Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren.

BACKGROUND: Patients allergic to pollen have been known to become more symptomatic during pollen season compared with the nonpollen season. However, there are few studies regarding whether higher exposure to pollen might increase the prevalence of allergic diseases. METHODS: An ecological analysis was conducted to evaluate whether pollen exposure is associated with the prevalence of allergic diseases in schoolchildren. Pollen count data of Japanese cedar (Cryptomeria japonica) and Japanese cypress (Chamaecyparis obtusa), which are the major pollen allergens in Japan, were obtained from each prefecture. The prevalence of allergic diseases in schoolchildren in each prefecture was based on a nationwide cross-sectional survey using the International Study of Asthma and Allergies in Childhood questionnaire. RESULTS: After omitting three prefectures where pollen data were not available, data of 44 prefectures were analysed. The prevalence of allergic rhinoconjunctivitis in children aged 6-7 years was positively associated with both cedar and cypress pollen counts (P = 0.01, both), whereas the prevalence of allergic rhinoconjunctivitis in children aged 13-14 years was positively associated with only cypress pollen counts (P = 0.003). Furthermore, the prevalence of asthma was positively associated with cedar pollen counts in 6- to 7-year-old children (P = 0.003) but not cypress pollen counts in either age group. CONCLUSIONS: There are ecological associations between pollen counts and the prevalence of allergic diseases in Japanese schoolchildren. Further studies are needed to determine whether the difference between the effects of cedar and cypress pollens is attributable to pollen counts or allergenicity.

The prevalence of rhinitis and its association with smoking and obesity in a nationwide survey of Japanese adults.

BACKGROUND: Rhinitis is a common disease, and its prevalence is increasing worldwide. Several studies have provided evidence of a strong association between asthma and rhinitis. Although smoking and obesity have been extensively analyzed as risk factors of asthma, associations with rhinitis are less clear. OBJECTIVE: The aims of our study were (i) to evaluate the prevalence of rhinitis using the European Community Respiratory Health Survey (ECRHS) questionnaire in Japanese adults and (ii) to evaluate the associations of smoking and body mass index (BMI) with rhinitis. METHODS: Following our study conducted in 2006-2007 to determine the prevalence of asthma using the ECRHS questionnaire, our present analysis evaluates the prevalence of rhinitis and its association with smoking and BMI in Japanese adults 20-79 years of age (N = 22819). We classified the subjects (20-44 or 45-79 years) into four groups as having (i) neither rhinitis nor asthma; (ii) rhinitis without asthma; (iii) asthma without rhinitis; or (iv) rhinitis with asthma. We then evaluated associations with smoking and BMI in each group. RESULTS: The overall age-adjusted prevalence of rhinitis was 35.1% in men and 39.3% in women. A higher prevalence was observed in the younger population than in the older population. Active smoking and obesity were positively associated with asthma without rhinitis. In contrast, particularly in the 20- to 44-year age-group, active smoking and obesity were negatively associated with rhinitis without asthma. CONCLUSION: The results of the present study suggest that smoking and obesity may have different effects on the development of rhinitis and asthma.

Psychosocial factors and adherence to treatment advice in childhood atopic dermatitis.

Poor adherence to maintenance treatment for atopic dermatitis and anxiety about using topical steroids are common features seen among children with atopic dermatitis and their mothers. No systematic study exploring factors associated with adherence to treatment advice on atopic dermatitis has been carried out to date. This study seeks to generate hypotheses regarding the relationship between a range of psychosocial factors and adherence to treatment advice on atopic dermatitis. An anonymous self-completed questionnaire containing adherence items, psychosocial items, some demographic items, and attitudes to steroid use was given to 258 mothers of atopic dermatitis follow-up patients who attended the National Children's Hospital, Tokyo. Responses from 205 families (80%) with complete data were then analyzed to explore the correlation between each factor and to build a structure equation model. The strongest predictor of adherence to skin-care treatment was a good doctor-patient (mother) relationship, followed by the severity of the disease as perceived by the mother. Surprisingly, the mother's anxiety about using topical steroids had no significant influence on reported use of topical steroids nor on adherence to skin-care treatment. This may have been overcome by the well-established doctor-patient (mother) relationship. Maternal personality, husband's cooperation, and social support were indirectly correlated with adherence via the doctor-patient relationship. Maternal self-efficacy of treatment was strengthened by good doctor-patient (mother) relationship.

RANTES production in a conjunctival epithelial cell line.

PURPOSE: Although corneal tissue damage in allergic ocular diseases is thought to be induced by inflammatory cells that infiltrate from conjunctival tissue, the mechanisms of recruiting these cells remain unclear. The objective of this study was to demonstrate whether conjunctival epithelial cells have the ability to produce "regulated on activation, normal T-cell expressed and secreted" (RANTES). To test this hypothesis, we investigated RANTES expression in the conjunctival tissue and also RANTES production by cytokine stimulation in a human conjunctival epithelial cell line. METHODS: We investigated the expression of the chemokine RANTES in conjunctival epithelium from two patients with atopic keratoconjunctivitis (AKC) and one patient with vernal keratoconjunctivitis (VKC) by using immunohistochemistry. We also investigated the production and suppression of RANTES from a human conjunctival epithelial cell line, Wong-Kilbourne-derived human conjunctiva (WK-hC) by using enzyme-linked immunosorbent assay (ELISA). RESULTS: Conjunctival epithelium from a patient with AKC stained positively for RANTES. We found that tumor necrosis factor-alpha (TNF-alpha) induced de novo production of RANTES, and interferon-gamma (IFN-gamma) synergistically increased the TNF-alpha-dependent production of RANTES from WK-hC cells. Dexamethasone suppressed the RANTES production from the cell line. CONCLUSION: Taken together, human conjunctival epithelial cells were capable of producing RANTES in response to inflammatory stimuli such as TNF-alpha and may play a role in recruiting inflammatory cells such as eosinophils and T lymphocytes toward the ocular surface.

[Investigation of the genetics in allergic children: the first report--Twin study on HLA in allergic disease].

Twenty-two twins' families were investigated to determine the influence of a genetic factor in the etiology of allergic diseases in children. Zygosity was confirmed by eight red cell blood types and HLA type. Eight pairs of monozygotic twins were divided by a probability of monozygosity as calculated from Essen-Möller's method. Concordance rate of allergic disease and asthma were 88% in MZ, 86% in DZ, 75%, 73% and that of positive rate of DF-specific IgE antibody were 60% in MZ, 58% in DZ. In DZ, not sharing the same HLA haplotypes, concordance of the positive rate of DF-specific IgE antibody was 0%. Concomitant coefficiency of total serum IgE levels were 0.593 in MZ, 0.063 in DZ. These data suggested that IgE production may be influenced by genetic factors.

[Investigation of the genetics of allergic children, the second report--family study to determine the major gene in allergic disease using affected sib pair method].

Twenty-six families with allergic siblings were investigated to define the mode of inheritance of asthma and DF specific IgE antibody production in children. The affected sib pair method was used to establish the linkage between disease susceptibility genes and HLA antigens. The affected sib pair method revealed that in asthmatic families chi 2 = 4.9 (no significance) and in DF-specific IgE positive families chi 2 = 6.2 (p less than 0.05). This study suggests that the gene of DF-specific IgE antibody production is linked to HLA haplotypes, but the mode of inheritance of DF-specific IgE antibody production couldn't be defined.

[The influence of indoor environmental factors on the onset of allergic disease].

To predict and prevent the onset of allergic diseases, we studied the effects of indoor environmental factors, such as diet, on pregnant women and carried out follow-up studies on their infants. Blood samples were collected at random from women who were diagnosed as pregnant (n = 2045). Umbilical cord blood was collected at delivery (n = 1453). To evaluate the efficacy of food guidance, the pregnant women were divided into two groups--one receiving simple diet guidance starting in the later stages of pregnancy, and one receiving no guidance whatsoever. A follow-up survey on allergic symptoms was done on their two-year-old infants, revealing a lower incidence of symptomatic manifestations in the diet guidance group (p < 0.001). Respiratory symptoms (p < 0.05) were associated with maternal smoking and outside work during pregnancy. A study on food guidance in combination with environmental factors revealed that the incidence of respiratory symptoms in two-year-old infants whose mothers received diet guidance in a good indoor environment was held down to around 36.1%, while the incidence in infants whose mothers received diet guidance in a poor indoor environment was 48.1%.

[Preventative effect of a whey hydrolyzed formula (Nestle, NAN H.A.) on the development of allergic symptoms in infants].

We examined the prevent effect of a whey hydrolyzed formula (NAN H.A.) on the development of allergic disease from new born infants. A hundred thirty three pregnant women were divided into the NAN H.A. group and the control group. Mothers, who agreed to use the whey hydrolyzed formula to their infant, were classified into the NAN H.A. group. We examined laboratory date such as IgE levels of these infants as well as clinical symptoms for evaluating of the preventive effect of NAN H.A. The serum IgE levels from infants of the NAN H.A. group were lower than those of the control group. The incidance of the infants who showed allergic clinical symptoms was significant lower in the NAN H.A. group. The odds ratio to skin symptom at 3 years of age with multiple logistic regression was 5.32 between the control group and the NAN H.A. group (p < 0.05). It was 6.68 between mother's history of allergy was positive and negative (p < 0.02). These results suggest that NAN H.A. can prevent the development of allergic symptoms in infants.

[Relationship between arterial blood gas tensions and a clinical scoring system in asthmatic patients].

We evaluated the relationship between blood gas tensions and a clinical scoring system in pediatric asthma patients, who were divided into two groups according to their ages (under 5 years and over 6 years). The clinical score was derived from Mitsui, which was constructed using reference only to clinical symptoms and signs. The clinical scores had a statistically significant correlation with PaO2, PaCO2, SaO2 and pH in both groups. However there were fluctuations between clinical score and blood gas tensions. A low clinical score did not exclude hypoxemia. There were no statistical differences between the two groups, but subjects under 5 years old showed better correlation. This scoring system is useful to evaluate the degree of asthma attack, especially severe attack, both in younger (under 5 years) and older (over 6 years) asthmatic patients.

[Safe administration of influenza vaccine in asthmatic children].

Thirty asthmatic children were examined allergic reaction against egg white, gelatin and vaccine solution before and after vaccination using skin prick test. We also measured the levels of specific IgE and IgG antibody against gelatin. The changes in clinical symptoms before and after vaccination were investigated in 25 asthmatic children by evaluating symptom and treatment score. The results were as follows; 1. In one subject who had delayed type of skin reaction to gelatin, the adverse reaction was also recognized at the skin site around 24 hrs after vaccination. In this subject, the levels of serum specific IgE and IgG to gelatin became positive after 5 months. 2. Specific IgE antibodies to gelatin were not detected in all subjects before and after vaccination. 3. The mean values of asthma symptom score before and after vaccination were 3.3 +/- 4.2 and 1.5 +/- 3.3 respectively. Those of treatment score before and after vaccination were 75.6 +/- 35.2 and 76.0 +/- 35.0 respectively. These results suggest that skin testing with gelatin and vaccine solution is useful as a screening method for predicting adverse reactions in asthmatic children and that influenza vaccination can be performed safely in skin test negative children.

The stimuli releasing histamine from murine bone marrow-derived mast cells. 2. Mechanisms involved in histamine release induced by extracellular ATP and its metabolites.

Extracellular ATP stimulated histamine release and generation of leukotrience C4 (LTC4) accompanied with the formation of inositol phosphates and a rapid increase in intracellular Ca2+ ([Ca2+]i) in mouse bone marrow-derived cultured mast cells (BMMC). The rank order of histamine-releasing potency of ATP and its metabolites is ATP greater than ADP greater than AMP greater than adenosine. Nonhydrolyzable ATP analog, adenosine-5'-O-[2-thiotriphosphate] (ATP-S) released more histamine from the cells than ATP. On the other hand, simultaneous addition of adenosine analogues at micromolar concentrations potentiated histamine release from the cells induced by ATP (50 microM) or DNP-HSA antigen (0.1 ng/ml) in the following rank order: adenosine greater than AMP much greater than ADP = ATP. Histamine release potentiated by adenosine was blocked by the treatment with pertussis toxin, whereas histamine release induced by ATP was not affected by the toxin, suggesting that extracellular ATP stimulate histamine release from BMMC probably via mechanisms independent of the potentiation of histamine release induced by adenosine.

Incidence of latex allergy in atopic children in Japan.

Many cases of latex-induced intraoperatived anaphylaxis have been reported in Europe and the U.S. but not in Japan. We measured latex-specific IgE antibody in sera from the 108 atopic children with high serum IgE levels (over 1,000 U/ml). All of them were diagnosed to have asthma, atopic dermatitis and/or food intolerance. Eleven (10.2%) out of 108 patients were found to have latex-specific IgE by RAST, and 6 of them were positive for latex antigen by skin test. Most of the children did not realize that they were allergic to latex until we discovered it. This data suggest that we should be cautious about latex allergy when atopic children have to be operated upon.

[Study of liver function in babies with atopic dermatitis by using 13C-methacetin breath test].

We measured serum GOT levels in babies with atopic dermatitis and food allergy. Two hundred and fourteen babies (133 male, 18 female, under 2 years of age) who first visited the Department of Allergy in the National Children's Hospital were examined. Their serum GOT levels were higher than normal; the younger they were, the higher the serum GOT levels were. We carried out the 13-methacetin breath test (MBT) on 11 babies with atopic dermatitis and high serum GOT levels as well as 5 normal babies to estimate their hepatic microsomal function. 13C-methacetin was administered (0.5 mg/kg) orally, and breath was collected at 30 minutes before and immediately before administration. After administration it was collected at 15 minute intervals for the first hour and 45 minute intervals for 90 consecutive minutes afterwards. The level of 13CO2 in their breath was determined with a mass spectrometer. The peak level of 13CO2 excretion (%dose/hr) in the atopic babies with high serum GOT levels was lower and the time required for 13CO2 excretion to reach its maximum level was longer than in normal babies. Also their 13CO2 clearance rate (%/hr) was lower. These results suggested that there was some relationship between atopic dermatitis and liver dysfunction in babies.

[The effect of sustained-release theophylline granules in the inhibition of exercise-induced asthma].

We studied the protective effect of sustained-release theophylline granules on early or late response in exercise-induced asthma (EIA) in 16 patients ranging in age from 7 to 18 years. A standardized exercise test was examined 2 hours after administration of theophylline granules on one day and after no medication on another day. On both days, the lung functions and the serum theophylline and cortisol concentrations of the patients were examined before exercise and over a period of 8 hours after exercise. On days without medication, early response was seen in 16 patients and late response in 6. On days with medication, the theophylline granules inhibited early response in 13 of the 16 patients and late response in 5 of the 6 patients. This suggests that theophylline preparation is a useful drug for inhibiting the dual responses of EIA.

[Studies of specific IgE and IgG antibodies in allergic children. Changes in specific IgE and IgG antibodies to egg white, milk, soybean and mite from children with atopic dermatitis].

Egg, milk, soybean, mite (DF)-specific IgG and IgE antibodies were measured in 276 atopic dermatitis children in whom dietary restrictions had never been done. We recommend cleaning house and bed clothes to decrease number of mites and elimination diet according to clinical symptoms and laboratory findings. After elimination periods (approximately 140 days) the same specific antibodies were examined again. In the patients who improved clinically by elimination of foods, the specific IgG antibodies to the foods decreased significantly. The other patients did not improved clinically suggesting that inadequate elimination diet were done and cleaning house and bed clothes was incomplete and/or other types of allergic reactions might exist.

[Does clinical stage have any influence on the results of provocation tests in allergic children? I. The best clinical stage for food provocation tests].

To investigate the best clinical stage for food provocation tests, twenty allergic patients who had early allergic reactions induced by any kind of food were tested. The patients were classified into two groups. Group I; open-food challenge tests were performed on eleven patients within 48 hours of admission. Group II; the tests were performed on nine patients seven or more days after admission. In these food provocation tests, there were nine positive results in Group II (p < 0.05). The percentage of eosinophils in the blood was higher in cases of positive provocation than in cases of negative provocation (p < 0.05). Moreover the percentage of eosinophils decreased after admission day by day in the provocation-negative patients of Group II, but there was no change in the provocation-positive patients. These results suggest that individual sensitivity to food decreased after admission. Therefore, in order to assess the actual sensitivity of allergic children it is necessary that food provocation tests be performed within two days of admission or before admission.