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.
and Examination of Hay Fever
@(1) Immunological examination : IgE of specific antigen to the target pollen
@(2) Otolaryngological and Ophthalmological examination
@(1) Symptomatic Therapy
@(2) The Early Treatment
@(3) Radical Treatment
3. Prevention of Hay Fever
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.
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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.
Comparison of between cases
with early treatment and cases without early treatment
line : cases without early treatment
line : cases with early treatment
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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.
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.
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(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.
@ @ 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.
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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.
(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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