ORIGINAL ARTICLES
Serum immunoglobulin E levels in relation to adenoid surgery
M. Prados, F. Sánchez*, M. Olivencia*, A. Paulino* andR. Aragón
The Allergy Unit. Hospital de Mérida (Spain). *The O.R.L. ward. Hospital de Mérida (Spain).
SUMMARY
The adenoid tissue is an immunecompetent lymphoid organ, which has the capacity of reacting against numerous antigens. We have studied the influence that the elimination of the said tissue would have on the total IgE serum levels in 33 patients of an average age of 5 and criteria of adenoidectomy and in whom these levels were measured before and after surgery. We have not noticed any statistically significant differences in the IgE values after adenoidectomy with respect to those prior to surgery, which were normal.
Adenoidectomy, like other authors have observed after tonsillectomy, does not alter the IgE serum values.
Key words: Adenoid disease. IgE levels. Adenoidectomy.
Allergol et Immunopathol 1998;26:52-4.
INTRODUCTION
The various structures that form the Waldeyer ring constitute the organization of the immunecompetent tissue specific to the upper aerodigestive tract, among which the tonsils palatines and pharyngeal or adenoids are the most important. They represent an intermediate functionality between the lymph nodes and the mucosa-associated lymphoid tissue (1-3).
Tonsils as well adenoids are lymphoids organs with specific antiboides and B-and T- cell activity which react against a great variety of antigens (4). The relative distribution of immunoglobulins types in the Waldeyer ring is similar to those found in the lymph nodes (1).
The different immunoglobulin serum levels in patients having undergone extirpation of the tonsils, adenoids or both, have been studied before and after surgery by different authors, with discordant results (5-7).
We have not found homogeneity in the results with respect to the total IgE serum levels (5, 8), however any author studies the patients extirpated of only the adenoids.
Given the results provided by the different authors in patients submitted to tonsillectomy and being the adenoids lymphoid organs we have studied the repercussion that the elimination of mentioned tissue would have on the total IgE serum levels.
MATERIAL AND METHODS
We have been studying during the year 1996 33 patient, 15 females and 18 males, between 3 and 11 years with an average of 5 and criteria of adenoidectomy.
Diseases leading to an increase in the total IgE were discarded in all studies through anamnesis, physical exploration, skin tests with allergens of our area, and analytical consisting of blood and urine test, biochemical profile, and parasites in feces (9).
The determination of the total IgE was accomplished by nephelometry in an Array Autoanalyser 360 (Beckman).
In all the studies patients the levels of the global IgE were quantified a week before surgery and between the second and third month after the same.
Adenoidectomy was performed with local anaesthesia and the technique and indications for the same are the described above (10, 11).
Statistical Analysis
The analytical study of quantitative variables was carried out comparing the means through the t paired method with the helpof the statistic program R Sigma (on a personal compatible IBM computer).
RESULTS
Table I displays the means and the standard desviations of the values of the total IgE found in the patients before and after the adenoids removal.
| Table I | |
| Serum immunoglobulin E levels in children with hypertrophy adenoid before and after adenoidectomy | |
| Adenoidectomy (n = 33) | IgE (UI/ml) |
| Before surgery | 52,30 ± 86,57 |
| After surgery | 37,42 ± 84,03 |
There is no statistically significant difference in the total IgE serum levels before and after the surgery.
DISCUSSION
In our study the total IgE serum levels are normal before surgery and they do not vary afterwords.
The immunoglobulins IgG, IgM e IgA in patients with chronic tonsillitis are increased (5, 12) or within the range of normality (6, 7) when compared with a population of control. In patients with adenoid hypertrophy values are normal (5). When tonsillectomy is performed on these patients, IgG, IgA and IgM descend (5-7, 12) being the decrease in the IgG significantly bigger (5, 12). Secretory IgA descends in patients who have been submitted to surgery of tonsils and adenoids (6). These previously indicated changes are not observed in the patients adenoidectomized exclusively (7). The increase and the subsequent decrease of the values of the immunoglobulins are due to the fact that chronic tonsillitis provokes a continous antigenic stimulus with a the following increase of the immunoglubulins, which descends when mentioned stimulus is eliminated by means of surgery (7, 8, 14). Adenoid hipertrophy and/or adenoiditis should not constitute a sufficiently intensive stimulus as to provoke the changes in the immunoglobulins as in the case of chronic tonsillitis (7).
The total IgE has been found increased in patients with chronic tonsillitis, recovering normality after tonsillectomy (8). In another work the levels were normal before and after surgery (5). We can not find an explanation of these differences, since the populations are practically identical and use the same method to determine the IgE. Our results coincide with this last work, though we accomplish exclusively tonsillectomy. Other authors state that the prevalence of allergic pathology in children with severe tonsil disease is the same as in the rest of the population and that tonsillectomy does not cause an increase in the prevalence of asthma (13).
Though the adenoids are lymphoid organs capable of secreting immunoglobulins, the values of IgA, IgG and IgM are not being influenced by their hypertrophy or removal (7). Nor have we found variations with respect to the total IgE. Therefore, the elimination of this lymphoid tissue, does not apparently influence the IgE serum levels.
RESUMEN
El tejido adenoideo es un órgano linfoide inmunocompetente que tiene la capacidad de reaccionar contra numerosos antígenos. Hemos estudiado la influencia que tendría la eliminación de dicho tejido sobre los niveles de IgE sérica total. Se han estudiado a 33 pacientes con una media de edad de cinco años y criterios de adenoidectomía, a los que se les ha medido la IgE sérica total antes y después de la intervención. No se han obtenido diferencias estadísticamente significativas en los valores de IgE tras adenoidectomía con respecto a los previos que eran normales.
La adenoidectomía al igual que otros autores han hallado tras la amigdalectomía, no altera los valores séricos de la IgE.
Palabras clave: Enfermedad adenoidea. Niveles de IgE. Adenoidectomía.
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| Correspondence: M. Prados Unidad de Alergología. Hospital de Mérida C/. Polígono Nueva Ciudad, s/n 6800 Mérida (Badajoz). Spain. |
