Adenoid enlargement is a challenge that many young children experience. Tonsil enlargement often occurs at the same time. However, adenoid swelling is sometimes dismissed by the medical provider saying, “It’s not a big deal; your child will just grow out of it." Sometimes the opposite occurs, and the sufferer is rushed off to surgery because “adenoids are not really needed, they’re in the way, and it’s affecting sleep." It is almost like a rite of passage for children to go through an adenoidectomy, or it’s the excuse of adults who snore or struggle with obstructive sleep problems. It is time to rethink the role of adenoids and researchers are doing that. Adenoid enlargement is linked with food allergies.

What are Adenoids?

The adenoids are lymph tissue that sit in your upper airway between your nose and back of your throat behind the tonsils. Together with your tonsils, the adenoids are immunological organs that make up a ring in the back of the throat called Waldeyer’s ring. The basic function of this ring is to produce antibodies to elements in the air and protect against germs that you swallow or breathe in. The size of these tissues often increases in children through about age six as the immune system develops and matures then slowly atrophies by age sixteen. Adults may on occasion experience adenoid hypertrophy, albeit more rare. For children and adults, chronic allergies and infections are the most common cause for adenoid enlargement. Environmental toxins like smoking and poor air quality often increase the risk for occurrence. In adults, there may be other causes for the adenoid enlargement, so it is important for proper diagnoses if there are concerns with snoring, breathing, or trouble with sleep apnea.

Adenoids and Inflammation

Adenoid enlargement often results in sleep disordered breathing, snoring, or obstructive sleep apnea. Difficulties with chewing, swallowing, articulation, and voice can also occur. This can be especially problematic in the toddler or preschooler with speech development. Immune inflammatory markers such as C-Reactive Protein, Interleukin-6 and TNF-alpha have been shown to be elevated with inflamed adenoids and tonsils. These same inflammatory markers are associated with increased risk of cardiovascular disease and obesity. Simultaneously, the disrupted sleep patterns from the airway obstruction provoke more immune inflammatory chemicals. This can become a slippery slope. The enlarged lymph tissue itself is inflammatory, the disrupted sleep is inflammatory, and the lack of adequate oxygen from obstructive sleep apnea also causes further oxidative stress in the body.

It can be frightening to hear and see the difficulties that your preschooler is experiencing. It can be just as disturbing for you to see this in your spouse. It is easy to start the process of removing adenoids and tonsils if they are swollen and interfering with sleep and speech. It seems like a good, quick fix to the problem. Surgery can immediately improve the obstructive breathing, but what about addressing the underlying issue that caused the tissue to enlarge in the first place?

I am always in favor of keeping as many body parts as possible and improving the terrain and health of the body. It was just a few years ago that medicine finally realized that the appendix has a powerful purpose for the gut microbiome and that it was not just a scrap appendage hanging around. We now know that childhood removal of the appendix increases the risk of early heart attack. Just like the appendix, the adenoids and surrounding tonsils have a purpose. They are the first lines of defense for what enters our mouth and nose. Removing the adenoids is like having the check engine warning light lit up on the dash board and removing the light simply because it is lit up. The light is gone with the removal, but the engine problem is still there. In this case, the immune system is reacting to something because it is a problem. I doubt you would want a car mechanic to fail to look at the engine to see what is wrong when the check engine light is on.

Adenoids and Allergy

In a recent study, the allergy marker IgE levels were measured both in tonsil/adenoid tissue and the blood in a group of children. Researchers found that 50% of the children had positive allergic responses or elevated IgE in the Waldeyer’s tissue ring. However, when testing for IgE in the blood, many of the children had no positive lab markers. The responses were inconsistent between the two tissues, but it identified that the allergic response was happening locally in the immediate tissue and was contained to that area. The IgE markers did not infiltrate further into the blood stream. IgE (Type I) reactions are an immediate immune reaction, happening within seconds to a few hours after exposure to the allergen. The primary chemical triggered from the immune system is histamine.

An eye opening study last year demonstrated the presence of specific IgG food antibodies or “allergic inflammation” in children with adenoid enlargement. IgG (Type III) is a “delayed” reaction. It can take anywhere from three hours to five days or longer for the body to form immune complexes or cytokines triggering “allergic inflammation." This is not the same as a histamine response or IgE immediate allergy. They found over half of the children had IgG food allergens that caused the adenoid enlargement. Researchers formed the conclusion that the role of the tonsils, adenoids, and allergic responses should be reconsidered and that adenoids have an immunological role. How long will it take medicine to stop removing body parts we don’t understand?

Having a family history of allergies is an early predictor that the child may have significant problems with adenoid hypertrophy. It is also common to have multiple family members with their tonsils and adenoids removed.

Once adenoids and tonsils are enlarged due to either IgE or IgG immune reactions, secondary infections are more apt to develop. Swollen tissues have more pockets or hiding spaces for germs, which allow for easy secondary infections to occur. Identifying and removing the allergies is the key to preventing the enlargement and the consequential infection to develop. If the symptoms or underlying causes are not resolved, the symptoms can progress and lead to otitis media or ear infections.

Adenoids and Germs

There are many different types of germs found with adenoid engorgement. Some of the identified germs causing adenoid swelling include H. pylori, Epstein Barr Virus, other enteroviruses and bacteria with biofilms. Many of the viruses can persist hidden for months in the adenoid-tonsilar tissue without major symptoms.

Management

Understanding that adenoid and tonsil enlargement is linked with food allergies should be a wake up call and make headline news. Identifying and removing the IgE and IgG food intolerances is the minimum that one wants to do to relieve the fire. Taking the tissues out doesn’t remove the cause. The allergic immune pathology still continues and may manifest elsewhere in the body with eczema, migraines, irritable bowel syndrome, ADHD, asthma, canker sores, gallbladder problems and more.

If one does experience a secondary infection with H. pylori, Epstein Barr Virus, or other germs, there are many nutrients that can help to fortify the immune system to help with the battle. The key is being proactive. Identify and remove the allergens. Children or adults who struggle with fussy taste buds or don’t get enough antioxidants through richly colored fruits and veggies will have to be more proactive in immune support and may need to use supplements to get back on track. Getting the child off to a healthy start with breastfeeding is fundamental. Swollen adenoids and tonsils shouldn’t cause automatic surgical removal. They are there for a reason.