进入2000年代，发现了以成人发病，双侧鼻窦炎，嗅觉障碍，外周血中嗜酸性粒细胞高，支气管哮喘合并为主要征的慢性鼻窦炎，春名等人提出了嗜酸性粒细胞性鼻窦炎。2014年确立了诊断标准，2015年7月被厚生劳动省登记为不治之症。作为上呼吸道的慢性炎症的嗜酸性粒细胞性鼻窦炎和作为下气道的慢性炎症的支气管哮喘，被认为是one airway one disease这一病态共同存在的气道炎症疾病。患率高合并。作为病理之一，作为获得性免疫应答的2型辅助性T细胞(Th2)，作为自然免疫应答的2型自然淋巴细胞(innate lymphoid cells type 2:ILC2)的IL-5的嗜酸性粒细胞诱导引起了气道炎症，但其全貌尚不明确。另外，众所周知，嗜酸性粒细胞性鼻窦炎合并的支气管哮喘多为阿司匹林哮喘，但其与阿司匹林不耐的关联性尚未明确。相对地，阿司匹林哮喘很早就发现合并了鼻蘑菇和嗅觉障碍，几乎所有被诊断为阿司匹林哮喘的患者都合并了嗜酸性粒细胞性鼻窦炎。阿司匹林哮喘患者的阿司匹林发作有时伴有意识障碍，导致死亡的例子也不少。因此，对于没有阿司匹林不耐的普通支气管哮喘患者，无论有无药物过敏史，都不应投与NSAIDs，这已成为目前整个医疗界的惯例。但是，相反，对于容易合并阿司匹林哮喘的嗜酸性粒细胞性鼻窦炎患者不使用NSAIDs，这一点并没有被广泛知晓。在具有鼻茸的病例中含有嗜酸性粒细胞性鼻窦炎的情况很多，而且，已知嗜酸性粒细胞性鼻窦炎中有很多阿斯皮林哮喘患者。因此，对于患有鼻蘑菇的病例，NSAIDs的处理必须慎重。此次经历了无NSAIDs过敏史，也未合并支气管哮喘的嗜酸性粒细胞性鼻窦炎患者的阿司匹林哮喘发作。如上所述，阿司匹林哮喘发作的支气管狭窄是严重的，有时还会导致死亡。考虑到患有鼻菇的患者中潜在存在对阿司匹林不耐受的患者，可以起到预防哮喘死亡的作用。在报告病例的同时，提醒注意NSAIDs的使用方法。
{"title":"How to use NSAIDs for patients with nasal polyps","authors":"T. Matsuyama, Hiroe Tada, K. Chikamatsu","doi":"10.5648/jjiao.37.229","DOIUrl":"https://doi.org/10.5648/jjiao.37.229","url":null,"abstract":"2000年代に入り, 成人発症, 両側鼻茸, 嗅覚障害, 末梢 血中好酸球の高値,気管支喘息の合併を主徴とする慢性副 鼻腔炎がみつかり,春名らにより好酸球性副鼻腔炎と提唱 された。2014年に診断基準が確立し,2015年 7月には 厚生労働省の指定難病として登録されている。この上気道 の慢性炎症である好酸球性副鼻腔炎と下気道の慢性炎症で ある気管支喘息は,one airway one diseaseという病態が共 通する気道炎症疾患であるとの概念が確立され,互いの疾 患は高率に合併する。その病態の一つとして,獲得免疫応 答である 2型ヘルパー T細胞 (Th2),自然免疫応答である 2型自然リンパ球(innate lymphoid cells type 2: ILC2) によ る IL-5の好酸球誘導が気道炎症を引き起こすことが考え られているが,その全貌は明らかになっていない。また, 好酸球性副鼻腔炎に合併する気管支喘息はアスピリン喘息 であることが多いことが知られているが,そのアスピリン 不耐との関連性に関してもいまだ明確にされていない。 対して,アスピリン喘息では早くから鼻茸や嗅覚障害が 合併することがわかっており,アスピリン喘息と診断さ れた患者のほぼ全例に好酸球性副鼻腔炎を合併している。 アスピリン喘息患者のアスピリン発作は時に意識障害を伴 うほどの大発作となり,死につながる例も珍しくない。そ のため,アスピリン不耐のない通常の気管支喘息患者に対 しても薬剤アレルギー歴の有無に関係なく,NSAIDsを投 与しないことは現在医療界全体で通例となっている。しか し,反対にアスピリン喘息を合併しやすい好酸球性副鼻腔 炎の患者に対してNSAIDsを投与しないことは広く周知さ れていない。鼻茸を有する症例の中には好酸球性副鼻腔炎 が含まれることが多く,また,好酸球性副鼻腔炎の中にア スピリン喘息患者が多いことが知られている。このため, 鼻茸を有する症例に対してはNSAIDsの取り扱いに慎重を 期する必要がある。 今回,NSAIDsアレルギー歴がなく,気管支喘息も合併 していない好酸球性副鼻腔炎の患者のアスピリン喘息発作 を経験した。上述のように,アスピリン喘息発作の気管支 狭窄は重症であり,時に死につながる可能性もある。鼻茸 を有する患者の中には,潜在的にアスピリン不耐の患者が 存在することを念頭に置くことは,喘息死の予防の一翼を 担うと考えられる。症例報告と共に,鼻茸患者に対する NSAIDsの取り扱い方に関して注意喚起を行う。","PeriodicalId":204414,"journal":{"name":"Journal of Japan Society of Immunology & Allergology in Otolaryngology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114684118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aiko Oka, Shougo Oyamada, Shinichiro Oka, Sakiko Hurutate, Masahiro Takahashi, S. Iwasaki, Maki Akamatsu, Y. Noguchi, S. Kariya, Kengo Kanai, S. Makihara, K. Nishizaki, M. Okano
Background: Prevalence of sensitization to insects and its clinical and immunological features remains largely unclear in Japan. Patients and methods: The study includes 524 patients (316 from International University of Health and Welfare (IUHW) Mita Hospital in Tokyo and 208 from IUHW Hospital in Tochigi) who complained of nasal symptoms and underwent ImmunoCAP IgE tests. We compared the ratio of insect sensitization (moth, chironomid and cockroach) in Tokyo and Tochigi and investigated the clinical and immunological features of the patients, focusing particularly on those with sensitization to insects alone. Results: The ratio of sensitization to moth, chironomid and cockroach were 30.7%, 10.0% and 10.6% in Tokyo, and 26.4%, 10.6% and 12.5% in Tochigi, respectively. The geographical comparison showed no significant difference. Among the insect allergic patients, 95.1% were sensitized to the moth. In comparison to those insensitive to arthropods, the group of patients sensitized to insects was male dominant and indicated higher total IgE. The group of those sensitized only to insects was relatively older than that of those sensitive to not only insects but also other inhaled allergens. Conclusion: The study showed the high ratio of sensitization to the moth carried significance of the moth as an allergen in allergic rhinitis. The ratio of insect sensitization showed no significant different between urban and rural area. Patients sensitized to insects alone were dominated by elderly male with high total IgE.
{"title":"Sensitization to insects in urban or rural area, and their clinical and immunological features","authors":"Aiko Oka, Shougo Oyamada, Shinichiro Oka, Sakiko Hurutate, Masahiro Takahashi, S. Iwasaki, Maki Akamatsu, Y. Noguchi, S. Kariya, Kengo Kanai, S. Makihara, K. Nishizaki, M. Okano","doi":"10.5648/jjiao.38.57","DOIUrl":"https://doi.org/10.5648/jjiao.38.57","url":null,"abstract":"Background: Prevalence of sensitization to insects and its clinical and immunological features remains largely unclear in Japan. Patients and methods: The study includes 524 patients (316 from International University of Health and Welfare (IUHW) Mita Hospital in Tokyo and 208 from IUHW Hospital in Tochigi) who complained of nasal symptoms and underwent ImmunoCAP IgE tests. We compared the ratio of insect sensitization (moth, chironomid and cockroach) in Tokyo and Tochigi and investigated the clinical and immunological features of the patients, focusing particularly on those with sensitization to insects alone. Results: The ratio of sensitization to moth, chironomid and cockroach were 30.7%, 10.0% and 10.6% in Tokyo, and 26.4%, 10.6% and 12.5% in Tochigi, respectively. The geographical comparison showed no significant difference. Among the insect allergic patients, 95.1% were sensitized to the moth. In comparison to those insensitive to arthropods, the group of patients sensitized to insects was male dominant and indicated higher total IgE. The group of those sensitized only to insects was relatively older than that of those sensitive to not only insects but also other inhaled allergens. Conclusion: The study showed the high ratio of sensitization to the moth carried significance of the moth as an allergen in allergic rhinitis. The ratio of insect sensitization showed no significant different between urban and rural area. Patients sensitized to insects alone were dominated by elderly male with high total IgE.","PeriodicalId":204414,"journal":{"name":"Journal of Japan Society of Immunology & Allergology in Otolaryngology","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117300942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Arachidonic acid metabolites-induced activation of group 2 innate lymphoid cell in eosinophilic upper airway inflammation","authors":"I. Tojima, Takeshi Shimizu","doi":"10.5648/jjiao.37.217","DOIUrl":"https://doi.org/10.5648/jjiao.37.217","url":null,"abstract":"","PeriodicalId":204414,"journal":{"name":"Journal of Japan Society of Immunology & Allergology in Otolaryngology","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130861225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"挨拶","authors":"","doi":"10.5648/jjiao.38.s1","DOIUrl":"https://doi.org/10.5648/jjiao.38.s1","url":null,"abstract":"","PeriodicalId":204414,"journal":{"name":"Journal of Japan Society of Immunology & Allergology in Otolaryngology","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124858773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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