{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:37:31Z","timestamp":1787027851960,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Evidence linking adenoid hypertrophy (AH) and atopy is conflicting. We examined whether Cassano-graded AH severity is more closely associated with inflammatory markers than with IgE-mediated sensitization. Methods: We retrospectively included children aged 3\u201312 years diagnosed with AH between December 2022 and December 2025. AH was graded according to the Cassano classification and dichotomized as advanced AH (Stage III\u2013IV). Atopic features were evaluated separately as clinical atopy, IgE-mediated sensitization, elevated total IgE, and eosinophilia. Multivariable logistic regression analyses were performed to assess factors associated with clinical atopy, sensitization, and advanced AH. Results: Among 426 children, clinical atopy was present in 28.2%, sensitization in 23.0%, elevated total IgE in 16.4%, and eosinophilia in 27.7%; 39.2% had advanced AH. In multivariable analysis, clinical atopy was independently associated with family history of atopy (aOR 13.9; 95% CI 7.9\u201324.4), elevated total IgE (aOR 3.86; 95% CI 2.10\u20137.08), and passive smoking exposure (aOR 1.73; 95% CI 1.07\u20132.79). Sensitization was independently associated only with family history of atopy (aOR 4.99; 95% CI 1.99\u201312.53). Advanced AH was independently associated only with eosinophilia (aOR 2.07; 95% CI 1.30\u20133.29). Conclusions: AH severity was associated with eosinophilia rather than classical IgE-mediated sensitization. Assessment of eosinophilia may aid routine severity evaluation in children with AH.<\/jats:p>","DOI":"10.3390\/children13030374","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:05:44Z","timestamp":1772795144000},"page":"374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Atopic Features and Inflammatory Markers Across Cassano-Graded Adenoid Hypertrophy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2980-5537","authenticated-orcid":false,"given":"Fatih","family":"Kaplan","sequence":"first","affiliation":[{"name":"Department of Pediatric Allergy and Immunology, Malatya Training and Research Hospital, 44000 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilge","family":"Kurnaz Kaplan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Malatya Training and Research Hospital, 44000 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-9115","authenticated-orcid":false,"given":"Abdulgani","family":"G\u00fcly\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Malatya Turgut \u00d6zal University, 44210 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0030-6665(20)31638-8","article-title":"Embryogenesis and anatomy of Waldeyer\u2019s ring","volume":"20","author":"Goeringer","year":"1987","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1542\/peds.113.2.351","article-title":"Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization","volume":"113","author":"Tarasiuk","year":"2004","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3030","DOI":"10.1128\/JCM.00870-14","article-title":"Hypertrophic adenoid is a major infection site of human bocavirus 1","volume":"52","author":"Paula","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1177\/000348940111000908","article-title":"Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis","volume":"110","author":"Brook","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jaci.2017.03.050","article-title":"Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines\u20142016 revision","volume":"140","author":"Bousquet","year":"2017","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1038\/nature07204","article-title":"The development of allergic inflammation","volume":"454","author":"Galli","year":"2008","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20140294","DOI":"10.1098\/rstb.2014.0294","article-title":"The role of the local microbial ecosystem in respiratory health and disease","volume":"370","author":"Sanders","year":"2015","journal-title":"Philos. Trans. R. Soc. Lond. B Biol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.ijporl.2015.02.017","article-title":"Adenoid hypertrophy in children with allergic disease and influential factors","volume":"79","author":"Evcimik","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bogaert, D., Keijser, B., Huse, S., Rossen, J., Veenhoven, R., van Gils, E., Bruin, J., Montijn, R., Bonten, M., and Sanders, E. (2011). Variability and diversity of nasopharyngeal microbiota in children: A metagenomic analysis. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0017035"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.smrv.2017.06.001","article-title":"Prevalence of adenoid hypertrophy: A systematic review and meta-analysis","volume":"38","author":"Pereira","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.ijporl.2003.07.018","article-title":"Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: A new approach to therapeutic management","volume":"67","author":"Cassano","year":"2003","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_12","unstructured":"Global Initiative for Asthma (GINA) (2026, February 24). Global Strategy for Asthma Management and Prevention. 2024 Update. Available online: https:\/\/ginasthma.org."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2340\/00015555924447","article-title":"Diagnostic features of atopic dermatitis","volume":"92","author":"Hanifin","year":"1980","journal-title":"Acta Derm. Venereol. Suppl."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"(1993). Severity scoring of atopic dermatitis: The SCORAD index. Dermatology, 186, 23\u201331.","DOI":"10.1159\/000247298"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.ijporl.2006.12.018","article-title":"An analysis of the incidence of adenoid hypertrophy in allergic children","volume":"71","author":"Modrzynski","year":"2007","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00405-016-4196-x","article-title":"Does adenoid hypertrophy affect disease severity in children with allergic rhinitis?","volume":"274","author":"Dogru","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S1081-1206(10)62251-X","article-title":"The risk of adenoid hypertrophy in children with allergic rhinitis","volume":"87","author":"Huang","year":"2001","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1067\/mai.2001.118891","article-title":"Allergic rhinitis and its impact on asthma","volume":"108","author":"Bousquet","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1067\/mai.2001.115569","article-title":"Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis","volume":"108","author":"Skoner","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.otohns.2006.05.003","article-title":"Validation of a new grading system for adenoid hypertrophy","volume":"135","author":"Parikh","year":"2006","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_21","first-page":"S359","article-title":"Eosinophilic inflammation in allergic disease","volume":"101","author":"Rothenberg","year":"1998","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jaci.2010.03.042","article-title":"Refining the definition of hypereosinophilic syndrome","volume":"126","author":"Simon","year":"2010","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.ijporl.2011.01.026","article-title":"Is there any correlation between allergy and adenotonsillar tissue hypertrophy?","volume":"75","author":"Ghaharri","year":"2011","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_24","first-page":"1620","article-title":"Simultaneous respiratory viral infection and bacterial colonization in adenoid tissue","volume":"79","author":"Kaur","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/374\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:48:52Z","timestamp":1772797732000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030374"],"URL":"https:\/\/doi.org\/10.3390\/children13030374","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]}}}