Skip to main content
Top
Published in: Current Allergy and Asthma Reports 6/2010

01-11-2010

Role of Adenoidectomy in Otitis Media and Respiratory Function

Author: Petri S. Mattila

Published in: Current Allergy and Asthma Reports | Issue 6/2010

Login to get access

Abstract

Adenoidectomy is among the most frequent surgical procedures performed on children. The rationale for adenoidectomy is to remove a chronically infected or enlarged and obstructing adenoid. Adenoidectomies are performed on children who have recurrent or chronic otitis media with effusion, on children with chronic rhinosinusitis, and on children with nasopharyngeal obstruction causing sleep disturbances and continuous mouth breathing. Various underlying factors that lead to adenoidectomy are also associated with asthma. Asthma is associated with recurrent respiratory tract infections predisposing individuals to recurrent or chronic otitis media and chronic rhinosinusitis. Children with asthma also have an increased risk of sleep-disordered breathing that is treated with adenoidectomy in the presence of nasopharyngeal obstruction. In nonasthmatic children, adenoidectomy does not influence the development of IgE-mediated allergy, bronchial hyperreactivity, or exhaled nitric oxide concentrations, all of which are surrogate asthma markers. Adenoidectomy in selected asthmatic children may relieve comorbidities associated with asthma.
Literature
2.
go back to reference Nguyen LH, Manoukian JJ, Yoskovitch A, Al-Sebeih KH: Adenoidectomy: selection criteria for surgical cases of otitis media. Laryngoscope 2004, 114:863–866.CrossRefPubMed Nguyen LH, Manoukian JJ, Yoskovitch A, Al-Sebeih KH: Adenoidectomy: selection criteria for surgical cases of otitis media. Laryngoscope 2004, 114:863–866.CrossRefPubMed
3.
go back to reference Gates GA, Avery CA, Prihoda TJ, Cooper JC Jr: Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med 1987, 317:1444–1451.CrossRefPubMed Gates GA, Avery CA, Prihoda TJ, Cooper JC Jr: Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med 1987, 317:1444–1451.CrossRefPubMed
4.
go back to reference Maw R, Bawden R: Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). BMJ 1993, 306:756–760.CrossRefPubMed Maw R, Bawden R: Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). BMJ 1993, 306:756–760.CrossRefPubMed
5.
go back to reference Paradise JL, Bluestone CD, Rogers KD, et al.: Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials. JAMA 1990, 263:2066–2073.CrossRefPubMed Paradise JL, Bluestone CD, Rogers KD, et al.: Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials. JAMA 1990, 263:2066–2073.CrossRefPubMed
6.
go back to reference Coyte PC, Croxford R, McIsaac W, et al.: The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. N Engl J Med 2001, 344:1188–1195.CrossRefPubMed Coyte PC, Croxford R, McIsaac W, et al.: The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. N Engl J Med 2001, 344:1188–1195.CrossRefPubMed
7.
go back to reference Mattila PS, Joki-Erkkilä VP, Kilpi T, et al.: Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol 2003, 129:163–168. Mattila PS, Joki-Erkkilä VP, Kilpi T, et al.: Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol 2003, 129:163–168.
8.
go back to reference Koivunen P, Uhari M, Luotonen J, et al.: Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. BMJ 2004, 328:487.CrossRefPubMed Koivunen P, Uhari M, Luotonen J, et al.: Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. BMJ 2004, 328:487.CrossRefPubMed
9.
go back to reference Hammaren-Malmi S, Saxen H, Tarkkanen J, Mattila PS: Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005, 116:185–189.CrossRefPubMed Hammaren-Malmi S, Saxen H, Tarkkanen J, Mattila PS: Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005, 116:185–189.CrossRefPubMed
10.
go back to reference Paradise JL, Bluestone CD, Colborn DK, et al.: Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes. JAMA 1999, 282:945–953.CrossRefPubMed Paradise JL, Bluestone CD, Colborn DK, et al.: Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes. JAMA 1999, 282:945–953.CrossRefPubMed
11.
go back to reference American Academy of Family Physicians, American Academy of Otolaryngology—Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media With Effusion: Otitis media with effusion. Pediatrics 2004, 113:1412–1429. American Academy of Family Physicians, American Academy of Otolaryngology—Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media With Effusion: Otitis media with effusion. Pediatrics 2004, 113:1412–1429.
12.
go back to reference •• Bull P, Haggard M, Raglan E, et al.: Surgical Management of Otitis Media With Effusion in Children. Clinical Guideline 60 NICE (National Institute for Health and Clinical Excellence). London: Royal College of Obstetricians and Gynaecologists; 2008. This guideline recommends the insertion of tympanostomy tubes in children with persistent bilateral otitis media with effusion documented over a period of 3 months. Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms. •• Bull P, Haggard M, Raglan E, et al.: Surgical Management of Otitis Media With Effusion in Children. Clinical Guideline 60 NICE (National Institute for Health and Clinical Excellence). London: Royal College of Obstetricians and Gynaecologists; 2008. This guideline recommends the insertion of tympanostomy tubes in children with persistent bilateral otitis media with effusion documented over a period of 3 months. Adjuvant adenoidectomy is not recommended in the absence of persistent and/or frequent upper respiratory tract symptoms.
13.
go back to reference Mattila PS: Adenoidectomy and tympanostomy tubes in the management of otitis media. Curr Allergy Asthma Rep 2006, 6:321–326.CrossRefPubMed Mattila PS: Adenoidectomy and tympanostomy tubes in the management of otitis media. Curr Allergy Asthma Rep 2006, 6:321–326.CrossRefPubMed
14.
go back to reference Mitchell RB, Kelly J: Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2004, 68:1375–1379.CrossRefPubMed Mitchell RB, Kelly J: Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2004, 68:1375–1379.CrossRefPubMed
15.
go back to reference Ramadan HH: Surgical management of chronic sinusitis in children. Laryngoscope 2004, 114:2103–2109.CrossRefPubMed Ramadan HH: Surgical management of chronic sinusitis in children. Laryngoscope 2004, 114:2103–2109.CrossRefPubMed
16.
go back to reference Pajusto M, Tarkkanen J, Mattila PS: Platelet endothelial cell adhesion molecule-1 is expressed in adenoidal crypt epithelial cells. Scand J Immunol 2005, 61:82–86.CrossRefPubMed Pajusto M, Tarkkanen J, Mattila PS: Platelet endothelial cell adhesion molecule-1 is expressed in adenoidal crypt epithelial cells. Scand J Immunol 2005, 61:82–86.CrossRefPubMed
17.
go back to reference Vogler RC, Ii FJ, Pilgram TK: Age-specific size of the normal adenoid pad on magnetic resonance imaging. Clin Otolaryngol 2000, 25:392–395.CrossRefPubMed Vogler RC, Ii FJ, Pilgram TK: Age-specific size of the normal adenoid pad on magnetic resonance imaging. Clin Otolaryngol 2000, 25:392–395.CrossRefPubMed
18.
go back to reference Rapola S, Salo E, Kiiski P, et al.: Comparison of four different sampling methods for detecting pharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children. J Clin Microbiol 1997, 35:1077–1079.PubMed Rapola S, Salo E, Kiiski P, et al.: Comparison of four different sampling methods for detecting pharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children. J Clin Microbiol 1997, 35:1077–1079.PubMed
19.
go back to reference Boersma WG, Lowenberg A, Holloway Y, et al.: The role of antigen detection in pneumococcal carriers: a comparison between cultures and capsular antigen detection in upper respiratory tract secretions. Scand J Infect Dis 1993, 25:51–56.PubMed Boersma WG, Lowenberg A, Holloway Y, et al.: The role of antigen detection in pneumococcal carriers: a comparison between cultures and capsular antigen detection in upper respiratory tract secretions. Scand J Infect Dis 1993, 25:51–56.PubMed
20.
go back to reference Regev-Yochay G, Raz M, Dagan R, et al.: Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 2004, 38:632–639.CrossRefPubMed Regev-Yochay G, Raz M, Dagan R, et al.: Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 2004, 38:632–639.CrossRefPubMed
21.
go back to reference •• Mattila PS, Hammaren-Malmi S, Saxen H, et al.: Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children. Arch Dis Child 2010 May 26 (Epub ahead of print). This is the first randomized study of the effect of adenoidectomy on nasopharyngeal carriage of bacterial pathogens causing otitis media. •• Mattila PS, Hammaren-Malmi S, Saxen H, et al.: Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children. Arch Dis Child 2010 May 26 (Epub ahead of print). This is the first randomized study of the effect of adenoidectomy on nasopharyngeal carriage of bacterial pathogens causing otitis media.
22.
go back to reference Styrt B: Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990, 88:33N-42N.CrossRefPubMed Styrt B: Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med 1990, 88:33N-42N.CrossRefPubMed
23.
go back to reference Bogaert D, De Groot R, Hermans PW: Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 2004, 4:144–154.CrossRefPubMed Bogaert D, De Groot R, Hermans PW: Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 2004, 4:144–154.CrossRefPubMed
24.
go back to reference Anderson HR, Bland JM, Peckham CS: Risk factors for asthma up to 16 years of age. Evidence from a national cohort study. Chest 1987, 91:127S–130S.CrossRefPubMed Anderson HR, Bland JM, Peckham CS: Risk factors for asthma up to 16 years of age. Evidence from a national cohort study. Chest 1987, 91:127S–130S.CrossRefPubMed
25.
go back to reference Mattila PS, Hammaren-Malmi S, Tarkkanen J, et al.: Adenoidectomy during early life and the risk of asthma. Pediatr Allergy Immunol 2003, 14:358–362.CrossRefPubMed Mattila PS, Hammaren-Malmi S, Tarkkanen J, et al.: Adenoidectomy during early life and the risk of asthma. Pediatr Allergy Immunol 2003, 14:358–362.CrossRefPubMed
26.
go back to reference van Hattum ES, Balemans WA, Rovers MM, et al.: Adenoidectomy and/or tonsillectomy in childhood is not associated with atopic disease later in life. Clin Exp Allergy 2006, 36:40–43.CrossRefPubMed van Hattum ES, Balemans WA, Rovers MM, et al.: Adenoidectomy and/or tonsillectomy in childhood is not associated with atopic disease later in life. Clin Exp Allergy 2006, 36:40–43.CrossRefPubMed
27.
go back to reference Ramagopal M, Scharf SM, Roberts DW, Blaisdell CJ: Obstructive sleep apnea and history of asthma in snoring children. Sleep Breath 2008, 12:381–392.CrossRefPubMed Ramagopal M, Scharf SM, Roberts DW, Blaisdell CJ: Obstructive sleep apnea and history of asthma in snoring children. Sleep Breath 2008, 12:381–392.CrossRefPubMed
28.
go back to reference Verhulst SL, Aerts L, Jacobs S, et al.: Sleep-disordered breathing, obesity, and airway inflammation in children and adolescents. Chest 2008, 134:1169–1175.CrossRefPubMed Verhulst SL, Aerts L, Jacobs S, et al.: Sleep-disordered breathing, obesity, and airway inflammation in children and adolescents. Chest 2008, 134:1169–1175.CrossRefPubMed
29.
go back to reference Kalra M, Buncher R, Amin RS: Asthma as a risk factor for respiratory complications after adenotonsillectomy in children with obstructive breathing during sleep. Ann Allergy Asthma Immunol 2005, 94:549–552.CrossRefPubMed Kalra M, Buncher R, Amin RS: Asthma as a risk factor for respiratory complications after adenotonsillectomy in children with obstructive breathing during sleep. Ann Allergy Asthma Immunol 2005, 94:549–552.CrossRefPubMed
30.
go back to reference Riedler J, Braun-Fahrlander C, Eder W, et al.: Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. Lancet 2001, 358:1129–1133.CrossRefPubMed Riedler J, Braun-Fahrlander C, Eder W, et al.: Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. Lancet 2001, 358:1129–1133.CrossRefPubMed
31.
go back to reference Illi S, von Mutius E, Lau S, et al.: Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ 2001, 322:390–395.CrossRefPubMed Illi S, von Mutius E, Lau S, et al.: Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ 2001, 322:390–395.CrossRefPubMed
32.
go back to reference Braun-Fahrlander C, Riedler J, Herz U, et al.: Environmental exposure to endotoxin and its relation to asthma in school-age children. N Engl J Med 2002, 347:869–877.CrossRefPubMed Braun-Fahrlander C, Riedler J, Herz U, et al.: Environmental exposure to endotoxin and its relation to asthma in school-age children. N Engl J Med 2002, 347:869–877.CrossRefPubMed
33.
go back to reference van Strien RT, Engel R, Holst O, et al.: Microbial exposure of rural school children, as assessed by levels of N-acetyl-muramic acid in mattress dust, and its association with respiratory health. J Allergy Clin Immunol 2004, 113:860–867.CrossRefPubMed van Strien RT, Engel R, Holst O, et al.: Microbial exposure of rural school children, as assessed by levels of N-acetyl-muramic acid in mattress dust, and its association with respiratory health. J Allergy Clin Immunol 2004, 113:860–867.CrossRefPubMed
34.
go back to reference Stein RT: Long-term airway morbidity following viral LRTI in early infancy: recurrent wheezing or asthma? Paediatr Respir Rev 2009, 10(Suppl 1):29–31.CrossRefPubMed Stein RT: Long-term airway morbidity following viral LRTI in early infancy: recurrent wheezing or asthma? Paediatr Respir Rev 2009, 10(Suppl 1):29–31.CrossRefPubMed
35.
go back to reference • Kelly JT, Busse WW: Host immune responses to rhinovirus: mechanisms in asthma. J Allergy Clin Immunol 2008, 122:671–682; quiz 683–684. This review describes how rhinovirus has emerged as the most frequent pathogen associated with exacerbations and other aspects of asthma and discusses how the epithelial airway antiviral response to rhinovirus may be defective in asthma. CrossRefPubMed • Kelly JT, Busse WW: Host immune responses to rhinovirus: mechanisms in asthma. J Allergy Clin Immunol 2008, 122:671–682; quiz 683–684. This review describes how rhinovirus has emerged as the most frequent pathogen associated with exacerbations and other aspects of asthma and discusses how the epithelial airway antiviral response to rhinovirus may be defective in asthma. CrossRefPubMed
36.
go back to reference Stein RT, Sherrill D, Morgan WJ, et al.: Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999, 354:541–545.CrossRefPubMed Stein RT, Sherrill D, Morgan WJ, et al.: Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999, 354:541–545.CrossRefPubMed
37.
go back to reference Papadopoulos NG, Papi A, Psarras S, Johnston SL: Mechanisms of rhinovirus-induced asthma. Paediatr Respir Rev 2004, 5:255–260.CrossRefPubMed Papadopoulos NG, Papi A, Psarras S, Johnston SL: Mechanisms of rhinovirus-induced asthma. Paediatr Respir Rev 2004, 5:255–260.CrossRefPubMed
38.
go back to reference Jartti T, Lehtinen P, Vuorinen T, et al.: Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis 2004, 10:1095–1101.PubMed Jartti T, Lehtinen P, Vuorinen T, et al.: Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis 2004, 10:1095–1101.PubMed
39.
go back to reference Heymann PW, Platts-Mills TA, Johnston SL: Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatr Infect Dis J 2005, 24:S217–S222.CrossRefPubMed Heymann PW, Platts-Mills TA, Johnston SL: Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatr Infect Dis J 2005, 24:S217–S222.CrossRefPubMed
40.
go back to reference Mallia P, Johnston SL: How viral infections cause exacerbation of airway diseases. Chest 2006, 130:1203–1210.CrossRefPubMed Mallia P, Johnston SL: How viral infections cause exacerbation of airway diseases. Chest 2006, 130:1203–1210.CrossRefPubMed
41.
go back to reference Murray CS, Poletti G, Kebadze T, et al.: Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax 2006, 61:376–382.CrossRefPubMed Murray CS, Poletti G, Kebadze T, et al.: Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax 2006, 61:376–382.CrossRefPubMed
42.
go back to reference Alfven T, Braun-Fahrlander C, Brunekreef B, et al.: Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle—the PARSIFAL study. Allergy 2006, 61:414–421.CrossRefPubMed Alfven T, Braun-Fahrlander C, Brunekreef B, et al.: Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle—the PARSIFAL study. Allergy 2006, 61:414–421.CrossRefPubMed
43.
go back to reference Kusel MM, de Klerk NH, Kebadze T, et al.: Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol 2007, 119:1105–1110.CrossRefPubMed Kusel MM, de Klerk NH, Kebadze T, et al.: Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol 2007, 119:1105–1110.CrossRefPubMed
44.
go back to reference Bisgaard H, Hermansen MN, Buchvald F, et al.: Childhood asthma after bacterial colonization of the airway in neonates. N Engl J Med 2007, 357:1487–1495.CrossRefPubMed Bisgaard H, Hermansen MN, Buchvald F, et al.: Childhood asthma after bacterial colonization of the airway in neonates. N Engl J Med 2007, 357:1487–1495.CrossRefPubMed
45.
go back to reference •• Mattila PS, Hammaren-Malmi S, Pelkonen AS, et al.: Effect of adenoidectomy on respiratory function: a randomised prospective study. Arch Dis Child 2009, 94:366–370. This is the first randomized study of the effect of adenoidectomy on respiratory function, airway inflammation, and the development of allergy. CrossRefPubMed •• Mattila PS, Hammaren-Malmi S, Pelkonen AS, et al.: Effect of adenoidectomy on respiratory function: a randomised prospective study. Arch Dis Child 2009, 94:366–370. This is the first randomized study of the effect of adenoidectomy on respiratory function, airway inflammation, and the development of allergy. CrossRefPubMed
46.
go back to reference Godfrey S, Springer C, Noviski N, et al.: Exercise but not methacholine differentiates asthma from chronic lung disease in children. Thorax 1991, 46:488–492.CrossRefPubMed Godfrey S, Springer C, Noviski N, et al.: Exercise but not methacholine differentiates asthma from chronic lung disease in children. Thorax 1991, 46:488–492.CrossRefPubMed
47.
go back to reference Malmberg LP, Mäkelä MJ, Mattila PS, et al.: Exercise-induced changes in respiratory impedance in young wheezy children and nonatopic controls. Pediatr Pulmonol 2008, 43:538–544.CrossRefPubMed Malmberg LP, Mäkelä MJ, Mattila PS, et al.: Exercise-induced changes in respiratory impedance in young wheezy children and nonatopic controls. Pediatr Pulmonol 2008, 43:538–544.CrossRefPubMed
48.
go back to reference Payne DN, Adcock IM, Wilson NM, et al.: Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med 2001, 164:1376–1381.PubMed Payne DN, Adcock IM, Wilson NM, et al.: Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med 2001, 164:1376–1381.PubMed
49.
go back to reference Malmberg LP, Pelkonen AS, Haahtela T, Turpeinen M: Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma. Thorax 2003, 58:494–499.CrossRefPubMed Malmberg LP, Pelkonen AS, Haahtela T, Turpeinen M: Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma. Thorax 2003, 58:494–499.CrossRefPubMed
50.
go back to reference Saito H, Asakura K, Hata M, et al.: Does adenotonsillectomy affect the course of bronchial asthma and nasal allergy? Acta Otolaryngol Suppl 1996, 523:212–215.PubMed Saito H, Asakura K, Hata M, et al.: Does adenotonsillectomy affect the course of bronchial asthma and nasal allergy? Acta Otolaryngol Suppl 1996, 523:212–215.PubMed
Metadata
Title
Role of Adenoidectomy in Otitis Media and Respiratory Function
Author
Petri S. Mattila
Publication date
01-11-2010
Publisher
Current Science Inc.
Published in
Current Allergy and Asthma Reports / Issue 6/2010
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-010-0138-7

Other articles of this Issue 6/2010

Current Allergy and Asthma Reports 6/2010 Go to the issue