| Co-Investigator(Kenkyū-buntansha) |
ITO Yukiko National TSU Hospital, 耳鼻科, Chief
HOSOI Susumu Kyoto University, 医学部, Associate professor
HATA Daishi Kishiwada City Hospital, 小児科, Chief
NAGAI Hirokazu Gifu Pharmaceutical University, Professor
KITABAYASHI Taeru National Atami Hospital, 小児科, Chief
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| Research Abstract |
In recent years, the increasing number of adult patients with Japanese cedar pollinosis has become an issue. On the other hand, the number of children affected by the disorder is certainly increasing also in the department of pediatrics. The allergy is now found in younger children who were previously considered not to show the disorder. Here we report on a research study that investigated the reality of the disease. We conducted a questionnaire survey in affected children who visited the pediatrics outpatient department during the season of Japanese cedar pollen dispersion. Consequently, 26.9% and 41.2% of children who replied to be affected by Japanese cedar pollinosis showed deteriorated symptoms of bronchial asthma and the aggravation of atopic dermatitis, respectively. To date, countermeasures for rhinitis and conjunctivitis have been implemented for the treatment of Japanese cedar pollinosis. However, the disorder has a potential of adversely affecting bronchial asthma and atopic
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dermatitis as well. Therefore, we consider it necessary to review the therapeutic regimen for the disorder while taking heed of this potential in the future. Furthermore, a question about the prevention against Japanese cedar pollens disclosed that only 35.7% of the responders wear a mask and that 46.7% of the responders take no measures at all. We consider it necessary to proactively recommend the wear of a mask or giasses in the future and to enlighten countermeasures, e.g., devisal of not bringing pollens into the house when coming home from outing and the use of a drier when hanging out the wash or comforter/mattress. A large-scale epidemiologic study in 56,108 primary and junior high-school studies in Kyoto and Shiga revealed that the prevalence of Japanese cedar pollinosis was 5.2% at the school child age and tended to increase with age. A study on the prevalence by season of birth indicated that children, who had been born in autumn, tended to show a high prevalence of Japanese cedar pollinosis. A comparison of the prevalances of Japanese cedar pollinosis between the rural area and the urban area indicated a tendency for greater prevalence in the urban area, suggesting the possible influence of urban environments, e.g., atmosphere pollution, on the pathogenesis of Japanese cedar pollinosis. We examined the severity of atopic dermatitis and bronchial asthma according to the presence or absence of comorbid Japanese cedar pollinosis. Consequently, only children with atopic dermatitis who were complicated by Japanese cedar pollinosis had severe atopic dermatitis, leading us to consider that Japanese cedar pollinosis or sensitization to Japanese cedar pollens possibly affects the clinical condition of atopic dermatitis. For the purpose of examining the relationship between Japanese cedar pollinosis and airway hyperresponsiveness, we used an asthograph to measure respiratory resistance in affected children who had ≧ class 3 Japanese cedar-specific IgE antibody as determined by the radioallergosorbent test (RAST). Consequently, RAST provided the result that initial respiratory resistance is significantly elevated during the season of Japanese cedar dispersion compared to the season of nondispersion. Furthermore, we conducted asthrography in eight adult patients with Japanese cedar pollinosis. Consequently, seven among them showed the same airway response pattern as that found in patients with bronchial asthma. This result led us to consider that Japanese pollens also affect the lower respiratory tract during the season of dispersion and influence airway hyperresponsiveness even when no symptoms are found. The treatment of children affected by Japanese cedar pollinosis primarily consists in pharmacotherapy. However, the inferior nasal concha is swollen intensively during the season of Japanese pollen dispersion ; we encounter children with severe Japanese cedar pollinosis who have difficulty in nasal respiration even when using a topical steroid preparation. In the present study, we tried to conduct inferior nasal concha cauterization using the CO_2 laser during the winter vacation season prior to the dispersion of Japanese cedar pollens in nine children 9 to 15 years of age who were affected by intractable Japanese cedar pollinosis. Consequently, we obtained favorable improvement rates in the first season as follows : 89% in severe disorder rate ; 100% in nasal congestion rate ; 78% in paroxysmal sneezing rate ; 78% in nasal discharge rate ; and 78% in symptom medication score. In six affected children whom we could follow until the second season, improvement rates were favorable because the rates did not become inferior to those found during the first season. When 1 year elapsed after surgery, however, the positivity rate of the induction test with Japanese cedar pollens increased and the number of basophils elevated. Therefore, we consider that further study on the long-term effects of the surgery will be required. The duration of the surgery including anesthesia was approximately 30 minutes, little bleeding was found during surgery, and pain and other adverse reactions were not observed. We plan to further examine the outcomes of the surgery by adjusting the laser output. Japanese cedar pollinosis has not been sufficiently investigated as an allergic disorder in childhood. Based on the results from the present study, we recognize the need to conduct a further research study on the disorder in the future. Less
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