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Background: Genetic and environmental factors are proposed to be involved in cedar pollen allergy sensitization and onset. The impact of these factors will provide key information for the prevention of cedar pollen sensitization and allergy onset, which we investigated in this cross-sectional study., Methods: Subjects were 382 young adult volunteers who completed a self-administered questionnaire on self-reported subjective symptoms of pollinosis, physician-diagnosed pollinosis, and background factors. We also measured their serum IgE antibody titers specific for cedar, cypress, and mites. Factors associated with subjective symptoms, physician diagnosis, and the three specific antigens were determined using both univariate and multivariate analyses., Results: Sensitization to cedar, cypress, and mites, defined as specific IgE levels of class 1 or above, was found in 78.8%, 64.4%, and 56.0% of subjects, respectively. The prevalence of cedar pollinosis was 41.2% based on subjective symptoms and 22.2% based on physician diagnosis. Factors associated with increased cedar pollen sensitization were mite sensitization, comorbid allergic rhinitis, and family history of cedar pollinosis. Risk-reducing factors for cedar pollen sensitization were keeping a cat, number of common colds, and hours of sleep. Risk-increasing factors for both subjective pollinosis symptoms and physician-diagnosed pollinosis were comorbid allergic rhinitis and family history of cedar pollinosis., Conclusions: Sensitization to cedar pollen in this population was extremely high. Both common and distinct factors were associated with sensitization to pollen and with the development of pollinosis. The distinct factors were associated with sensitization to cedar and cypress antigens., (Copyright © 2018 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.)

Background: It is difficult to know how the children with Japanese cedar pollinosis (JCP) recognize their own symptoms and quality of life (QOL). In addition, the adversely impact of pediatric JCP on the QOL of the parents is not understood. The aim of this study was to investigate the symptoms and troubles due to pediatric JCP evaluated by patients and their parents, and analyze the difference., Methods: Twenty-six pair of children (7-15 years of age) with JCP and their parents/grandparents who visited our ENT clinic filled out questionnaire regarding the symptoms and hindrances due to JCP., Results: There were significantly correlations between the severity of symptoms evaluated by children and parents/grandparents. The most frequent problem was "rubbing nose and eyes", both in children and parents/grandparents. The children were tended to be troubled by practical problems. The parents/grandparents were tended to be worried about the emotion, sleep and activity in daily life and health condition of their children. The total nasal symptom score was significantly higher in children of parents/grandparents with the anxiety about the health condition than in ones without the anxiety., Conclusions: The school age children with JCP can express their symptom appropriately. There is a different tendency in hindrances due to pediatric JCP between in patients and parents/grandparents. It is necessary to develop the QOL questionnaire sheets for children with allergic rhinitis and their parents.

Background: This study aims to examine the immunological parameters, focusing IL-10 productivity, in prophylactic sublingual immunotherapy (SLIT) in asymptomatic subjects sensitized to Japanese cedar pollen (JCP)., Methods: This study was conducted as part of a randomized, double-blind, placebo-controlled, multiple center trial, and was performed for two consecutive pollen seasons in 2012 and 2013. The present results were based only on our institution. We recruited 29 participants with specific IgE against JCP of at class 2 and higher levels without history of the pollinosis symptoms at the time of JCP scattering. The SLIT group received standardized JCP extract for five months over the pollen season. We observed and judged development of the symptoms in the pollen season. The percentage of IL-10 producing CD4(+) T (Trl) cells, B cells and monocytes were analyzed by flow cytometry. JCP specific IgE and total IgE were also measured., Results: The ratio of development of cedar pollinosis was significantly lower in the SLIT group compared to the placebo group in 2013. In 2012, the percentage of circulating Tr1 cells and IL-10 producing monocytes significantly increased in the SLIT group. In 2013, the percentage of circulating Tr1 cells and IL-10 producing B cells increased significantly in the SLIT group. The percentage of circulating IL-10 producing monocytes significantly decreased in the placebo group., Conclusions: Prophylactic SLIT is effective for prevention of the development of pollinosis. Induction of IL-10 producing T cells, B cells and monocytes is an important mechanism of SLIT for prevention of pollinosis in asymptomatic but sensitized subjects., (Copyright © 2014 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.)

Background: Japanese cedar pollen (JCP) is the most common allergen for seasonal allergic rhinitis in Japan. Little is known about local production of immunoglobulin (Ig)E in people with or without Japanese cedar pollinosis. The aims of this study were to measure levels of JCP-specific IgE in nasal secretions and determine correlations with levels in serum., Methods: Forty-six subjects were enrolled in this study, comprising 24 symptomatic subjects, 9 asymptomatic subjects sensitized to JCP, and 13 subjects not sensitized to JCP. Nasal secretions were obtained during a period of Japanese cedar dispersal, and levels of JCP-specific IgE were measured with CAP-fluorescent enzyme immunoassay. Serum JCP-specific IgE and total IgE were also measured using the same method., Results: Among the 46 subjects enrolled, JCP-specific IgE in nasal secretions was measureable in 43 subjects. Irrespective of symptom development, sensitized subjects showed higher levels of JCP-specific IgE in nasal secretions than non-sensitized subjects. A significant moderate correlation was observed between JCP-specific IgE levels in nasal secretions and serum in all 43 subjects. With stratification by subject group, only symptomatic subjects showed a substantial correlation between JCP-specific IgE levels in nasal secretions and serum., Conclusions: Our results imply a certain association between JCP-specific IgE in nasal secretions and sensitization of Japanese cedar pollinosis. Therefore, levels of allergen-specific IgE in nasal secretions can be used as an alternative diagnostic marker for allergic rhinitis patients.

Background: Methylated catechin, one of the active ingredients in green tea, has been reported to ameliorate allergic reactions. We evaluated the efficacy of 'Benifuuki' green tea, which contains O-methylated epigallocatechin-3-O-[3-O-methyl] gallate (O-methylated EGCG), in alleviating Japanese cedar pollinosis (JCP)., Methods: The study was a double-blind, randomized, placebo-controlled trial. The subjects with JCP were randomly assigned to drink 700ml of 'Benifuuki' green tea containing O-methylated EGCG or 'Yabukita' green tea (not containing O-methylated EGCG) as a placebo every day from December 2007 through March 2008, which includes the pollen season. The primary outcome was the area under the curve (AUC) of symptom scores during the peak pollen season., Results: Fifty-one adults with JCP participated in the study. Twenty-six subjects were assigned to 'Benifuuki' and 25 to 'Yabukita'. The AUC of symptom score during the peak pollen season in the 'Benifuuki' group was significantly smaller than in the 'Yabukita' group for each of runny nose, itchy eyes, tearing, total nasal symptom score, total ocular symptom score, nasal symptom-medication score and ocular symptom-medication score. The total QOL-related questionnaire score for one week in the peak pollen season was significantly better in the 'Benifuuki' group. Increase in the peripheral eosinophil count in response to pollen exposure was suppressed in the 'Benifuuki' group. No adverse events were reported in either group., Conclusions: 'Benifuuki' green tea containing a large amount of O-methylated EGCG reduced the symptoms of JCP and has potential as a complementary/alternative medicine for treating seasonal allergic rhinitis.

Objective: Japanese cedar pollinosis is increasing rapidly in Japan. Although analysis has been made concerning the factors influencing the development of the cedar pollinosis, analysis concerning the risk factors influencing the sensitization in asymptomatic subjects has not been done., Methods: Risk factors for sensitization to Japanese cedar pollen were analyzed among 73 subjects (32 men and 41 women) who do not develop symptoms of pollinosis at the time of Japanese cedar pollen scattering. Their ages ranged from 18 to 60 years with the mean of 34.1 years. Possible factors influencing sensitization were investigated through a written questionnaire and doctors' questioning. Japanese cedar-specific IgE titers and Dermatophagoides pteronyssinus-specific IgE titers in the serum were measured by CAP-FEIA (fluorescent enzyme immunoassay)., Results: Of the 73 subjects, 26 were sensitized to the Japanese cedar pollen, for a 36% sensitization rate. Among the eleven factors examined, only one factor was shown to significantly influence the sensitization rate to Japanese cedar pollen. It was sensitization to house dust mites (56.5% vs. 26.0% χ(2) value=6.27, p=0.012). The sensitization rate to the pollen did not correlate to the presence of other allergic diseases, history of rhinosinusitis, family history of Japanese cedar pollinosis, food preference, presence or absence of cedar trees in the surroundings, present living circumstances, childhood circumstances, age, sex, or smoking habits. We calculated odds ratios in order to estimate how much those factors influence the sensitization to Japanese cedar pollen. Significantly high odds ratio for sensitization to house dust mite (6.63; 95% confidence interval (CI): 1.76-32.2) was found., Conclusion: The present study indicates that sensitization to the pollen in the subjects without pollinosis is influenced by sensitization to house dust mite., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

To initiate, monitor, and complete effective immunotherapy, biomarkers to predict and visualize the immune responses are needed. First, we need to identify the right candidate for immunotherapy. Secondly, the immune responses induced by immunotherapy should be monitored. For the first objective, analysis of polymorphisms of candidate genes may be helpful, but still be in development. Regarding biomarkers for immune responsese, there are numerous reports that evaluate immunotherapy-induced immune changes such as suppression of effector cells, deviation to Th1 cytokine production, and induction of regulatory T cells. No standardized methods, however, have been established. Among them, a functional assay of blocking IgG activity, the IgE-facilitated allergen binding assay, may be useful. We quantitated induced expression of an activation marker, CD203c, on basophils and found that the assay efficiently predicts sensitivity to particular allergen and severity of the allergen-induced symptoms. In patients who received rush immunotherapy for Japanese cedar pollinosis, reduction in CD203c expression after the therapy was observed, suggesting the utility of the test for monitoring immunotherapy.

Background: Rush immunotherapy (RIT) can confer rapid clinical benefit on patients with allergic rhinitis or asthma. However, biomarkers representing mechanisms for the efficacy of RIT are still to be established. CD203c is a basophil activation marker known to be upregulated by cross-linking of the FcepsilonRIalpha receptor and may serve as a useful marker., Objective: We sought to investigate the changes in allergen-induced CD203c expression in patients with Japanese cedar pollen (JCP) pollinosis who received RIT., Methods: Nine patients treated with RIT were enrolled in the study. Whole blood was incubated with various concentrations of JCP extract. CD203c expression on basophils was quantitated by means of flow cytometry. JCP-specific IgG4 levels in sera were measured with ELISA. Basophil histamine release, CAP-RAST to JCP (JCP-IgE) and total IgE were also examined. The biomarkers listed above were evaluated before and sequentially after RIT. Symptom and quality of life scores were obtained during pre- and posttreatment pollen seasons., Results: All patients showed significant improvement in symptom and quality of life scores after RIT. Serum JCP-specific IgG4 titers were significantly elevated at 1 month and remained at high levels 12 months after the treatment. Stimulation with JCP extract induced enhancement of basophil CD203c expression in a concentration-dependent manner except for 2 subjects in whom no increase in CD203c by an anti-IgE antibody was observed (nonresponders). Significant reductions in the responses were observed in 4 subjects after RIT (reduction in CD203c expression, RCE) whereas no changes were seen in 3 subjects (non-RCE). RCE subjects were older than non-RCE counterparts, with mean ages of 20 and 12 years, respectively. No significant changes in JCP-specific IgE and total IgE levels were seen before and after RIT., Conclusion: Allergen-induced CD203c expression in basophils may represent, at least in part, the cellular mechanism for the therapeutic responses to RIT for JCP pollinosis. However, further larger-scale studies to confirm the utility of the test are necessary., (Copyright 2008 S. Karger AG, Basel.)

Background: In Japan, morbidity of Japanese cedar pollinosis has dramatically increased, especially in children. However, little is known about the prevalence of pollinosis and sensitization to Japanese cedar pollen (JCP) in young children., Objective: The aim of this study is to investigate the prevalence of sensitization to JCP in allergic and non-allergic children from infancy to adolescence., Methods: Two hundred forty three children with allergic diseases (age 8 months-16 years, mean 5 years) and 137 children without allergic diseases (age 1 month-15 years, mean 4 years) were recruited. Their specific IgE to JCP, house dust mite, orchard grass pollen, egg white, and milk were measured with the CAP-RAST system. A questionnaire was filled out by their parents., Results: The percentage of positive (> or = 2) CAP-RAST to JCP was 47.1% in children with allergic diseases and 19.9% in children without allergic diseases. In children with allergic diseases, the ratio had risen rapidly from 3 to 5 years old. In children without allergic diseases, the ratio of JCP sensitization has gradually increased from the infancy to adolescence. The youngest child who had been sensitized to JCP was 23-month-old boy with atopic dermatitis. The proportion of children who were born from January to march was significantly higher in JCP sensitized group than JCP non-sensitized group. The ratio of house dust mite and orchard grass pollen sensitization was higher in JCP sensitized group than those in JCP non-sensitized group., Conclusion: Large number of children acquire sensitization to JCP in their preschool age. We need to develop the way how to protect JCP sensitization in the early stage of life.

Background: Bronchial asthma is often complicated with allergic rhinitis (AR)., Objective: To investigate the relationship between the upper and lower airway diseases in children with asthma, we performed a questionnaire survey at 6 centers in Kinki area in Japan., Methods: A questionnaire was filled out by parents of 333 asthmatic children (0-16 years, median age 7). It included questions concerning nasal symptoms, onset ages of rhinitis and asthma, correlation between nasal symptoms and asthma symptoms, and family history of allergic diseases., Results: One hundred and fifty five (46.5%) subjects answered to have any nasal diseases; 20 with sinusitis, 46 with seasonal AR, and 119 (35.7%) with perennial AR. To further clarify the relationship of asthma and concomitant AR, we focused on patients with perennial AR and compared the clinical characteristics with patients with no nasal diseases. Percentage of non-atopic asthma was significantly lower in patients with comorbid AR than those without. Severity of asthma tended to be milder and family history of perennial AR was more often in the former than the latter group. Interestingly, asthmatic children with comorbid AR were more likely to have cold air-induced asthma exacerbations. In the subjects with comorbid AR, concomitant exacerbation of the upper and lower airways occurred in 38.7%. The median age of onset of asthma and nasal symptoms was 2 and 4 years, respectively. In 43.9% of them, upper airway symptoms started either before or simultaneously with asthma., Conclusion: The attention should be paid to the nasal symptoms in children with asthma, especially they have atopic asthma and positive family history of perennial allergic rhinitis. It is important that an appropriate diagnosis and treatment of nasal symptoms to better control asthma in children.