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Nationwide paediatric cohort study of a protective association between allergy and complicated appendicitis
E Omling1,2, M Salö1,2, P Stenström1,2
1Department of Clinical Sciences in Lund, Paediatrics, Lund University, Lund, Sweden.
Insights
Children with allergies have a reduced risk of complicated appendicitis. Seasonal antigen exposure appears protective, while antihistamine treatment may increase the risk of severe appendicitis in children.
Area of Science:
- Pediatric Medicine
- Immunology
- Gastroenterology
Background:
- The relationship between allergic conditions and appendicitis outcomes is not fully understood.
- Investigating the protective association between allergy and complicated appendicitis is crucial for pediatric health.
- Factors like seasonal antigens and antihistamine use may influence appendicitis risk in allergic children.
Purpose of the Study:
- To analyze the potentially protective association between allergy and complicated appendicitis in a nationwide cohort.
- To assess the influence of seasonal antigens, antihistamine treatment, and allergy onset timing on appendicitis outcomes.
- To compare the risk of complicated appendicitis in allergic versus non-allergic children.
Main Methods:
- A nationwide cohort study followed over 1.1 million children born between 2000 and 2010.
- Cross-sectional analysis compared appendicitis risk in allergic and non-allergic children.
- Longitudinal analysis examined appendicitis incidence in allergic children and matched controls.
Main Results:
- Allergic children had a significantly lower odds of complicated appendicitis (adjusted OR 0.80).
- The risk of complicated appendicitis was reduced by one-third in allergic children during longitudinal analysis (HR 0.68).
- Seasonal antigen exposure showed a protective effect (adjusted OR 0.82), while antihistamine medication increased risk (adjusted OR 2.28).
Conclusions:
- Children with allergies exhibit a lower risk of complicated appendicitis but not simple appendicitis.
- Seasonal antigen exposure is associated with reduced risk, whereas antihistamine treatment is linked to increased risk of complicated appendicitis.
- Findings suggest a complex interplay between allergy, environmental factors, and appendicitis severity in children.
Background:
In a nationwide cohort the potentially protective association between allergy and complicated appendicitis was analysed, and the influence of seasonal antigens, antihistamine treatment, and timing of allergy onset assessed.
Methods:
Some 1 112 571 children born between 2000 and 2010 were followed from birth until the end of 2014. A cross-sectional analysis of appendicitis cases, with comparison of allergic versus non-allergic children for absolute risk and odds of complicated appendicitis was first undertaken. This was followed by a longitudinal analysis of children with allergy and matched controls who had never had an allergy, for incidence rate and hazard of subsequent complicated or simple appendicitis.
Results:
Of all children, 20.4 per cent developed allergy and 0.6 per cent had appendicitis during follow-up. Among children with appendicitis, complicated appendicitis was more common among non-allergic children (18.9 per cent, 948 of 5016) than allergic children (12.8 per cent, 173 of 1351) (P < 0.001), and allergic children had a lower adjusted odds of complicated appendicitis (adjusted odds ratio (OR) 0.80, 95 per cent c.i. 0.67 to 0.96; P = 0.021 ). The risk of complicated appendicitis among children with manifest allergy was reduced by one-third in the longitudinal analysis (incidence rate 0.13 versus 0.20 per 1000 person-years; hazard ratio (HR) 0.68, 95 per cent c.i. 0.58 to 0.81; P < 0.001), whereas the risk of simple appendicitis remained unchanged (incidence rate 0.91 versus 0.91; HR 1.00, 0.94 to 1.07; P = 0.932 ). Seasonal antigen exposure was a protective factor (adjusted OR 0.82, 0.71 to 0.94; P = 0.004) and ongoing antihistamine medication a risk factor (adjusted OR 2.28, 1.21 to 4.28; P = 0.012).
Conclusion:
Children with allergy have a lower risk of complicated appendicitis, but the same overall risk of simple appendicitis. Seasonal antigen exposure reduced, and antihistamine treatment increased, the risk of complicated disease.
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