Experience of specific immunotherapy with standardized Japanese cedar pollen extract]

A study was conducted in 165 subjects with Japanese cedar pollinosis (JC) to evaluate the switching to the new standardized extract (SE) for patients who are going on specific immunotherapy (SP-IT) with conventional non-standardized extracts, products of Trii Co. or Hollister-Stier Co. Eight of 137 subjects exhibited adverse systemic reactions such as general skin eruption and despnea when JC allergen extract of Hollister-Stier Co. was switched to JC-SE. There were 6 cases where concentration of the extract had to be decreased due to extraordinary late reactions, while none of 28 subjects exhibited adverse side effect, when conventional allergen extract by Torii Pharmaceutical Co. was switched to JC-SE. Careful switching to high concentration of SE is required, because eight cases with adverse side effect were shown in switching to 200 JAU/ml and 2000 JAU/ml. 20 subjects started with SP-IT by JC-SE after spread of JC in the year of 2000 exhibited no adverse side effects in our protocol.     

A long-term follow-up study after discontinuation of immunotherapy for Japanese cedar pollinosis]

BACKGROUND: To elucidate how long the effect of immunotherapy (IT) persist after discontinuation in patients with Japanese cedar pollinosis (JCP). METHODS: After discontinuation of IT 485 patients with JCP who completed one course of IT for 3.6 years in average were followed repeatedly up by means of author's original evaluation system of symptom-medication system from 1996 to 2005 using the method of questionnaire. Since the variations of terms after discontinuation and times of examination existed, the outcomes were averaged in every one year and follow-up seasons after discontinuation. Comparison of score and type in the year of discontinuation (base-line level) with those of follow-up was made for evaluation of outcomes. In addition, of these, 100 JCP patients, who had both intervals of 3 years or more from the discontinuation and examination times of 3 or more during the follow-up period, were examined as the evidence of reliability. RESULTS: Although the scores and types in each year were affected slightly by yearly changes in air borne pollen count, the effect persisted for 10 years with a slight change, keeping score 3 to 4. Forty two% of patients had no symptom and medication even in 2005, a year of large pollen count. Conclusively effect of the JCP IT persists satisfactorily for at least 10 years. This is the first study of long term follow-up in JCP against cross sectional study.     

Influence of the difference in the pollen count on medical costs in an allergen-specific immunotherapy for Japanese cedar pollinosis]

BACKGROUND: We studied medical economic efficacy and influence by the different number of pollen scattering in patients treated with allergen-specific immunotherapy for Japanese cedar pollinosis. METHODS: We calculated medical treatment costs and the medicine expense from medical records in eighteen cedar pollinosis patients treated with allergen-specific immunotherapy (IT-G) and with medications (M-G). We examined with the same patients for three years of different pollen scattering, mass scattering year (2005), moderate scattering year (2003), a few scattering year (2004). Furthermore, satisfaction of treatment and symptom score measured by visual analog scale in both subjects was studied in a mass scattering year. RESULTS: Total medical costs at hospital was cheaper in IT-G than in M-G. The result was depended on prescribed medical costs. In addition, prescribed medicine agents and total medical costs did not increase by the mass scattering year of pollen. Satisfaction of treatment and symptom score in IT-G was better than that in M-G. CONCLUSION: Immunotherapy had a benefit on a medical economy.     

Study of recent yearly trend of increase in airborne pollen of Japanese cedar and cypress pollen]

BACKGROUND: Based on epidemiological studies of prevalence, sensitization as well as pollen survey, it is presumed that airborne Japanese cedar pollen (JCP) and cypress (JCyP) have increased progressively for past 40 years. However, because of their large yearly variations, accurate objective and scientific study is required to confirm if it is true or not. METHODS: We analyzed the time trends of JCP and JCy separately in 11 districts throughout Japan where have records of continuous past survey from 1986 to 2005, by regression analysis using net pollen count and their 3 and 5 running means. RESULTS: When significant slope of regression line (regression coefficient) is assumed as p < 0.05 and R2 (coefficient of determination) >0.4, significant increase in airborne pollen was revealed in the use of 5 point running mean (6 districts of total 11 in JCP and 5 in JCyP) but not net count or 3 point running mean because of correction of statistic error due to large yearly variations. This study suggested that our method used for analysis of a recent increase in airborne JCP and JCyP was useful and scientific.     

A relationship between the annual onset day of Japanese cedar pollinosis and pollen dispersion]

A statistical analysis of the annual day of onset of Japanese cedar pollinosis was carried out on a total of 305 patients seen at the out-patient clinic for allergic diseases in the Department of Otorhinolaryngology of Kyoto Prefectural University of Medicine between 1989 and 1991 (3 years). The day of onset varied among individuals and was distributed over a period of about one month, in patient number statistics, however, a clear single peak was seen for all 3 years. The day of onset in most patients showed tendency to peak after January 1, i.e., when the maximum temperature integral is approximately 450 degrees C, on warm days where the maximum temperature exceeds 15 degrees C, on days where there is little rain, and on days when there is a strong southerly wind. This peak onset day is about 3 weeks after first day of pollen count, or 3 or 4 days before the first dispersion peak, which corresponds to the day on which pollen dispersion begins in earnest. Furthermore, it was found that there was a drastic increase in the attack rate (from 10% to more than 50%) in pollinosis patients about 1 week before the peak day of onset. By the first dispersion peak, 70-80% of the patients had experienced an attack. The results of the present study may be useful in pollen forecasting and in treating early pollinosis in the dispersion season.     

Investigation of trends in patients with pollinosis by using web site and the correlation access number and Japanese cedar pollen counts]

BACKGROUND: Recently the number of patient with Japanese cedar pollinosis is increasing. We think many patients are not consulted by a doctor, therefore the questionnaire survey only at hospitals is not enough to know patient's trend. In this study, we examined the trend of patients with pollinosis by the use of a web site. METHODS: For this examination, questionnaire on web site was used from February 1 to April 30, 2003. In this time, the correlation between the pollen counts and access number, how to collect information of pollinosis and the presence of early treatment were focused. RESULTS: The access number to the web site was 348,045 and 1,612 patients answered the questionnaire. There was a good correlation between Japanese cedar pollen counts and the access number to the web site. Most patients (61.2%) collected information about pollinosis and pollen counts by television/radio as well as internet. Patients under 40 years had a medical consultation after the onset symptoms of pollinosis, on the other hand patients over 40 years had a medical consultation before the onset symptoms of pollinosis. Patients who lived in east Japan had a medical consultation before the onset of pollinosis and lived in west Japan after having symptoms. CONCLUSION: It concluded that age and area of patients influenced the patient's trends. Nowadays the spread of internet is remarkable. Therefore, the reliable presentation of information of pollinosis through internet become more important.     

Japanese cedar pollen in house dust]

Caring for oneself against Japanese cedar pollinosis is important as well as receiving medical-care. Although the importance of avoiding pollen is described in the guideline for nasal allergy medical treatment, however, there is no information for effective dust cleaning for the home. This study examined how many cedar pollens were included in indoor dust in order to obtain basic data whether dust removal for cedar pollen is available for pollinosis suffers. As a result, the study found that there were many Japanese cedar pollens in indoor dust even before the pollen season. Cedar pollen increased with the increasing number of airborne pollen. The highest number of pollen found in one week was approximately 450 pollens in a square meter of a living room floor. The study concluded that cleaning is one of the best way to remove Japanese cedar pollens found in indoor dust.     

Regional comparison of patient-reported outcomes in Japanese cedar pollinosis]

BACKGROUND: There is little information about the relationship between local pollen counts and pollinosis symptoms of the local patients. In this study, we compared patient-reported outcomes (PROs) of Japanese cedar pollinosis (JCP) according to regions. METHODS: The study was conducted between February 24 and March 8, 2003 (peak pollen season), and 1200 patients were recruited from 15 ENT clinical sites in 4 regions : central Osaka (n = 576), southern Osaka (n = 195), northern Wakayama (n = 234), and southern Wakayama (n = 195). PROs consisted of nasal symptoms, ocular symptom, learning and work impairment, and QOL (SF-36). RESULTS: In non-treatment group, there were significant differences in ocular symptom and learning and work impairment among regions. On the other hand, patients with longer duration of treatment had better symptom relief regardless of pollen level in early treatment group. As to QOL, SF-36 summary scores did not differ among regions in both groups. CONCLUSION: This study shows that patients without early treatment seemed to be affected by pollen level on their ocular symptom and its related outcomes. In patients with early treatment, however, the treatment duration had bigger impact on PROs than the local pollen counts.     

Japanese cedar pollinosis in infants in the allergy clinic]

Recently, the number of patients with Japanese cedar (Cryptomeria japonica) pollinosis has increased, especially in children. However, little is known about the incidence in infants. We studied on the rate of sensitization and the onset of pollinosis in children under 6 years old. The percentage of positive CAP-RAST to Japanese cedar pollen was 27.6%, in 76 infants (51 male and 25 female, 2 months-5 years old) who visited National Mie Hospital pediatric allergy clinic due to bronchial asthma and/or atopic dermatitis. The youngest child who has been sensitized to pollen was 1 year 8 month old boy. The percentage of positive rate of CAP-RAST to house dust mite was 61.8%. Twenty-seven infants (20 male and 7 female, 2-5 years of age) were diagnosed as Japanese cedar pollinosis in National Mie Hospital Otorhinolaryngology clinic in 1999 and 2000. The youngest child with pollinosis was 2 year 5 month old boy. Most of the 27 infants complained of rhinorrhea and/or eye symptoms and some of them complained cough, snoring, or epistaxis. About 40% were sensitized to Japanese cedar and/or cupressaceae pollen alone, 60% were also sensitized to house dust mite. In conclusion, it is possible that the sensitization to Japanese cedar pollen occurs after 2 season of pollen exposure and pollinosis occurs in 2 years old. Japanese cedar pollen has been an important allergen not only in school children, but also in infants.     

Japanese cedar pollinosis is a risk factor for bronchial asthma in Japanese adult asthmatics]

It is well known that allergic rhinitis and asthma often coexist in the same patients. Here, we investigated the influence of Japanese cedar pollinosis on the exacerbation of asthma investigated by questionnaire, daily asthma diary, and peak expiratory flow (PEF) monitoring. Furthermore, airway responsiveness to histamine before pollen season was also investigated in some patients. 333 adult patients with asthma were enrolled into the study and 116 patients (34.8%) were suffering from Japanese cedar pollinosis diagnosed by the presence of nasal allergic symptoms during pollen season and high titer of Japanese cedar-specific IgE antibody. Exacerbation of asthma symptoms, including wheezing, dyspnea, cough, and sputum, was detected in 41 of 116 patients (35.3%) during pollen season. Decrease in morning PEF more than 10% compared with the baseline values before pollen season was observed in 13 of 41 patients (11.2% of total asthmatic patients who complicated with Japanese cedar pollinosis). No significant differences in airway responsiveness to histamine and the titer of Japanese cedar-specific IgE antibodies before pollen season were observed between the patients whose asthma exacerbated and the patients whose asthma was not exacerbated. These results suggest that Japanese cedar pollinosis is one of risk factors for asthma in Japanese adult patients with asthma.     

Treatment of Japanese cedar pollinosis and its impact on patient satisfaction]

Japanese cedar pollinosis is a major public health problem in Japan because of its severe symptom and high prevalence. However, patient satisfaction by treatment is poor according to current reports. As the treatments, pre-seasonal medication and single peroral anti-allergic drug on demand are frequently used in Japan. Against conventional methods, we treated 301 patients with Japanese cedar pollinosis by persistent use of combined drugs (topical steroid, peroral anti-allergic drug and eye drop) without pre-seasonal medication in 2003. Immunotherapy was also used in 90 patients treated. As a result, 97% of patients was satisfied in this treatment and immunotherapy contributed to reduction in the amount of drug and high treatment outcome.     

Changes of histamine release rate from basophils measured by HRT Shionogi kit in immunotherapy for cedar pollinosis]

We studied changes in histamine release from basophil measured by HRT Shionogi kit as laboratory procedure to evaluate immunotherapy of allergic rhinitis. Nine cedar pollinosis patients (ages 12-64 yrs, 3 male and 6 female) that started immunotherapy with standardized cedar pollen extract (Torii Co) in 2001 were evaluated. Histamine release rate was measured before immunotherapy and at 6 months after starting immunotherapy. As a result, the histamine release rate after immunotherapy was suppressed in all cases. The average of histamine release rate was significantly decreased by the stimulation at 3, 30 and 300 ng/ml with cedar pollen antigen (p<0.05). These data suggested that the measurement of histamine release rate was usable for evaluating the efficacy of immunotherapy, and it has a possibility for monitoring in immunotherapy. In addition, a new different mechanism that T lymphocyte or serum does not concern can be considerable, because the procedure by HRT Shionogi kit is measured from basophils at the condition without serum.     

Analysis of natural history of Japanese cedar pollinosis

BACKGROUND: The marked increase in the incidence of Japanese cedar (Cryptomeria japonica; JC) pollinosis is a social problem in Japan. Elucidation of its natural history is, therefore, essential. METHODS: Cross-sectional and vertical-sectional studies were performed regarding the effects of aging on sensitization to Japanese cedar pollen (JCP) and development of JC pollinosis by measuring serum IgE titers to JCP and by oral examination of residents of the Maruyama Town, Chiba, Japan from 1995 to 2001. We also studied the incidence of its spontaneous remission and the background factors. RESULTS: In a vertical-sectional study, the serum IgE titer to JCP was strongly influenced by the amounts of pollen scattered. An increase in age by 6 years did not reduce the IgE titer to JCP in subjects in their 40s. However, in subjects aged 60 or more, annual differences in the JCP count did not affect serum IgE titer to JCP, which remained low even after a season with a high pollen count. In subjects with JC pollinosis aged over 40 showing a CAP RAST score of more than 2 to JCP in 1995, spontaneous remission of JC pollinosis was observed in 16.1% over a period of 6 years. Factors affecting spontaneous remission include sex, age at the time, serum IgE titer to JCP and age at first onset of JC pollinosis. CONCLUSIONS: The CAP RAST score was strongly associated with spontaneous remission in the multivariable model.     

Epidemiology of Japanese cedar pollinosis throughout Japan.

BACKGROUND: Japanese cedar pollinosis (JCP) is a common disease posing a major public health problem in Japan. For health care policy planning and development of new treatment modalities, investigation of the accurate prevalence and current status of JCP nationwide is imperative. OBJECTIVE: To ascertain the prevalence and the current status of JCP in Japan with use of a cross-sectional random sampling method. METHODS: In a nationwide survey conducted shortly after the peak pollen season, self-evaluation questionnaire were mailed to 10,920 subjects from 390 of 3,370 places in 12 regions in Japan. RESULTS: The response rate was 53.7%, and the usable response rate was 51.5%. The age-adjusted prevalence was 19.4%; the estimated prevalence was 13.1% after adjustment for misdiagnosis, incorrect answers, response rate, and case mix. JCP was most prevalent in the Kanto, Tokai, and Kinki areas and in working adults rather than in children or subjects ages 60 to 79 years. Total pollen count during the pollen season correlated well with the prevalence of JCP in individual regions. In subjects with JCP, nasal symptom were more severe than eye symptoms, 62.5% had severe or moderate interference with daily activities and consulted physicians, 54.1% took prescribed drugs, and 82% used some method to avoid pollen. CONCLUSIONS: The age-adjusted prevalence of JCP was 19.4% of the Japanese population, and estimated prevalence after correction of possible biases was 13.1%. Prescribed drugs treated approximately 60% of subjects with JCP, and 80% of subjects tried self-care by avoiding pollen.     

The incidence of Japanese cedar pollinosis and sensitization to the pollen allergens among Japanese monkeys in a troop

The natural occurrence of Japanese cedar (Cryptomeria japonica; CJ) pollinosis has been reported in Japanese monkeys (Macaca fuscata), an appropriate animal model for developing antipollinosis therapies. However, there has been no study on the incidence of Japanese cedar pollinosis in monkeys. To evaluate the incidence of CJ pollinosis in Japanese monkeys, we investigated the presence of pollinosis symptoms among monkeys in a troop, and the response to CJ allergens in pollinosis monkeys. We examined the presence of pollinosis symptoms in 272 monkeys in a troop throughout the CJ pollination season (February to April). Of the 272 monkeys, 21 (7.7%) showed pollinosis symptoms during the CJ pollen season. Blood samples were taken from the 21 monkeys that showed pollinosis symptoms and were tested for the presence of immunoglobulin E (IgE) antibody for CJ allergens. All 21 monkeys with CJ pollinosis had anti-CJ IgE. Of the 21 monkeys, peripheral blood mononuclear cells (PBMC) could be taken from 12, all of which showed CJ allergen-specific PBMC proliferation. The incidence of CJ pollinosis in a troop was 7.7%. The monkeys with CJ pollinosis demonstrated specific IgE and PBMC proliferation for CJ allergens.     

The incidence of Japanese cedar pollinosis and sensitization to the pollen allergens among Japanese monkeys in a troop

The natural occurrence of Japanese cedar (Cryptomeria japonica; CJ) pollinosis has been reported in Japanese monkeys (Macaca fuscata), an appropriate animal model for developing antipollinosis therapies. However, there has been no study on the incidence of Japanese cedar pollinosis in monkeys. To evaluate the incidence of CJ pollinosis in Japanese monkeys, we investigated the presence of pollinosis symptoms among monkeys in a troop, and the response to CJ allergens in pollinosis monkeys. We examined the presence of pollinosis symptoms in 272 monkeys in a troop throughout the CJ pollination season (February to April). Of the 272 monkeys, 21 (7.7%) showed pollinosis symptoms during the CJ pollen season. Blood samples were taken from the 21 monkeys that showed pollinosis symptoms and were tested for the presence of immunoglobulin E (IgE) antibody for CJ allergens. All 21 monkeys with CJ pollinosis had anti-CJ IgE. Of the 21 monkeys, peripheral blood mononuclear cells (PBMC) could be taken from 12, all of which showed CJ allergen-specific PBMC proliferation. The incidence of CJ pollinosis in a troop was 7.7%. The monkeys with CJ pollinosis demonstrated specific IgE and PBMC proliferation for CJ allergens.