Falsaperla" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054614000238?idApp=UINPBA00004N" "url" => "/03010546/0000004300000001/v1_201501250943/S0301054614000238/v1_201501250943/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research Letter</span>" "titulo" => "Effect of tonsillectomy on the efficacy of house dust mite sublingual immunotherapy" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "108" "paginaFinal" => "111" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Refaat, Z.A. Ashour, M.N. Farres, A.M. Eissa, M.M. Elsayed" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Refaat" ] 1 => array:2 [ "nombre" => "Z.A." "apellidos" => "Ashour" ] 2 => array:4 [ "nombre" => "M.N." "apellidos" => "Farres" "email" => array:1 [ 0 => "mnfarris@yahoo.co.uk" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "A.M." "apellidos" => "Eissa" ] 4 => array:2 [ "nombre" => "M.M." "apellidos" => "Elsayed" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1526 "Ancho" => 2766 "Tamanyo" => 158414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Total and mite-specific IgE levels in serum at baseline and after three months of SLIT in both study groups.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tonsils are part of Waldeyer's ring and play important immunological roles, including mucosal antigen capture and presentation to lymphocytes. A healthy immune response to allergens and successful allergen-specific immunotherapy both require the generation of allergen-specific cells for induction of peripheral T-cell tolerance.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Functional allergen-specific T-regulatory cells have been identified in lingual and palatine tonsils with percentages approximately three times higher than those in peripheral blood, indicating their role in controlling allergen-specific T-cell responses in human tonsils.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To date, nothing is known about the possible effect of tonsillectomy on the efficacy of sublingual immunotherapy (SLIT).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to assess the effect of tonsillectomy on clinical and immunological responses before and after three months of SLIT. The study was conducted at Ain Shams University Hospital, Cairo, Egypt, from January 2011 to August 2011, and included 26 adult patients with bronchial asthma and/or allergic rhinitis, of whom 13 had undergone tonsillectomy during childhood. All patients had a positive skin prick test (SPT) reaction to house dust mite. An informed consent was obtained from all study participants, and the study was approved by the Research Ethics Committee of the Faculty of Medicine, Ain Shams University. Clinical and immunological assessments were performed at baseline and after three months of SLIT with a house dust mite extract. Clinical parameters included the presence of cough, wheezing, sneezing and itchy nose, rhinorrhea, and nasal obstruction. Immunological parameters included SPT reactivity, serum levels of total IgE, house dust mite-specific IgE, total IgA and total IgG.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Tonsillectomy and non-tonsillectomy groups were comparable at baseline in age (21<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.5 years <span class="elsevierStyleItalic">vs.</span> 26.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.1 years, respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.172), gender [4 males (30.8%) <span class="elsevierStyleItalic">vs.</span> 6 males (46.2%), respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.420], serum levels of mite-specific IgE, total IgA and total IgG, whereas total IgE levels were significantly higher in the tonsillectomy group (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). After three months, SPT reactivity to house dust mite decreased significantly in both groups. The number of patients with a positive SPT to house dust mite was significantly reduced to four (30.8%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004 in the tonsillectomy group, and three (23.1%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002 in the non-tonsillectomy group. Furthermore, a highly significant reduction in serum levels of total and mite-specific IgE was observed in both groups after three months (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). However, no significant differences were observed after three months of SLIT in the serum levels of total IgG (943.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>204.7<span class="elsevierStyleHsp" style=""></span>IU/mL, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.133 for the tonsillectomy group; 909.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>253.1<span class="elsevierStyleHsp" style=""></span>IU/mL, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.133 for the non-tonsillectomy group) or total IgA (101.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>37.7<span class="elsevierStyleHsp" style=""></span>IU/mL, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.814 for the tonsillectomy group; 107.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.1<span class="elsevierStyleHsp" style=""></span>IU/mL, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.401 for the non-tonsillectomy group). As regards the studied clinical parameters, a significant reduction in the frequency of wheezing, sneezing and itchy nose was observed in the non-tonsillectomy group but not in the tonsillectomy group (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). However, the frequency of cough, rhinorrhea, and nasal obstruction did not change significantly in either group (data not shown).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Short-term reductions in serum levels of immunoglobulins have been observed following tonsillectomy, followed by a return of these levels to normal within a few months.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> However, studies on the long-term immunological effects of tonsillectomy are scarce, and have been conducted mostly on children. Kaygusuz et al. recorded no difference in serum IgA, IgG or IgM levels among children 54 months after tonsillectomy, compared to that in non-tonsillectomised children.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> On the other hand, long-term reductions have been reported for IgA levels in serum among the tonsillectomised compared to the non-tonsillectomised children, while other immunological parameters, including IgE, IgG and IgM, were preserved.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the present study, serum levels of mite-specific IgE, total IgA and IgG were all comparable at baseline in both groups, which may be attributed to the long time since tonsillectomy. However, an interesting finding which warrants further investigation is the significantly higher total IgE levels in tonsillectomised adults at baseline, in comparison to levels in non-tonsillectomised adults.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our results show that previous tonsillectomy does not affect the efficacy of SLIT in reducing SPT reactivity or in changing serum immunoglobulin levels. Both total and mite-specific IgE levels in serum were successfully reduced in both groups after SLIT. However, there was no change in serum levels of IgG in either group after treatment. Concerning this point, it may be more useful to measure the blocking activity of allergen-specific IgG or IgG subsets, including IgG1 and IgG4, instead of total IgG levels in sera.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Similarly, IgA levels in our study did not change significantly in either group after three months. Data on serum IgA levels after SLIT are still conflicting, and it appears that in contrast to subcutaneous immunotherapy, SLIT elicits mucosal IgA responses, and shows IgA subclass selectivity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In line with our findings, an absence of early systemic immunological changes has been demonstrated for allergen-specific IgG1, IgG4, and IgA levels in plasma during the first eight weeks of SLIT in respiratory allergic children.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> A possible explanation for the similar trends in all measured immunological parameters in both of our study groups after three months of SLIT is that maybe during tonsillectomy, only palatine tonsils and occasionally adenoids are removed; the lingual and tubal tonsils are preserved and continue their lifelong role in the induction of immunological responses<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>; thus the effect of tonsillectomy might be limited and is of short duration.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite the similar changes in immunological parameters between the tonsillectomy and the non-tonsillectomy groups, the reduction in the frequency of wheezing, sneezing and itchy nose after SLIT was not statistically significant in the tonsillectomy group. This suggests that tonsillectomy might affect the efficacy of SLIT in improving local allergic symptoms. Since this finding depends on patient-reported outcomes, it could have been affected by the patients’ and the researchers’ knowledge of the study objective – namely, checking whether tonsillectomy negatively affects the efficacy of SLIT. To minimise this potential bias, triple-blinding should be performed for future studies (patients should be blinded to this specific objective of the study, and researchers and statisticians should be blinded to the tonsillectomy status of the subjects). In addition, large-scale randomised controlled studies may confirm these findings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To our knowledge, this is the first study to report the effect of previous tonsillectomy on the clinical and immunological efficacy of SLIT. Further large-scale investigations should focus on the effect of tonsillectomy on local immunological changes following SLIT, and on similar findings for other allergens.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patients’ data protection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Confidentiality of data. The authors declare that no patient data appears in this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article. An informed consent was obtained from all study participants, and the study was approved by the Research Ethics Committee of the Faculty of Medicine, Ain Shams University.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of human subjects and animals in research</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no funding or grant was received for the study, and that they have no conflict of interest, financial or personal relationship related to the study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients’ data protection" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Right to privacy and informed consent" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human subjects and animals in research" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack123030" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1326 "Ancho" => 2254 "Tamanyo" => 135501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Symptoms at baseline and after three months of SLIT in both study groups.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1526 "Ancho" => 2766 "Tamanyo" => 158414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Total and mite-specific IgE levels in serum at baseline and after three months of SLIT in both study groups.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">All values are presented as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD except total IgE as median (interquartile range).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tonsillectomy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-tonsillectomy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total IgE (IU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">600.0 (224.0, 692.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225.0 (115.5, 444.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mite-specific IgE (kU/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.508 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total IgG (IU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">990.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>245.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">954.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>220.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.700 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total IgA (IU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>32.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.845 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646897.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Baseline serum levels of immunological markers in both groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triggering of specific toll-like receptors and proinflammatory cytokines breaks allergen-specific T-cell tolerance in human tonsils and peripheral blood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U.C. Kücüksezer" 1 => "O. Palomares" 2 => "B. Rückert" 3 => "T. Jartti" 4 => "T. Puhakka" 5 => "A. Nandy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2012.10.051" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "875" "paginaFinal" => "885" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23265862" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Induction and maintenance of allergen-specific FOXP3+ Treg cells in human tonsils as potential first-line organs of oral tolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Palomares" 1 => "B. Rückert" 2 => "T. Jartti" 3 => "U.C. Kücüksezer" 4 => "T. Puhakka" 5 => "E. Gomez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2011.09.031" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2012" "volumen" => "129" "paginaInicial" => "510" "paginaFinal" => "520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22051696" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is immune system influenced by adenotonsillectomy in children?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Ikincio¿ullari" 1 => "F. Do¿u" 2 => "A. ikincio¿ullari" 3 => "Y. E¿in" 4 => "E. Babacan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2002" "volumen" => "66" "paginaInicial" => "251" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12443814" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in immunoglobulin levels following adenoidectomy and tonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.I. Amorós Sebastiá" 1 => "M.J. Ferrer Ramírez" 2 => "C. López Mollá" 3 => "M. Carrasco Llatas" 4 => "A. Plá Mochilí" 5 => "M. Díaz Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2004" "volumen" => "55" "paginaInicial" => "404" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15605804" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of long-term impacts of tonsillectomy on immune functions of children: a follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Kaygusuz" 1 => "H.C. Alpay" 2 => "A. Gödekmerdan" 3 => "T. Karlidag" 4 => "E. Keles" 5 => "S. Yalcin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2008.11.014" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "445" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19150575" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.H. van den Akker" 1 => "E.A. Sanders" 2 => "B.K. van Staaij" 3 => "G.T. Rijkers" 4 => "M.M. Rovers" 5 => "A.W. Hoes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1081-1206(10)60022-1" "Revista" => array:6 [ "tituloSerie" => "Ann Allergy Asthma Immunol" "fecha" => "2006" "volumen" => "97" "paginaInicial" => "251" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16937760" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of allergen-specific immunotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Akdis" 1 => "M. Akdis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2010.11.030" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2011" "volumen" => "127" "paginaInicial" => "18" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21211639" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Calderón" 1 => "F.E. Simons" 2 => "H.J. Malling" 3 => "R.F. Lockey" 4 => "P. Moingeon" 5 => "P. Demoly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2011.02761.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "302" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22150126" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Absence of systemic immunologic changes during dose build-up phase and early maintenance period in effective specific sublingual immunotherapy in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Dehlink" 1 => "T. Eiwegger" 2 => "M. Gerstmayr" 3 => "E. Kampl" 4 => "B. Bohle" 5 => "K.W. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2222.2006.02400.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Allergy" "fecha" => "2006" "volumen" => "36" "paginaInicial" => "32" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16393263" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack123030" "titulo" => "Acknowledgments" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">The authors wish to thank Professor Al-Saied M. Abou-Gamrah, Professor Emeritus of Allergy and Clinical Immunology, Ain Shams University, Egypt, for his role in conceiving the study, and also Professor Cezmi A. Akdis, Director of the Swiss Institute of Allergy and Asthma Research, University of Zurich, Switzerland, for his valuable contribution in scientific revision of the article.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004300000001/v1_201501250943/S0301054613002796/v1_201501250943/en/main.assets" "Apartado" => array:4 [ "identificador" => "5550" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004300000001/v1_201501250943/S0301054613002796/v1_201501250943/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613002796?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 47 | 11 | 58 |
| 2024 September | 63 | 5 | 68 |
| 2024 August | 33 | 4 | 37 |
| 2024 July | 26 | 4 | 30 |
| 2024 June | 39 | 1 | 40 |
| 2024 May | 45 | 3 | 48 |
| 2024 April | 25 | 4 | 29 |
| 2024 March | 41 | 6 | 47 |
| 2024 February | 45 | 4 | 49 |
| 2024 January | 72 | 6 | 78 |
| 2023 December | 53 | 9 | 62 |
| 2023 November | 45 | 9 | 54 |
| 2023 October | 81 | 16 | 97 |
| 2023 September | 62 | 6 | 68 |
| 2023 August | 61 | 7 | 68 |
| 2023 July | 88 | 6 | 94 |
| 2023 June | 69 | 8 | 77 |
| 2023 May | 103 | 12 | 115 |
| 2023 April | 48 | 5 | 53 |
| 2023 March | 38 | 5 | 43 |
| 2023 February | 22 | 5 | 27 |
| 2023 January | 30 | 13 | 43 |
| 2022 December | 31 | 4 | 35 |
| 2022 November | 24 | 9 | 33 |
| 2022 October | 24 | 17 | 41 |
| 2022 September | 28 | 17 | 45 |
| 2022 August | 19 | 20 | 39 |
| 2022 July | 18 | 8 | 26 |
| 2022 June | 15 | 10 | 25 |
| 2022 May | 13 | 5 | 18 |
| 2022 April | 16 | 10 | 26 |
| 2022 March | 13 | 4 | 17 |
| 2022 February | 8 | 11 | 19 |
| 2022 January | 29 | 6 | 35 |
| 2021 December | 9 | 8 | 17 |
| 2021 November | 10 | 14 | 24 |
| 2021 October | 19 | 15 | 34 |
| 2021 September | 16 | 27 | 43 |
| 2021 August | 12 | 23 | 35 |
| 2021 July | 7 | 14 | 21 |
| 2021 June | 12 | 7 | 19 |
| 2021 May | 11 | 6 | 17 |
| 2021 April | 14 | 22 | 36 |
| 2021 March | 13 | 16 | 29 |
| 2021 February | 9 | 16 | 25 |
| 2021 January | 11 | 8 | 19 |
| 2020 December | 0 | 3 | 3 |
| 2020 November | 0 | 2 | 2 |
| 2020 October | 0 | 1 | 1 |
| 2020 September | 0 | 1 | 1 |
| 2020 August | 0 | 1 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2020 June | 0 | 1 | 1 |
| 2020 May | 0 | 1 | 1 |
| 2020 April | 0 | 2 | 2 |
| 2020 February | 0 | 1 | 1 |
| 2019 December | 0 | 3 | 3 |
| 2019 September | 0 | 2 | 2 |
| 2019 July | 0 | 4 | 4 |
| 2019 June | 0 | 1 | 1 |
| 2019 May | 0 | 13 | 13 |
| 2018 February | 10 | 1 | 11 |
| 2018 January | 16 | 0 | 16 |
| 2017 December | 13 | 1 | 14 |
| 2017 November | 8 | 1 | 9 |
| 2017 October | 14 | 3 | 17 |
| 2017 September | 8 | 5 | 13 |
| 2017 August | 15 | 5 | 20 |
| 2017 July | 12 | 3 | 15 |
| 2017 June | 14 | 3 | 17 |
| 2017 May | 24 | 9 | 33 |
| 2017 April | 15 | 10 | 25 |
| 2017 March | 19 | 1 | 20 |
| 2017 February | 19 | 4 | 23 |
| 2017 January | 17 | 2 | 19 |
| 2016 December | 17 | 12 | 29 |
| 2016 November | 24 | 6 | 30 |
| 2016 October | 30 | 7 | 37 |
| 2016 September | 34 | 23 | 57 |
| 2016 August | 32 | 6 | 38 |
| 2016 July | 13 | 5 | 18 |
| 2016 June | 16 | 11 | 27 |
| 2016 May | 18 | 11 | 29 |
| 2016 April | 12 | 9 | 21 |
| 2016 March | 16 | 12 | 28 |
| 2016 February | 17 | 12 | 29 |
| 2016 January | 22 | 11 | 33 |
| 2015 October | 0 | 1 | 1 |
| 2015 May | 0 | 1 | 1 |
| 2015 April | 2 | 5 | 7 |
| 2015 March | 1 | 2 | 3 |
| 2015 February | 2 | 3 | 5 |
Show all
