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Original Investigation
October 2018

Association of IgE-Mediated Allergy With Risk of Complicated Appendicitis in a Pediatric Population

Author Affiliations
  • 1Department of Pediatric Surgery, Children’s Hospital, Skåne University Hospital, Lund, Sweden
  • 2Department of Clinical Sciences, Section of Pediatrics, Lund University, Lund, Sweden
  • 3World Health Organization Collaborating Centre for Surgery and Public Health, Department of Clinical Sciences, Lund University, Lund, Sweden
JAMA Pediatr. 2018;172(10):943-948. doi:10.1001/jamapediatrics.2018.1634
Key Points

Question  Do children with IgE-mediated allergy have a lower risk of complicated appendicitis?

Findings  In this cohort study of 605 children undergoing appendectomy, those with IgE-mediated allergy had a 3 times lower risk of complicated appendicitis compared with those without allergy.

Meaning  These findings present previously unknown risk factors for complicated appendicitis and shed light on pathogenesis and clinical detection of adverse outcomes.

Abstract

Importance  Childhood appendicitis is commonly complicated by gangrene and perforation, yet the causes of complicated appendicitis and how to avoid it remain unknown.

Objective  To investigate whether children with IgE-mediated allergy have a lower risk of complicated appendicitis.

Design, Setting, and Participants  This retrospective cohort study included all consecutive patients younger than 15 years (hereinafter referred to as children) who underwent appendectomy for acute appendicitis at a tertiary pediatric surgery center in Sweden between January 1, 2007, through July 31, 2017. Children were stratified between those with and without IgE-mediated allergies.

Main Outcome and Measures  Risk of complicated appendicitis with gangrene or perforation, with occurrence of IgE-mediated allergy as an independent variable and adjusted for age, sex, primary health care contacts, seasonal antigenic exposure, allergy medications, appendicolith, and duration of symptoms.

Results  Of 605 included children (63.0% boys; median age, 10 years; interquartile range, 7-12 years), 102 (16.9%) had IgE-mediated allergy and 503 (83.1%) had no allergy. Complicated appendicitis occurred in 20 children with IgE-mediated allergy (19.6%) compared with 236 with no allergy (46.9%; adjusted odds ratio, 0.33; 95% CI, 0.18-0.59). No significant allergy effect modification by sex, seasonal antigenic exposure, or allergy medication was found. Children with IgE-mediated allergy had a shorter hospital stay (median, 2 days for both groups; interquartile range, 1-2 days vs 1-5 days; P = .004).

Conclusions and Relevance  In this study, children with IgE-mediated allergy had a lower risk of complicated appendicitis. The findings suggest that immunologic disposition modifies the clinical pattern of appendiceal disease. This theory introduces novel opportunities for understanding of the pathogenesis and clinical decision making for one of childhood’s most common surgical emergencies.

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