Otitis Media With Effusion (<scp>OME</scp>) and Eustachian Tube Dysfunction: The Role of Allergy and Immunity—An <scp>EAACI</scp> Position Paper

IgE-mediated allergies play a significant role in respiratory diseases. Given the similar mucosal epithelium of the upper and lower respiratory tracts and their shared (patho)physiological immune responses, the "unified airways" concept views these tracts as a single system. Recently, this model has been extended to include the middle ear, with studies confirming that the Eustachian tube and middle ear are both anatomically and functionally part of the upper airways. However, the relationship between allergies and middle ear disorders remains controversial, with conflicting findings regarding pathogenesis and treatment. The increasing prevalence of allergies highlights the importance of further research. In Germany, the current sensitization rate to aeroallergens is 33.6%, with similar trends across Europe, where rates commonly range up to 30%. This widespread increase underscores the urgent need for a deeper understanding of the correlation between allergies and middle ear disorders across diverse European populations. Ineffective pharmacotherapy or possibly harmful medication for acute and chronic OME, such as systemic steroids, is most likely used globally in an uninformed way, due to a lack of evidence on the connection between allergic inflammation and eustachian tube dysfunction. Further research is essential to clarify the mechanisms linking IgE-mediated allergies to middle ear pathologies and to develop effective treatment strategies. Addressing these knowledge gaps is critical for improving patient outcomes and managing the rising burden of allergic diseases.

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Publication Details

Journal
Allergy
Published
2025-04-17
DOI
https://doi.org/10.1111/all.16554
Citations
12
Primary Topic
Ear Surgery and Otitis Media
Type
article
Field-Weighted Citation Impact
22.18

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article

Otitis Media With Effusion (OME) and Eustachian Tube Dysfunction: The Role of Allergy and Immunity—An EAACI Position Paper

Leticia de las Vecillas, Antonella Cianferoni, Tilman Huppertz, Moritz Gröger et al.
12 citations
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Ear Surgery and Otitis Media
22.18
article

Otitis Media With Effusion (OME) and Eustachian Tube Dysfunction: The Role of Allergy and Immunity—An EAACI Position Paper

Leticia de las Vecillas, Antonella Cianferoni, Tilman Huppertz, Moritz Gröger, Laura Van Gerven, Barbara Wollenberg, Mattia Giovannini, Michael Rudenko, Ralph Mösges, Wytske J. Fokkens, Wojciech Feleszko, Ümit Murat Şahiner, Simon Gane, Ioana Agache, Óscar Palomares, Sven Becker, Oliver Pfaar, Ludger Klimek, Jolanta Walusiak‐Skorupa, Peter Valentin Tomazic, Cemal Cingi, Adam Chaker, Eva Untersmayr, Friederike Bärhold, Cezmi A. Akdiş, Marek Jutel, Andre M. Moreira, Michele Schiappoli, Aspasia Karavelia, Patrizia Bonadonna, Mohamed H. Shamji, Sietze Reitsma, Stefania Arasi, Juan M. Solano, Carmen Rondón, Stefano R. Del Giacco, Jean Bousquet, Ibon Eguíluz‐Gracia, Patrick Huber, Jan Hagemann, Philippe Gevaert, Marı́a José Torres, Christoph Bergmann, Helen A. Brough, Sanna Toppila‐Salmi, Valérie Hox, Mandy Cuevas, Banu Bozkurt
article en
12 citations

Abstract

IgE-mediated allergies play a significant role in respiratory diseases. Given the similar mucosal epithelium of the upper and lower respiratory tracts and their shared (patho)physiological immune responses, the "unified airways" concept views these tracts as a single system. Recently, this model has been extended to include the middle ear, with studies confirming that the Eustachian tube and middle ear are both anatomically and functionally part of the upper airways. However, the relationship between allergies and middle ear disorders remains controversial, with conflicting findings regarding pathogenesis and treatment. The increasing prevalence of allergies highlights the importance of further research. In Germany, the current sensitization rate to aeroallergens is 33.6%, with similar trends across Europe, where rates commonly range up to 30%. This widespread increase underscores the urgent need for a deeper understanding of the correlation between allergies and middle ear disorders across diverse European populations. Ineffective pharmacotherapy or possibly harmful medication for acute and chronic OME, such as systemic steroids, is most likely used globally in an uninformed way, due to a lack of evidence on the connection between allergic inflammation and eustachian tube dysfunction. Further research is essential to clarify the mechanisms linking IgE-mediated allergies to middle ear pathologies and to develop effective treatment strategies. Addressing these knowledge gaps is critical for improving patient outcomes and managing the rising burden of allergic diseases.

AllergyVol. 80(9)
University of Verona (IT), Universidad Complutense de Madrid (ES), University of London (GB), Hospital Sant Joan de Déu Barcelona (ES), Cliniques Universitaires Saint-Luc (BE), St Thomas' Hospital (GB), Children's Hospital of Philadelphia (US), University of Helsinki (FI), Selçuk University (TR), Philipps University of Marburg (DE), University of Cagliari (IT), University of Eastern Finland (FI), University of Cologne (DE), Universidade do Porto (PT), King's College London (GB), Johannes Gutenberg University Mainz (DE), Medical University of Graz (AT), University of Zurich (CH), Nofer Institute of Occupational Medicine (PL), Medical University of Warsaw (PL), Helsinki University Hospital (FI), Hospital Universitario La Paz (ES), School of Advanced Study (GB), Hospital de São João (PT), Transylvania University of Brașov (RO), Ghent University (BE), Wroclaw Medical University (PL), Hospital Universitario Virgen Macarena (ES), Centre Hospitalier Universitaire de Montpellier (FR), University Medical Center of the Johannes Gutenberg University Mainz (DE), Hospital La Paz Institute for Health Research (ES), Hospital Regional Universitario de Málaga (ES), NIHR Imperial Biomedical Research Centre (GB), Meyer Children's Hospital (IT), Zentrum für Rhinologie und Allergologie (DE), Bambino Gesù Children's Hospital (IT), Royal National Throat Nose and Ear Hospital (GB), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Amsterdam University Medical Centers (NL), Istituti di Ricovero e Cura a Carattere Scientifico (IT), General Hospital of Nafplio (GR), i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto (PT), University Hospital Carl Gustav Carus (DE), Instituto de Investigación Biomédica de Málaga (ES), University of Florence (IT), Imperial College London (GB), Eskişehir Osmangazi University (TR), Technical University of Munich (DE), Hacettepe University (TR), Medical University of Vienna (AT), Technische Universität Dresden (DE), University of Pennsylvania (US), University of Tübingen (DE), University of Amsterdam (NL), Philadelphia University (US), KU Leuven (BE)
National Science Foundation, Bristol-Myers Squibb, Eli Lilly and Company, AstraZeneca, GlaxoSmithKline, Sanofi, Teva Pharmaceutical Industries, Stryker, Regeneron Pharmaceuticals, Mylan, Allergy Therapeutics, Celltrion, Amsterdam University Medical Centers, European Commission, Deutsche Forschungsgemeinschaft, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Technische Universität München, European Academy of Allergy and Clinical Immunology, G. Pohl-Boskamp, National Institutes of Health, Novartis Pharma, Allergopharma, Sanofi Genzyme, EIT Health
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Ear Surgery and Otitis Media
22.18
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