ASSOCIATION OF OTITIS-MEDIA WITH EFFUSION AND ALLERGY AS DEMONSTRATEDBY INTRADERMAL SKIN TESTING AND EOSINOPHIL CATIONIC PROTEIN-LEVELS INBOTH MIDDLE-EAR EFFUSIONS AND MUCOSAL BIOPSIES

This study was performed to ascertain the role of allergy, as defined by skin testing and histochemical markers, in the pathogenesis of otit is media with effusion (OME). A historical perspective of allergy as i t relates to OME is presented. The study included 89 patients: 48 with persistent effusion but no recent acute infection, 25 with purulent O ME complicated by a superimposed infection, and 16 control subjects. A ll 89 patients had persistent effusion for more than 2 months and subs equently required the placement of tympanostomy tubes. Allergy was def ined using the radioallergosorbent test (RAST), serum immunoglobulin E (IgE) levels, and skin tests. Allergies were present in 97% of the pa tients with nonacute OME. The relationship between allergy and OME was corroborated clinically in 89% of patients and was also substantiated by elevated levels of effusion eosinophil cationic protein (ECP) in 8 7.5% of OME patients. Hstologically, polyclonal antibody staining for ECP demonstrated the presence of eosinophils in middle ear mucosal bio psy specimens. This study confirms that OME is a sign of allergic infl ammation in the middle ear that is associated with an increase in eosi nophils and a concomitant release of ECP into the effusion in individu als with allergy demonstrated by skin testing.