pollen
amount1.
Hay Fever (Allergic rhinitis)
From the middle 10 days of January,
cases complaining of allergy to cedar pollen have been reported.
Hay Fever is the name of a syndrome with allergic rhinitis and
allergic conjunctivitis, and its cause is various such as cedar
pollen, Japanese cypress, tall goldenrod and some true grasses,
in addition mold, ticks and housedust etc are important allergen
of these diseases.
1. Diagmosis
and Examination of Hay Fever
@(1) Immunological examination : IgE of specific
antigen to the target pollen
@(2)
Otolaryngological and Ophthalmological examination
2. Treatment
@(1) Symptomatic
Therapy
@(2) The Early
Treatment
@(3) Radical Treatment
3. Prevention of Hay Fever
1. Diagmosis
and Examination of Hay Fever(1) Immunological examination : Ig-E of specific
antigen to the target pollen
1. Intradermal
reaction test and skin scratch test
2. Diagnosis
is done by checking the Ig-E antibody in blood, and there are
some method such as CAP-RAST, MAST, FAST etc. The Ig-E RAST is
the common examination method in Japan and we can check various
antibody by this method at our clinic. They (house-dusts, food
and ticks etc) can be the causes of allergic rhinitis, asthma
bronchiale due to allergy, allergic dermatitis including atopic
dermatitis.
(2) Otolaryngological and Ophthalmological
examination
An otolaryngologist can do this
examination to check allergic reaction of nasal mucous membrane
directly by putting allergen patch on the membrane. And Ophthalmologist
can do almost same examination at conjunctiva.
2. Treatment
There
are 2 treatment ways, one is symptomatic therapy which reduces
the present symptoms, and the other is radical therapy which cure
the patient radically.
(1) Symptomatic
Therapy
To reduce patients'
complaints, doctors use various types of medicine and their combination
such as anti-histamine drugs (the 1st and the 2nd generation),
the inhibitors to release the chemical transmitter (anti-allergic
medicine), Th2-cytokine blockers etc with combination of eye-drops
and nose-drops in case of necessity.
(2) The
Early Treatment
The
early treatment using the 1st generation anti-histamine drugs,
the inhibitor to release the chemical transmitter and Th2-cytokine
blockers 2 - 4 weeks before pollen scattering season is common,
and it is known to get good result for treatment. Another reason
is that these drugs don't work at once.
clinical symptompollen
amount
Comparison of between cases
with early treatment and cases without early treatment
@@@@@@@@@@Red
line : cases without early treatment
@@@@@@@@@@Blue
line : cases with early treatment
Various Drugs
1. Anti-histamine drugs
Anti-histamine drugs inhibit the action of histamine
which is a cause of allergic reaction by binding to histamine
receptor at the target area of the reaction previously. Anti-histamine
drugs work as a sedative, so patient may feel general malaise
and sleepiness though there are differences between individuals.
There are 2 types of anti-histamine drugs, one is the 1st generation
drugs and the other is the 2nd generation drugs. The 1st generation
of anti-histamine drugs work at once but they have some side effects
mentioned above, on the other hand, the 2nd generation of anti-histamine
drugs work slowly though side effect is rare. These drugs have
70% therapeutic effect in cases of hay fever with sneezing and
snivel.
2. Inhibitor of the chemical transmitter
releasing
Inhibitor of chemical transmitter
releasing works as stabilizer of mast cells which are related
with allergic reaction, and works to inhibit chemical transmitter
as histamine to move out of the cells. It has no side effect as
sleepiness because it has no sedative action, but there are some
gastroenteric disorders as the side effect. The effectiveness
is reported as 60%, and it is good for the early treatment.
RDleukotriene receptor antagonist
Leukotriene
receptor antagonists inhibits the exasperation of the vascular
permeability, vasodilatation and membrane permeability at the
nose mucous membrane, so it works to inhibit nasal obstruction,
snivel and sneezing. Furthermore, leukotriene receptor antagonist
inhibits the inflammation of the airway, bronchial contraction
and bronchial hypersensitivity, so it is used to treat asthma.
This drug is effective for especially nasal obstruction in cases
of moderate and serious allergic rhinitis.
S.
Th2-cytokine blockers
Th2-cytokine blocker
controls cytokine produced by lymphocytes which control mast cells
related with allergic reaction, and it does not work to histamine
and mast cells. This drug has also 10% of gastroenteric disorders
as the side effect, and it does not work at once, but it is good
for the early treatment by the same reason as the inhibitor of
chemical transmitter releasing.
T. Local treatment
by Steroid
Steroid is effective for all symptoms
of hay fever such as snivel, nasal obstruction and sneezing etc.
and it has very rare side effect because steroid itself does not
enter in the blood.
U. Anticholinergic drugs
Anticholinergic drugs block a chemical called
a neurotransmitter receptor of the parasympathetic nervous system
and inhibit rhinorrohea especially, so the effectiveness of the
anti-snivel action is more than 80% but there is no effectiveness
to nasal obstruction. However, there are some side effects such
as thirsty, urinary disturbance in a case of prostate hypertrophy
and deterioration in a case of glaucoma, so we have to select
cases.
V. Vasoconstrictor
Vasoconstrictor stimulates
the sympathetic nervous system and suppresses the vessels dilatation,
so it is very effective for nasal obstruction. it has no effect
for snivel and sneezing at all. But its overdose sometimes makes
the symptom be worse, so it is uses as a drug to be taken at one
draft.
(3) Radical Treatment
1. Hyposensitization therapy
It
is ideal as the radical treatment to avoid and remove pollen perfectly,
but it is impossible in actuality. So the hyposensitization therapy
is adapted to the serious cases with hay fever. The hyposensitization
therapy is called the immunotherapy of the specific antigen, and
a patient will get the extract of the pollen of which consistency
should be increased gradually in order to acclimate [acclimatize]
oneself to the pollen (to get the immunity against the pollen).
The treatment should be begun 3 months before the season of hay
fever and should continue at least for 2 years. The sixty percent
of the patients who have undergone this therapy have been satisfied,
but there are some cases with no effectiveness. You should hear
a detail explanation from your doctor about its effectiveness
and side effect such as allergic reaction, hives and the deterioration
of asthma etc.
2. Immunotharapy
@
@ Antigen labeled
with other materials
@
A Immunotherapy by other
method except injection (pills, nose drops and sublingual medicine
etc)
@
B Immunotherapy using Peptide which only
T-cell (lymphocyte) can be reactive
@
C Gene immunotherapy
: now under animal trials
@
D Anti-IgE therapy and
anti-cytokine therapy : clinical trials have been finished in
America.
3.
Prevention of Hay Fever
The prevention
options are classified into the conservative therapy and radical
therapy same as treatment. The early treatment using the 2nd generation
anti-histamine drugs, inhibitors of the chemical transmitter releasing
and Th2-cytokine blockers before hay fever season is one of the
effective prevention method, and this treatment will shorten the
duration of therapy. And it is also effective to know the
information about pollen scattering (cedar pollen in Japan)
and adopt a proper preventive method personally.
Prevention
measure
(1) Goggles : Goggles inhibits
pollen volume to half amount, and 10 - 20% of effectiveness is
reported. The contact lenses sometimes wounds on the conjunctiva
so it is better to wear glasses in this season.
(2)
Mask : Wearing a flu mask is also effective. A flu mask
can reduce pollen to enter the nasal cavity to 1/3 and a mask
for hay fever can reduce pollen amount to 1/5.
(3)
Clothes : Woolen clothes have a tendency to carry pollen.
(4) Washing face : Washing nose and eyes is
sometimes effective to reduce symptoms.
(5) Others
: Prevention of common cold
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