Effect of delivery type on allergic rhinitis and adenotonsillar hypertrophy in children

Abstract

Background and Objectives: The development of the early microbiome is important for immune maturation and delivery mode is a major determinant of the respiratory microbial composition in infants. Cesarean section (CS) has been associated with alteration of upper respiratory microbiome, but controversial findings have also been reported. We aimed to assess whether the mode of delivery is associated with allergic rhinitis and adenotonsillar hypertrophy. Subjects and Methods: Total of 176 patients diagnosed with adenotonsillar hypertrophy were enrolled from August 2012 to February 2020. Gestational age, birth weight, and mode of delivery were checked. Tonsillar hypertrophy was assessed by tonsil grade (0-4) and PNS X-ray was used for adenoid-nasopharynx ratio (ANR) and rhinosinusitis. All patients underwent assays for serum total IgE, blood eosinophil, eosinophil cationic protein, and allergic tests of skin prick, MAST, or Immunocap. Questionnaires were used to assess clinical symptoms of allergic rhinitis (ARIA severity, total nasal symptom score: TNSS, and quality of life) and obstructive sleep apnea (OSA-6). Results: Seventy two (40.9%) children were born through CS. There was no difference of allergic lab results between CS and vaginal delivery (VD) group. However, allergic rhinitis was more prevalent in CS group than vaginal delivery group (63.9% vs. 49.0%, respectively, p=0.051). Moreover, CS group showed increased ARIA severity (p=0.039) and TNSS (p=0.003) compared to VD group. Nasal congestion scores were higher in CS group compared to VD group (OR=2.44, p=0.046). However, mode of delivery had no effect on adenotonsillar hypertrophy (tonsil grade: p=0.263, ANR: p=0.445), OSA-6 (p=0.057), and rhinosinusitis (p=0.727). Conclusion: Mode of delivery may be associated with allergic rhinitis but there was lack of effect on adenotonsillar hypertrophy and rhinosinusitis in children.