THE AETIOLOGY OF ACUTE APPENDICITIS. IS ALLERGY THE MISSING LINK? A NARRATIVE REVIEW
DOI:
https://doi.org/10.34635/rpc.893Keywords:
appendicitis, allergy, aetiology, hypersensitivity type 1 reaction, immune reaction, immune responseAbstract
Acute appendicitis is the most common abdominal surgical emergency. Since the work of Fitz in the XIX century it has been assumed that luminal obstruction is the main pathological event. However, this theory has been recently challenged by some new insights that suggest that an allergic reaction can be one of the possible causes or co-factors. The current knowledge on the aetiology of acute appendicitis was reviewed in this article, with a special emphasis on allergic features.
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References
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2. Petroianu A, Villar Barroso TV. Pathophysiology of Acute Appendicitis. JSM Gastroenterol Hepatol. 2016;4(3):4-7.
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5. Ergul E. Heredity and familial tendency of acute appendicitis. Scand J Surg. 2007;96(4):290-292. doi:10.1177/145749690709600405
6. Carr NJ, Weldon F. The pathology of Acute Appendicitis. Annals Diagnostic Pathology. 2000; 4:46-58.
7. Engin O, Yildirim M, Yakan S, Coskun GA. Can fruit seeds and undigested plant residuals cause acute appendicitis. Asian Pac J Trop Biomed. 2011;1(2):99-101. doi:10.1016/S2221-1691(11)60004-X
8. Walker ARP, Segal I. Appendicitis: An African perspective. J R Soc Med. 1995;88(11):616-619. doi:10.1177/014107689508801104
9. Jackson HT, Mongodin EF, Davenport KP, Fraser CM, Sandler AD, Zeichner SL. Culture-independent evaluation of the appendix and rectum microbiomes in children with and without appendicitis. PLoS One. 2014;9(4). doi:10.1371/journal.pone.0095414
10. Tsuji M, McMahon G, Reen DJ, Puri P. New insights into the pathogenesis of appendicitis based on immunocytochemical analysis of early immune response. J Pediatr Surg. 1990;25(4):449-452. doi:10.1016/0022-3468(90)90392-M
11. Aravindan KP. Eosinophils in acute appendicitis: possible significance. Ind J Pathol Microbiol 40. 1997:491-498.
12. Carvalho N, Barros A, Coelho HO, Moita CF, Neves-Costa A, Pedroso D et al. A Th2 Cytokine Profile in Appendicular Lavage Fluid Suggests Allergy as a Possible Etiology for Acute Appendicitis. Mediators Inflamm. 2019;2019:7-11. doi:10.1155/2019/8146257
13. Schülin S, Schlichting N, Blod C, Opitz S, Suttkus A, Stingu CS et al. A comparative study. Medicine (2017) 96:52:e9518. doi: 10.1097/MD.0000000000009518
14. Oh SJ, Pimentel M, Leite G, Celly S, Villanueva-Millan M, Lacsina I, et al. Acute appendicitis is associated with appendiceal microbiome changes including elevated Campylobacter jejuni levels. BMJ Open Gastro 2020;7:e000412. doi:10.1136/bmjgast-2020-000412
15. Rogers MB, Brower-Sinning R, Firek B, Zhong D, Morowitz MJ. Acute appendicitis in children is associated with a local expansion of fusobacteria. Clin Infect Dis. 2016;63(1):71-78. doi:10.1093/cid/ciw208
16. Lamps LW. Infectious Causes of Appendicitis. Infect Dis Clin North Am. 2010;24(4):995-1018. doi:10.1016/j.idc.2010.07.012
17. Peeters T, Penders J, Smeekens SP, Galazzo G, Houben B, Netea MG et al. The fecal and mucosal microbiome in acute appendicitis patients: An observational study. Future Microbiol. 2019;14(2):111-127. doi:10.2217/fmb-2018-0203
18. Dimberg J, Rubér MS. Genetic polymorphism patterns suggest a genetic driven inflammatory response as pathogenesis in appendicitis. Int J Colorectal Dis, 35, pages277–284(2020)
https://doi.org/10.1007/s00384-019-03473-1
19. Wagner M, Tubre DJ, Asensio J. Evolution and Current Trends in the Management of Acute Appendicitis. Surg Clin N Am 98 (2018) 1005 – 1023 https://doi.org/10.1016/j.suc.2018.05.006 surgical.theclinics.com 0039-6109/18/ª 2018
20. Guinane CM, Tadrous A, Fouhy F, Ryan A, Dempsey E, Murphy B et al. Microbial composition of human appendices from patients following appendectomy. 2013mBio 4(1):e00366-12. doi:10.1128/mBio.00366-12.
21. Salö M, Marungruang N, Roth B, Sundberg T, Stenström P, Arnbjörnsson E et al. Evaluation of the microbiome in children’s appendicitis Int J Colorectal Dis (2017) 32:19–28 doi 10.1007/s00384-016-2639-x
22. Vanhatalo S, Munukka E, Sippola S, Jalkanen S, Grönroos J, Marttila H et al. The APPAC collaborative study group. Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial. BMJ Open 2019;9:e031137. doi:10.1136/bmjopen-2019-031137
23. Barker DJP, Osmond C, Golding J, Wadsworth MEJ. Acute appendicitis and bathrooms in three samples of British children. Br Med J (Clin Res Ed). 1988;296(6627):956-958. doi:10.1136/bmj.296.6627.956
24. Li HM, Liu SZ, Huang YK, Su YC, Kao CH. Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study. Int. J. Environ. Res. Public Health 2018, 15, 1601; doi:10.3390/ijerph15081601
25. Girard-Madoux MJH, Gomez de Agüero M, Ganal-Vonarburg SC, Mooser C, Belz GT, Macpherson AJ, Vivier E. The immunological functions of the Appendix: An example of redundancy? Semin Immunol. 2018 Apr;36:31-44. doi: 10.1016/j.smim.2018.02.005. Epub 2018 Mar 2.
26. Jones AB, Demetriades D, Segal DB. The Prevalence of Appendiceal Fecaliths in Patients with and without Appendicitis. A comparative study from Canada and South Africa Ann Surg. 1985 Vol. 202:80-82.
27. Nelson M, Morris J, Barker DJP, Simmonds S. A case-control study of acute appendicitis and diet in children. Journal of Epidemiology and Community Health, 1986, 41, 316-318
28. Arnbjörnsson E. Acute appendicitis and dietary fiber. Arch Surg. 1983
Jul;118(7):868-70. doi: 10.1001/archsurg.1983.01390070076015. PMID: 6305309.
29. Damanik B, Fikri E, Pahlevi I, Nasution P. Relation between fiber diet and
appendicitis incidence in children at H. Adam Malik central hospital Medan North Sumatra-Indonesia. Bali Medical Journal (Bali Med J) 2016, Volume 5, Number 2: 268-271
30. Rivera-Chavez FA, Peters-Hybki DL, Barber RC, et al. Innate immunity genes influence the severity of acute appendicitis. Ann Surg. 2004;240(2):269-277. doi:10.1097/01.sla.0000133184.10676.26
31. CG Murphy, JN Glickman KT, Tomczak K, Wang YY, Shannon MW, Horwitz BH et al. AA is characterized by a uniform and highly selective pattern of inflammatory gene expression. Mucosal Immunol. 2008; Vol 1 N4:297-308.
32. Kim SY, Min C, Oh DJ, Choi HG. Increased risk of appendectomy due to appendicitis after tonsillectomy in women: A longitudinal follow-up study using a national sample cohort. Medicine (Baltimore). 2019;98(19):e15579. doi:10.1097/MD.0000000000015579
33. Hennington MH, Tinsley EA Jr, Proctor HJ, Baker CC. Acute appendicitis following blunt abdominal trauma. Incidence or coincidence? Ann Surg.: 1990; 214(1): 61–63. doi: 10.1097/00000658-199107000-000.
34. Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526. 10.1001/archsurg.1937.01190090121006
35. Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. doi:10.1136/bmj.j1703
36. Katz E, Hana R, Jurim O, Pisuv G, Gutman A, Durst AL. Experimental model of acute appendicitis in the rabbit with determination of leucine amino peptidase (LAP) and acid phosphatase (Acid-P) activities in portal blood samples. J Surg Res. 1990;48(3):230-236. doi:10.1016/0022-4804(90)90218-Q
37. Sellars H, Boorman P. Acute appendicitis. Surg (United Kingdom). 2017;35(8):432-438. doi:10.1016/j.mpsur.2017.06.002
38. Kim SY, Oh DJ, Park B, Park I-S, Choi HG. Increased risk of appendectomy in patients with asthma. Medicine (Baltimore). 2019;98(38):e17203. doi:10.1097/md.0000000000017203
39. Tsuji M, Puri P, Reen DJ. Caracterization of the local inflammatory response in appendicitis J Ped Gastr Nutr1993; 16 (1):43-8
40. Baggot MG. Aseptic appendicitis, exemplifying the Universal Disorder, namely muscular and endocameral hypertension, which initiates various secondary diseases including infections. Med Hypotheses. 1999;53(5):429-431. doi:10.1054/mehy.1998.0789
41. Berin MC, Sampson HA. Mucosal immunology of food allergy. Curr Biol. 2013;23(9):R389-R400. doi:10.1016/j.cub.2013.02.043
42. Harlak A, Gulec M, Mentes O, Kilbas Z, Onguru O, Acikel C et al. Atopy is a risk factor for acute appendicitis? A prospective clinical study. J Gastrointest Surg. 2008;12(7):1251-1256. doi:10.1007/s11605-008-0511-1
43. Cevizci MN, Sogut A, Cayir A, Demir M, Ozman SA, Erdoğan F. The Place of Atopy in the Aetiology of Acute Appendicitis in Children. West Indian Med J 2016; 65 (2): 287
44. O’Brien RM. Skin prick testing and in vitro assays for allergic sensitivity. Aust Prescr. 2002;25(4):91-93. doi:10.18773/austprescr.2002.077
45. Selye H. Acute Phlemognous appendicitis produced by intravenous administration of histamine. Lancet. 1929:1210-1211.
46. Shakib F, Ghaemmaghami AM, Sewell HF. The molecular basis of allergenicity. Trends Immunol. 2008;29(12):633-642. doi:10.1016/j.it.2008.08.007
47. Renauld JC. New insights into the role of cytokines in asthma. J Clin Pathol. 2001;54(8):577-589. doi:10.1136/jcp.54.8.577
48. M. Yazdanbakhsh, Biggelaar A, Maizels R. “Th2 responses without atopy:
immunoregulation in chronic helminth infections and reduced allergic disease,” Trends in Immunology, 2001 vol. 22, no. 7, pp. 372–377.
49. Ohashi Y, Nakai Y, Kuroki K, Nakata J, Maruoka K, Ikeoka H et al. Topical immunology of nasal allergy and mucosal IgE antibodies. Arch Otorhinolaryngol. 1985;241(2):169-174. doi:10.1007/BF00454351
50. Kleinjan A, Vinke JG, Severijnen LWFM, Fokkens WJ. Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients. Eur Respir J. 2000;15(3):491-497. doi:10.1034/j.1399-3003.2000.15.11.x
51. Das DN, Thomas DS, Aravindan DK. Morphology and Serum IgE Levels in Recurrent Acute Appendicitis. Int J Adv Res. 2016;4(10):855-859. doi:10.21474/ijar01/1869
52. Salö M, Gudjonsdottir J, Omling E, Hagander L, Stenström P. Association of IgE-Mediated Allergy with Risk of Complicated Appendicitis in a Pediatric Population. JAMA Pediatr. 2018;172(10):943-948. doi:10.1001/jamapediatrics.2018.1634
53. Hamilton RG. Clinical laboratory assessment of immediate-type hypersensitivity. J Allergy Clin Immunol. 2010;125(2 SUPPL. 2):S284-S296. doi:10.1016/j.jaci.2009.09.055
54. Bernstein L. S., Surick B., Leitman I. M. Is acute appendicitis in the weather forecast? The Journal of Surgical Research. 2013;185(1):e23–e25. doi: 10.1016/j.jss.2012.08.022.
55. Rubér M, Andersson M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery. 2010;147(3):366–372. doi: 10.1016/j.surg.2009.09.039.
56. Rubér M, Berg A, Ekerfelt C, Olaison G, Andersson RE. Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis. Clinical and Experimental Immunology. 2006;143(1):117–124. doi: 10.1111/j.1365-2249.2005.02957.x
57. Levin MD. Pathogenesis of acute appendicitis: review. Gastroenterol Hepatol Open Access. 2019;10(6):279‒285. doi: 10.15406/ghoa.2019.10.00396
58. Barnes PJ. Pathophysiology of asthma Eur Respir Mon, 2003, 23, 84–113.
59. Rogers MB, Brower-Sinning R, Firek B, Zhong D, Morowitz MJ. Acute Appendicitis in Children Is Associated With a Local Expansion of Fusobacteria. Clin Infect Dis. 2016 Jul 1;63(1):71-78. doi: 10.1093/cid/ciw208. Epub 2016 Apr 7. PMID: 27056397.
60. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article.Ital J Pediatr. 2017;43:1-9. doi:10.1186/s13052-017-0335-2
2. Petroianu A, Villar Barroso TV. Pathophysiology of Acute Appendicitis. JSM Gastroenterol Hepatol. 2016;4(3):4-7.
3. Orlova E, · Andrew Yeh MS et al. Genetic association and differential expression of PITX2 with acute appendicitis. Hum Genet. 2019;138:37–47.
4. Walker RPA, Segal I. Editorial: What causes appendicitis? J Clin Gastroenterol. 1990;12(2):127-129. doi:10.1097/00004836-199004000-00002
5. Ergul E. Heredity and familial tendency of acute appendicitis. Scand J Surg. 2007;96(4):290-292. doi:10.1177/145749690709600405
6. Carr NJ, Weldon F. The pathology of Acute Appendicitis. Annals Diagnostic Pathology. 2000; 4:46-58.
7. Engin O, Yildirim M, Yakan S, Coskun GA. Can fruit seeds and undigested plant residuals cause acute appendicitis. Asian Pac J Trop Biomed. 2011;1(2):99-101. doi:10.1016/S2221-1691(11)60004-X
8. Walker ARP, Segal I. Appendicitis: An African perspective. J R Soc Med. 1995;88(11):616-619. doi:10.1177/014107689508801104
9. Jackson HT, Mongodin EF, Davenport KP, Fraser CM, Sandler AD, Zeichner SL. Culture-independent evaluation of the appendix and rectum microbiomes in children with and without appendicitis. PLoS One. 2014;9(4). doi:10.1371/journal.pone.0095414
10. Tsuji M, McMahon G, Reen DJ, Puri P. New insights into the pathogenesis of appendicitis based on immunocytochemical analysis of early immune response. J Pediatr Surg. 1990;25(4):449-452. doi:10.1016/0022-3468(90)90392-M
11. Aravindan KP. Eosinophils in acute appendicitis: possible significance. Ind J Pathol Microbiol 40. 1997:491-498.
12. Carvalho N, Barros A, Coelho HO, Moita CF, Neves-Costa A, Pedroso D et al. A Th2 Cytokine Profile in Appendicular Lavage Fluid Suggests Allergy as a Possible Etiology for Acute Appendicitis. Mediators Inflamm. 2019;2019:7-11. doi:10.1155/2019/8146257
13. Schülin S, Schlichting N, Blod C, Opitz S, Suttkus A, Stingu CS et al. A comparative study. Medicine (2017) 96:52:e9518. doi: 10.1097/MD.0000000000009518
14. Oh SJ, Pimentel M, Leite G, Celly S, Villanueva-Millan M, Lacsina I, et al. Acute appendicitis is associated with appendiceal microbiome changes including elevated Campylobacter jejuni levels. BMJ Open Gastro 2020;7:e000412. doi:10.1136/bmjgast-2020-000412
15. Rogers MB, Brower-Sinning R, Firek B, Zhong D, Morowitz MJ. Acute appendicitis in children is associated with a local expansion of fusobacteria. Clin Infect Dis. 2016;63(1):71-78. doi:10.1093/cid/ciw208
16. Lamps LW. Infectious Causes of Appendicitis. Infect Dis Clin North Am. 2010;24(4):995-1018. doi:10.1016/j.idc.2010.07.012
17. Peeters T, Penders J, Smeekens SP, Galazzo G, Houben B, Netea MG et al. The fecal and mucosal microbiome in acute appendicitis patients: An observational study. Future Microbiol. 2019;14(2):111-127. doi:10.2217/fmb-2018-0203
18. Dimberg J, Rubér MS. Genetic polymorphism patterns suggest a genetic driven inflammatory response as pathogenesis in appendicitis. Int J Colorectal Dis, 35, pages277–284(2020)
https://doi.org/10.1007/s00384-019-03473-1
19. Wagner M, Tubre DJ, Asensio J. Evolution and Current Trends in the Management of Acute Appendicitis. Surg Clin N Am 98 (2018) 1005 – 1023 https://doi.org/10.1016/j.suc.2018.05.006 surgical.theclinics.com 0039-6109/18/ª 2018
20. Guinane CM, Tadrous A, Fouhy F, Ryan A, Dempsey E, Murphy B et al. Microbial composition of human appendices from patients following appendectomy. 2013mBio 4(1):e00366-12. doi:10.1128/mBio.00366-12.
21. Salö M, Marungruang N, Roth B, Sundberg T, Stenström P, Arnbjörnsson E et al. Evaluation of the microbiome in children’s appendicitis Int J Colorectal Dis (2017) 32:19–28 doi 10.1007/s00384-016-2639-x
22. Vanhatalo S, Munukka E, Sippola S, Jalkanen S, Grönroos J, Marttila H et al. The APPAC collaborative study group. Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial. BMJ Open 2019;9:e031137. doi:10.1136/bmjopen-2019-031137
23. Barker DJP, Osmond C, Golding J, Wadsworth MEJ. Acute appendicitis and bathrooms in three samples of British children. Br Med J (Clin Res Ed). 1988;296(6627):956-958. doi:10.1136/bmj.296.6627.956
24. Li HM, Liu SZ, Huang YK, Su YC, Kao CH. Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study. Int. J. Environ. Res. Public Health 2018, 15, 1601; doi:10.3390/ijerph15081601
25. Girard-Madoux MJH, Gomez de Agüero M, Ganal-Vonarburg SC, Mooser C, Belz GT, Macpherson AJ, Vivier E. The immunological functions of the Appendix: An example of redundancy? Semin Immunol. 2018 Apr;36:31-44. doi: 10.1016/j.smim.2018.02.005. Epub 2018 Mar 2.
26. Jones AB, Demetriades D, Segal DB. The Prevalence of Appendiceal Fecaliths in Patients with and without Appendicitis. A comparative study from Canada and South Africa Ann Surg. 1985 Vol. 202:80-82.
27. Nelson M, Morris J, Barker DJP, Simmonds S. A case-control study of acute appendicitis and diet in children. Journal of Epidemiology and Community Health, 1986, 41, 316-318
28. Arnbjörnsson E. Acute appendicitis and dietary fiber. Arch Surg. 1983
Jul;118(7):868-70. doi: 10.1001/archsurg.1983.01390070076015. PMID: 6305309.
29. Damanik B, Fikri E, Pahlevi I, Nasution P. Relation between fiber diet and
appendicitis incidence in children at H. Adam Malik central hospital Medan North Sumatra-Indonesia. Bali Medical Journal (Bali Med J) 2016, Volume 5, Number 2: 268-271
30. Rivera-Chavez FA, Peters-Hybki DL, Barber RC, et al. Innate immunity genes influence the severity of acute appendicitis. Ann Surg. 2004;240(2):269-277. doi:10.1097/01.sla.0000133184.10676.26
31. CG Murphy, JN Glickman KT, Tomczak K, Wang YY, Shannon MW, Horwitz BH et al. AA is characterized by a uniform and highly selective pattern of inflammatory gene expression. Mucosal Immunol. 2008; Vol 1 N4:297-308.
32. Kim SY, Min C, Oh DJ, Choi HG. Increased risk of appendectomy due to appendicitis after tonsillectomy in women: A longitudinal follow-up study using a national sample cohort. Medicine (Baltimore). 2019;98(19):e15579. doi:10.1097/MD.0000000000015579
33. Hennington MH, Tinsley EA Jr, Proctor HJ, Baker CC. Acute appendicitis following blunt abdominal trauma. Incidence or coincidence? Ann Surg.: 1990; 214(1): 61–63. doi: 10.1097/00000658-199107000-000.
34. Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526. 10.1001/archsurg.1937.01190090121006
35. Baird DLH, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357:j1703. doi:10.1136/bmj.j1703
36. Katz E, Hana R, Jurim O, Pisuv G, Gutman A, Durst AL. Experimental model of acute appendicitis in the rabbit with determination of leucine amino peptidase (LAP) and acid phosphatase (Acid-P) activities in portal blood samples. J Surg Res. 1990;48(3):230-236. doi:10.1016/0022-4804(90)90218-Q
37. Sellars H, Boorman P. Acute appendicitis. Surg (United Kingdom). 2017;35(8):432-438. doi:10.1016/j.mpsur.2017.06.002
38. Kim SY, Oh DJ, Park B, Park I-S, Choi HG. Increased risk of appendectomy in patients with asthma. Medicine (Baltimore). 2019;98(38):e17203. doi:10.1097/md.0000000000017203
39. Tsuji M, Puri P, Reen DJ. Caracterization of the local inflammatory response in appendicitis J Ped Gastr Nutr1993; 16 (1):43-8
40. Baggot MG. Aseptic appendicitis, exemplifying the Universal Disorder, namely muscular and endocameral hypertension, which initiates various secondary diseases including infections. Med Hypotheses. 1999;53(5):429-431. doi:10.1054/mehy.1998.0789
41. Berin MC, Sampson HA. Mucosal immunology of food allergy. Curr Biol. 2013;23(9):R389-R400. doi:10.1016/j.cub.2013.02.043
42. Harlak A, Gulec M, Mentes O, Kilbas Z, Onguru O, Acikel C et al. Atopy is a risk factor for acute appendicitis? A prospective clinical study. J Gastrointest Surg. 2008;12(7):1251-1256. doi:10.1007/s11605-008-0511-1
43. Cevizci MN, Sogut A, Cayir A, Demir M, Ozman SA, Erdoğan F. The Place of Atopy in the Aetiology of Acute Appendicitis in Children. West Indian Med J 2016; 65 (2): 287
44. O’Brien RM. Skin prick testing and in vitro assays for allergic sensitivity. Aust Prescr. 2002;25(4):91-93. doi:10.18773/austprescr.2002.077
45. Selye H. Acute Phlemognous appendicitis produced by intravenous administration of histamine. Lancet. 1929:1210-1211.
46. Shakib F, Ghaemmaghami AM, Sewell HF. The molecular basis of allergenicity. Trends Immunol. 2008;29(12):633-642. doi:10.1016/j.it.2008.08.007
47. Renauld JC. New insights into the role of cytokines in asthma. J Clin Pathol. 2001;54(8):577-589. doi:10.1136/jcp.54.8.577
48. M. Yazdanbakhsh, Biggelaar A, Maizels R. “Th2 responses without atopy:
immunoregulation in chronic helminth infections and reduced allergic disease,” Trends in Immunology, 2001 vol. 22, no. 7, pp. 372–377.
49. Ohashi Y, Nakai Y, Kuroki K, Nakata J, Maruoka K, Ikeoka H et al. Topical immunology of nasal allergy and mucosal IgE antibodies. Arch Otorhinolaryngol. 1985;241(2):169-174. doi:10.1007/BF00454351
50. Kleinjan A, Vinke JG, Severijnen LWFM, Fokkens WJ. Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients. Eur Respir J. 2000;15(3):491-497. doi:10.1034/j.1399-3003.2000.15.11.x
51. Das DN, Thomas DS, Aravindan DK. Morphology and Serum IgE Levels in Recurrent Acute Appendicitis. Int J Adv Res. 2016;4(10):855-859. doi:10.21474/ijar01/1869
52. Salö M, Gudjonsdottir J, Omling E, Hagander L, Stenström P. Association of IgE-Mediated Allergy with Risk of Complicated Appendicitis in a Pediatric Population. JAMA Pediatr. 2018;172(10):943-948. doi:10.1001/jamapediatrics.2018.1634
53. Hamilton RG. Clinical laboratory assessment of immediate-type hypersensitivity. J Allergy Clin Immunol. 2010;125(2 SUPPL. 2):S284-S296. doi:10.1016/j.jaci.2009.09.055
54. Bernstein L. S., Surick B., Leitman I. M. Is acute appendicitis in the weather forecast? The Journal of Surgical Research. 2013;185(1):e23–e25. doi: 10.1016/j.jss.2012.08.022.
55. Rubér M, Andersson M, Petersson BF, Olaison G, Andersson RE, Ekerfelt C Systemic Th17-like cytokine pattern in gangrenous appendicitis but not in phlegmonous appendicitis. Surgery. 2010;147(3):366–372. doi: 10.1016/j.surg.2009.09.039.
56. Rubér M, Berg A, Ekerfelt C, Olaison G, Andersson RE. Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis. Clinical and Experimental Immunology. 2006;143(1):117–124. doi: 10.1111/j.1365-2249.2005.02957.x
57. Levin MD. Pathogenesis of acute appendicitis: review. Gastroenterol Hepatol Open Access. 2019;10(6):279‒285. doi: 10.15406/ghoa.2019.10.00396
58. Barnes PJ. Pathophysiology of asthma Eur Respir Mon, 2003, 23, 84–113.
59. Rogers MB, Brower-Sinning R, Firek B, Zhong D, Morowitz MJ. Acute Appendicitis in Children Is Associated With a Local Expansion of Fusobacteria. Clin Infect Dis. 2016 Jul 1;63(1):71-78. doi: 10.1093/cid/ciw208. Epub 2016 Apr 7. PMID: 27056397.
60. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article.Ital J Pediatr. 2017;43:1-9. doi:10.1186/s13052-017-0335-2
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License
Para permitir ao editor a disseminação do trabalho do(s) autor(es) na sua máxima extensão, o(s) autor(es) deverá(ão) assinar uma Declaração de Cedência dos Direitos de Propriedade (Copyright). O acordo de transferência, (Transfer Agreement), transfere a propriedade do artigo do(s) autor(es) para a Sociedade Portuguesa de Cirurgia.
Se o artigo contiver extractos (incluindo ilustrações) de, ou for baseado no todo ou em parte em outros trabalhos com copyright (incluindo, para evitar dúvidas, material de fontes online ou de intranet), o(s) autor(es) tem(êm) de obter, dos proprietários dos respectivos copyrights, autorização escrita para reprodução desses extractos do(s) artigo(s) em todos os territórios e edições e em todos os meios de expressão e línguas. Todas os formulários de autorização devem ser fornecidos aos editores quando da entrega do artigo.
