Atopic Features and Inflammatory Markers Across Cassano-Graded Adenoid Hypertrophy

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 3–12 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–IV). 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 7.9–24.4), elevated total IgE (aOR 3.86; 95% CI 2.10–7.08), and passive smoking exposure (aOR 1.73; 95% CI 1.07–2.79). Sensitization was independently associated only with family history of atopy (aOR 4.99; 95% CI 1.99–12.53). Advanced AH was independently associated only with eosinophilia (aOR 2.07; 95% CI 1.30–3.29). 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.