GALTectomy increases the risk of allergic rhinitis: A nationwide population-based cohort study

To the Editor:
The prevalence of allergic diseases has increased worldwide. Both genetic and environmental factors, including dysbiosis, contribute to the pathogenesis of allergic diseases.1 Tonsils and the appendix are crucial gut-associated lymphoid tissues (GALTs) in the mucosa-associated immune system. Appendectomy and tonsillectomy are often performed to treat recurrent or acute infection in childhood or adolescence. These surgeries may alter immune function and microbiota, thereby altering the risks of certain diseases.2 The altered immune function and dysbiosis after appendectomy or tonsillectomy may also alter the risk of allergic diseases. The results of studies on this topic have been inconsistent.3-6 Thus, we conducted this retrospective nationwide cohort study to investigate the risk of three allergic diseases (atopic dermatitis, allergic rhinitis [AR], and asthma) following GALTectomy.

We analyzed the data in the Taiwan National Health Insurance Research Database recorded between 2006 and 2015 (Figure S1). The selected patients had no allergic diseases prior to enrollment; 276 patients received dual appendectomy–tonsillectomy (Group 1), 175,353 patients received appendectomy (Group 2), 20,624 patients received tonsillectomy (Group 3), and 20,930,884 patients received no related surgery (Group 4), as displayed in Table 1. These patients were tracked until the development of an allergic disease or the end of their follow-up.