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Effectiveness and safety of olopatadine hydrochloride were studied in 30 patients with cedar pollenosis by administering the agent before and after cedar pollen began to disperse. After receiving a pre-scription for olopatadine hydrochloride 5mg twice a day, patients recorded nasal symptoms, any hindrance in daily activities, itching of the eye and compliance daily from the first day of treatment to the eighth week after pollen began to disperse. Patients were divided into two groups; one group of patients started the agent before pollen began to disperse (the pre-dispersion group, n=15) and the other group of patients started after pollen began to disperse (the post-dispersion group, n=15). Symptoms and findings were compared between the two groups. All scores for runny nose, nasal obstruction, severity of hindrance in daily activities, itching of the eyes, severity of symptoms and symptom-medication were lower in the pre-dispersion group than in the post-dispersion group. In the post-dispersion group, the minimol sectional area of the nasal cavity and the capacity of the nasal cavity tended to increase following administration of olopatadine hydrochloride. Olopatadine hydrochloride could be sufficiently effective for cedar pollenosis, even when administration started after pollen began to disperse. However, it seemed that when administration started before dispersion, the onset of nasal symptoms was delayed and exacerbation of symptoms was decreased. In addition, the agent seemed to be more effective for relief of itching eyes and preventing hindrance in daily activities.

The clinical efficacy and safety of 200 μg/day (100μg b. i. d) of mometasone furoate nasal spray (MFNS) administered for 2 weeks was evaluated by comparison with a low dose of MFNS of 50μg/day (50μg o. d.) using the envelope-method in a total of 65 patients with Japanese cedarpollenosis.The pollen counts for Japanese cedar in 1995 were extremely high in the Kansai district. About 5, 000 counts/cmz was confirmed in and around Osaka.In the analysis of final overall improvement, marked or moderate improvement was observed in 76.2% (16/21) and 20.8% (5/24) of patients receiving MFNS 200μg/day and 50μg/day, respectively. The difference in efficacy between the two dosage groups was confirmed independently of timing of the initiation of administration. In the analysis of overall safety, high safety was observed with both treatments. The above results suggest that 200μg/day of MFNS can be considered the recommended dose for the treatment of Japanese cedar pollenosis.

The clinical usefulness of 200μg/day of mometasone furoate (MF) nasal spray administered over 2 weeks was compared against 31.2μg/day of disodium cromoglycate (DSCG) using a telephone nominating method in a total of 69 patients with Japanese cedar pollenosis.The Japanese cedar pollen count in 1996 was extremely low, apporoximately 1/10-4/20 of that in 1995. On an analysis of the overall improvement, marked or moderate improvement was observed in 69.0% (20/29) and 20.7% (6/29) of patients receiving MF and DSCG, respectively; this was statistically different. MF also showed significantly superior efficacy over DSCG in almost all subjective and objective nasal symptoms. A significant correlation between the total nasal symptom scores based on three main symptoms of nasal allergy and overall improvement judged by an independent investigator was confirmed. The proper discriminant rate by discriminant analysis was high at 93.1%. On an analysis of the overall safety, good safety was observed for both treatment groups. The above results suggest that MF is highly useful in the treatment of Japanese cedar pollenosis.

In recent years, a growing number of chronic sinusitis cases have been accompanied by allergic rhinitis. Based on the author's data, allergic rhinitis is found in 25% and 52% of chronic sinusitis cases in adults and children respectively. Despite this high incidence, relatively little is known about the effects of allergies on the pathology and severity of sinusitis. This study was designed to elucidate allergic contributions to sinusitis. The pathological and clinical features of sinusitis were studied in 2 groups of patients, with and without allergy.The intensity of labeling for proliferating cell nuclear antigen (PCNA) in the sinus goblet cells and the intermediate cells was significantly higher in the group with sinusitis than in the control group. There was a positive relationship between infiltrating cell counts and PCNA labeling score in the mucosa. In chronic sinusitis with pollenosis, the submucosal eosinophiles increased during the pollen season. Furthermore, chronic sinusitis tended to be exacerbated during this season.The rate of submucosal eosinophiles to lymphocytes was significantly higher in cases of sinusitis with perennial allergy than without allergy. The results indicate that allergic reaction contributes to the development and prolongation of chronic sinusitis.

Immunomodulatory activity of five new synthetic muramyl dipeptide (MDP) derivatives (β-heptylglycoside-MDP, β-hexadecylglycoside-MDP, polyacrylamide-MDP, polyacrylamide-MDP-phosphatidylethanolamine, and dexal-MDP) is studiedin vitro in different test systems.

Numbers of patients suffering from allergic diseases, such as asthma, pollenosis, atopic dermatitis, etc. have been increased in industrially advanced countries. The increases are remarkable especially in urban area in such countries. It has been generally accepted that not only genetic but also environmental factors contribute to the pathogenesis of various diseases. Allergic diseases are also caused by both factors. Genetic factors can be explained by a concept of single nucleotide polymorphism (SNP), which means that only one nucleotide mutation can make a person highly sensitive to allergic diseases. However, the recent increase in the number of allergic patients cannot be explained merely by SNP. It has been widely indicated that environmental factors such as air pollution, improvement of hygiene, changes in foods and dwelling, etc. are closely associated with the increase in patients. In this chapter, the relationship between air pollutants and allergic diseases in the airway tissues is Focused on. In order to demonstrate this relationship, experimental animal models of allergic asthma have been widely utilized. First, the findings obtained from animal models are summarized. Second, we have actually evaluated whether the pyrenes present in diesel exhaust particles, cigarette smoke, etc. aggravate allergic rhinitis symptoms in a pollenosis guinea pig model (Mizutani et al., 2007). The methodology of development of this model of pollenosis and the effects of pyrenes on the model are also described.

Japanese cedar (Cryptomeria japonica) pollenosis is a common clinical problem in otorhinolaryngeal practice. Japanese cedar pollen affects a very large fraction of the population, and its symptoms are more severe and various than perennial allergic rhinitis. Beclomethasone dipropionate is a potent, topically active corticosteroid drug and most widely used, but patients with severe rhinitis often fail to obtain relief. Therefore, a clinical trial was undertaken to assess the efficacy of pre-seasonal administration in the prevention of Japanese cedar pollenosis. Pre-seasonal treatment with beclomethasone appeared to significantly suppress attacks in comparison with patients who are not treated before the pollen season.

Summary Objectives: To evaluate the effectiveness and safety of a homoeopathic drug combination in the treatment of pollenosis under condition of daily practice. Design: Care review. Setting: A General practice in Germany. Patients: 35 patients with pollenosis. Main outcome measures: Objective and subjective symptoms of acute pollenosis. Results: During an average treatment period of 61 days it was found that 28 of 35 patients experienced an improvement in pollenosis symptoms. The medication was well tolerated thought patients preserved oral to subcutaneous administration. Conclusion: Patients receiving the homoeopathic drug combination experienced improvements without side effects. Whether this improvement is due to the medicine or some other factor would need to be determined in a controlled trial.

Rhinitis is an inflammatory condition of the nasal mucosa characterized by sneezing, itching, rhinorrhea, and nasal congestion.1–3 Allergic rhinitis, the most common primary cause, is an antibody-mediated immunologic process. It is classified as seasonal or perennial according to the timing and duration of symptomatic periods. Characteristic symptoms of paroxysms of sneezing, nasal and ocular pruritus, rhinorrhea, and nasal congestion occur during specific periods with seasonal or acute allergic rhinitis (seasonal pollenosis or hay fever). With perennial or chronic allergic rhinitis the same cluster of symptoms, either intermittent or continuous, occurs throughout the year with no distinct seasonal pattern.1–4 Although allergic rhinitis can begin at any age, most individuals develop symptoms before age 20; and the highest rate of increase in the onset of symptoms occurs between the ages of 12 and 15 years.1–4

Fifteen patients with Japanese cedar pollenosis were examined for lower airway function. Flow-volume patterns obtained from flow-volume and volume-time curves during the pollen season (March) and outside of the pollen season (June) were evaluated. In a previous report we classified maximal expiratory flow-volume (MEFV) curves in five patterns from A to E. In the present study, the patterns did not vary between the two periods except in one patient. Eleven patients out of 15 showed type E patterns, in which the flow-volume curve was concave along its entire course. In most of the patients with severe or moderate symptoms of allergic rhinitis only during the pollen season, the curve shifted to the right, but the parameters of the curves did not increase significantly outside of season. These findings suggest that patients with Japanese cedar pollenosis suffer from continuous latent peripheral airway obstruction. Extremely slight changes in the flow rate were detected by comparing the curves obtained during the two periods.

Nasal provocation testing using a measured dose of dry grass pollen has been used as a method of controlling the amount of injection treatment required to achieve decreased sensitivity to grass pollen. This could seldom be shown at the usual top dose of 10,000 P.N.U., but by repeating the top dose until the reaction was negative, complete freedom from pollenosis was achieved in most cases. Strict criteria for assessment of results were used. Conventional dosage regimens produced only 27 percent excellent results, but 94 percent of those patients who became demonstrably nasal test-negative were completely or almost completely free from symptoms in the pollen season.

Pollenosis is a IgE-mediated allergic disease which has the symptoms of snivel, sneezing, eye mucus, and/or tear resulting from mucous membrane inflammation of nostrils and/or eye. In Japan, Japanese cedar (Cryptomeria japonica) pollenosis is a typical one occurring in spring, and recently the number of its patients is remarkably increasing.We found the pollenosis in adult-female Japanese monkeys (Macaca fuscata) inhabiting Miyajima Island under free-ranging conditions, who are derived from different female lineages one another. Their sera contained higher level of specific IgE antibody against Japanese cedar pollen than those of normal monkeys. The sera also induced a skin allergic reaction to the pollen upon Prausnitz-Kustner Test using normal healthy monkeys as a recipient. Thus, the current paper is the first report concerning naturally occurring pollenosis in wild non-human primates.

Summary Hyposensitization therapy gave a subjective improvement in 84% of grass pollen-sensitive patients receiving an eighteen dose course of aqueous pollen extract (SDV) and in 69 % of patients receiving a three dose course of glutaraldehyde-treated pollen-tyrosine adsorbate (Pollinex). Systemic reactions to treatment were considerably more frequent with the aqueous course, but virtually absent with the short adsorbate course, which seems therefore more convenient for the patient. The SDV treatment induced a more pronounced IgG antibody response both in patients and in guinea-pigs receiving the clinical dosage schedule. The Pollinex treatment showed a tendency to enhance the IgE antibody response in new patients.

In the last 5 years some models of human IgE production in vitro have been investigated in our laboratory. Spontaneous IgE synthesis was found in cultures of B cells from most patients with atopic dermatitis or atopic patients with multiple sensitivities and from some patients with pollenosis, but only during the pollination period. A small and variable increase of the spontaneous IgE synthesis was induced by soluble factor(s) produced by T cells from patients with severe atopy. Selected helper T cell clones were also able to induce IgE synthesis in vitro by both atopic and normal B cells.

We followed 47 ragweed hay fever patients (not on immunotherapy) through a ragweed season by means of clinical evaluation and symptom scores. The radioallergosorbent test (RAST) and lymphocyte stimulation index (LSI) were done to determine their reliability as predictors of clinical symptomatology. Symptom scores of 10 or above, denoting at least moderate daily symptoms, occurred in 36 patients (80%). Preseasonally, RAST class 2 or above was found in 34 patients (75%), of whom 29 patients (64%) had symptom scores of 10 or above. At that time, LSI was elevated in about 50% of the patients. Patients in RAST class 3 had the highest LSI as a group. Seasonal exposure boosted the LSI in 50% of the patients, whereas 25% were unchanged and 25% showed a decrease. The results suggest that neither RAST nor LSI are reliable predictors of clinical severity in ragweed pollenosis.

There are few ways to evaluate nasal allergy provocation tests objectively and quantitatively. The thread dying test method which was devised for lacrimation test (Kurihashi & Yanagihara) has been also used as a nasal secretion test (Kumazawa et al).The efficacy of this test was evaluated by nasal provocation tests of 10 patients with cryptomeria pollenosis and 10 normal individuals as controls. The test was compared with Okuda's gradings for nasal allergy. The effect of drug therapy (Tranilast) was also evaluated by this method and by Okuda's subjective gradings. The results showed that 70% of the patients experienced relief and that objective signs of improvement correlated fairly well with subjective symptoms (p

Patients with vasomotor rhinitis (28) and polle-nosis (23) were subjected to psychosomatic examination and treated either by acupuncture or phonostimulation exclusively. Acupuncture was performed after the classical method in 22 patients and phonostimulation in 29. Evaluation of the results was based on laryngological examinations and appraisals entered by the patients in special personal diaries. In pollenosis the condition was unchanged by the treatment. In vasomotor rhinitis, on the other hand, in which psychic factors were of importance, some of the patients usually improved temporarily at the beginning of treatment, whereas a few suffered exacerbation. These effects may be attributable to suggestion.

INJECTIONS of allergenic extracts as a means of mitigating the effects of seasonal exposure to pollens, to be referred to as injection therapy, has been practiced for over fifty years. The number of patients in this country receiving injection therapy is unknown, but it must be very large — probably of the order of 1,000,000. The mere magnitude of this medical enterprise might suffice as evidence for its efficacy except that objective criteria for success or failure are lacking and that factors other than injection treatment may profoundly influence the course of pollenosis and the opinion of both patient and . . .

Allergy questionnaires were given to 1,000 consecutive patients in a large medical clinic. An incidence of 19.8 per cent seasonal allergy was found in this survey. Only 34.3 per cent of the survey population gave no indication of past or present symptoms which might be allergic. Of the seasonal allergic patients, 82 per cent had hay fever, 16 per cent had hay fever and asthma, and 1.5 per cent had seasonal asthma. The allergic symptoms in relatives of patients with seasonal allergy varied with the patients' seasonal complaints. Forty-one per cent of patients with seasonal allergic rhinitis had relatives with hay fever, and 9 per cent had relatives with asthma or asthma and hay fever. Forty-four per cent of the near relatives of patients with both pollenosis and asthma had asthma, and 25 per cent had hay fever only. During the past 10 years, 37 per cent of the hay fever patients indicated improvement or disappearance of symptoms, and 45 per cent indicated that their symptoms were worse. Seventy-two per cent of patients with both asthma and hay fever indicated that symptoms improved or disappeared, but 6 per cent claimed increased symptoms. Fifteen per cent of the patients with seasonal allergy had no colds in a year compared to 32 per cent of the nonallergic patients. Seven per cent of seasonally allergic patients had three or more colds a year compared to 1.4 per cent of nonallergic patients.

Background As a non-injection route for immunotherapy, local nasal immunotherapy has been examined in allergic rhinitis patients. However, it is unclear how the immunotherapy affects sneezing, biphasic nasal blockage and nasal hyperresponsiveness. Thus, we evaluated the therapeutic effects of nasal immunotherapy on the symptoms of guinea pig allergic rhinitis. Additionally, we also evaluated whether the immunotherapy relieved pollen-induced allergic conjunctivitis. Methods Sensitized animals were repeatedly challenged by pollen inhalation once every week. After the 7th challenge, the pollen extract was intranasally administered 6 times a week until the 30th challenge. Sneezing frequency was counted after each of the challenges. As an indicator of nasal blockage, changes in specific airway resistance were measured. Nasal hyperresponsiveness was assessed by measuring leukotriene D4-induced nasal blockage. Additionally, during the immunotherapy, we applied pollen onto the ocular surface to induce the allergic conjunctivitis symptoms. Results At the 11th—30th challenges, the nasal immunotherapy showed inhibition or a tendency to inhibit the biphasic nasal blockage although the inhibitions were variable at respective challenges. The development of nasal hyperresponsiveness was markedly suppressed by the immunotherapy. Nevertheless, neither sneezing nor antigen-specific IgE antibody production was substantially influenced by the immunotherapy. On the other hand, the nasal immunotherapy did not affect the induction of allergic conjunctivitis symptoms. Conclusions Local nasal immunotherapy may be clinically useful for allergic nasal blockage associated with nasal hyperresponsiveness. The mechanisms responsible for this effectiveness might not be related to IgE production. Additionally, the effectiveness for nasal tissue was dissociated from that seen for the ocular tissue.

Seasonal elevation in total serum IgE and IgE antibody specific for antigen E (IgE-a-AgE) are well recognized in patients with ragweed pollenosis. We found that the ratio of specific IgE-a-AgE to total IgE in plasma was the only measure predictive of the number of specific IgE-a-AgE molecules per basophil. Although both total and specific IgE rose with season, the ratio did not change, the number of IgE-a-AgE molecules per basophil did not change, and histamine release in response to AgE did not increase.

Because of the relative frequency of pollenosis ("hay fever") in childhood and the tendency for it to be followed by asthma or perennial allergic rhinitis, a critical reevaluation of the treatment of this condition seems indicated. The purpose of this study was to determine by means of a controlled study the relative value of the three most widely used techniques of hyposensitization therapy. Methods The protocol for the study was written before the experiment was begun. Population sampling and random selection procedures were previously discussed with a statistician. It was decided that the experimental population be made up entirely of children referred to the pediatric allergy clinic of the Strong Memorial Hospital. The only weed pollen extract to be used was ragweed. As each new patient with a history of pollenosis was referred to the pediatric allergy clinic, he was assigned by strictly random selection procedures to one of the

A double-blind study was carried out to determine the effect of dosage in the treatment of ragweed hay fever with injections of aqueous ragweed pollen extract. Two concentrations of extract were used, one 20-fold smaller than the other. The volumes administered were such that the dose at the higher concentration was close to the maximum that it is practical to administer. During the ragweed season, the group of patients receiving the higher concentration fared significantly better than the group receiving the lower concentration. It is concluded that large dosages of pollen extract are more effective than small dosages in the treatment of hay fever. The findings indicate that the very low dosages recommended by some would have little influence on the course of pollenosis.

To the Editor.— This concerns a double-blind study of the neutralizing dose as used in the provocative testing technique. The technique of testing for abnormal reactivity or allergy by deliberate trial of suspected allergens is often the only practical way to identify offenders. In the last eight or nine years, an attempt has been made to systematize this study by using injections of various dilutions of antigens to provoke a mild systemic response after which it is claimed that often another dose of antigen can be found which relieves the induced symptoms within minutes (Rinkle or Lee provocative testing method). This "relieving dose" is administered repeatedly for therapy when continued exposure to the antigen is anticipated as in coseasonal treatment for pollenosis or to offset intolerance to common food offenders. This study did not investigate the possible long-term benefit of such therapy, but was concerned with whether immediate effectiveness of