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Background and Objectives One of the most common surgical procedures in children isadenoidectomy, but the causes of adenoid hypertrophy are not fully understood. Some studieshave found that allergies can be a risk factor for adenoid hypertrophy, asthma being one of theseallergic diseases. This study aimed to investigate the relationship between adenoid size andasthma in a group of children. Subjects and Method This study reviewed a total of 2063 pediatric patients with or withoutatopy and asthma who visited the Otorhinolaryngology and Pediatric unit at a tertiary medicalcenter from January 2011 to June 2016. We classified these patients into 4 groups according tothe presence of asthma or atopy and randomly selected 100 patients from each group (to a totalof 400 pts): group 1 (asthma-, atopy-); group 2 (asthma-, atopy+); group 3 (asthma+, atopy-)and group 4 (asthma+, atopy+). The presence of allergic sensitization (atopy) was evaluated byCAP test and total IgE. Asthma was diagnosed according to the diagnosis criteria in the Koreanguideline for asthma. Adenoid size was evaluated with the adenoidal-nasopharyngeal ratio(A/N ratio) by the adenoid view. Results The four groups did not differ from each other significantly in age or sex. There wasa negative correlation between adenoid size and atopic and asthmatic condition. Group 1 had asignificantly larger A/N ratio than the other groups (group 1=0.534±0.138; group 2=0.469±0.140; group 3=0.476±0.135; group 4=0.482±0.128, p<0.05). However, group 4 showed nearlyidentical results to groups 2 and 3, despite the combination of asthma and atopy in group 4. Conclusion Large adenoids were negatively associated with atopy and asthma. This findingmay be explained by a decrease in adenoid stimulation by nasal obstruction and a differencein the immune system, including allergic immune reactions. Further studies are needed.