Hirokuni Otsuka

Changes in nasal metachromatic cells during allergen immunotherapy

We have investigated changes of nasal metachromatic cell number, nasal symptoms and nasal provocation at the third and sixth month during allergen immunotherapy. Twenty‐five subjects with perennial allergic rhinitis (house dust (23), Alternaria (2)) were divided into two groups: an immunotherapy‐treated group (n= 14) and a control group (n=11). At the first visit nasal symptom scores, nasal provocation reactions and the number of metachromatic cells in nasal mucosal epithelial scrapings were not significantly different between groups. At the third and sixth month after immunotherapy nasal symptom scores, nasal provocation and the metachromatic cells in epithelial scrapings were significantly reduced (P < 0.05) compared with the pretreatment values in the immunotherapy group, but unchanged in the control group. These results suggest that the reduction in metachromatic cell number at the nasal mucosal surface may be one of the mechanisms which could explain the improvement of nasal allergic symptoms by immunotherapy.

Basophilic cells in allergic nasal secretions.

SummaryEvidences on the important role of tissue mast cells in inducing allergy have accumulated. These cells are known to be present in nasal secretion but have not been well studied. In the present study basophilic cells containing granules which stained metachromatically appeared in the nasal secretion in various kinds of inhalant allergy. An increase in their number was observed after nasal provocation and during the pollinosis season and showed a decrease after a course of immunotherapy or during the off-season of pollinosis. They were well correlated in degree with nasal symptoms, nasal eosinophilia, and nasal provocative reactions. These results suggest that the appearance of the basophilic cell in nasal secretion is related to their specifity in nasal allergy. The possibility of onset of nasal allergy due to the release of chemical mediators from basophilic cells in nasal secretion was discussed.

Mast cell quantitation in nasal polyps, sinus mucosa and nasal turbinate mucosa

The distribution and abundance of mast cells in nasal polyps, the maxillary sinus mucosa of patients with sinusitis and the turbinate mucosa of allergic rhinitis was microscopically examined using different methods of fixation. In the epithelium of the surface and the ducts of nasal polyps (n = 8), the mean number of mast cells was over 20,000 per mm3 using Motas fixation and the increase was correlated with the epithelial thickness (P < 0.05). On the other hand those of the maxillary sinus mucosa (n = 6) and the nasal turbinate mucosa (n = 7) were less than 6,000 per mm3. In the subepithelial layer or areas deeper than the area with the glands, however, mast cell counts were less than 3,200 per mm3 in all diseases. More than 70-90 per cent of all mast cells in the epithelium of the mucosal surface and the ducts of the polyp, the maxillary sinus mucosa and nasal turbinates were formalin sensitive. Most of the mast cells in the subepithelial and deeper areas were formalin resistant in all diseases. These results suggest that conditions for mast cell growth differ between polyps and the other diseases, and that the conditions which affect mast cells may contribute to polyp development.

Electron microscope study of basophilic cells in allergic nasal secretions.

SummaryIn order to elucidate whether basophilic cells in nasal secretion belong to blood basophil or tissue mast cell, basophilic cells in the blood, nasal secretion, and nasal mucous membrane were electron microscopically observed in patients with house dust nasal allergy. The majority of basophilic cells in the nasal secretion was identical with the blood basophil in structure. The blood basophils pass through the vessels and emigrate in the mucous blanket in allergy.

Effect of anti-allergic treatment on nasal surface basophilic metachromatic cells in allergic rhinitis.

The nasal surface basophilic metachromatic cells increase in allergic rhinitis and play an important role in the manifestation of nasal symptom. Their numbers were decreased in good correlation with the severity of symptom and nasal provocation reaction after clinical treatment with specific immunotherapy or topical steroid, beclomethasone dipropionate. The percentages of allergen induced histamine release from these cells were not changed after clinical treatment with cromolyn sodium.

Involvement of Staphylococcus aureus and Moraxella catarrhalis in Japanese cedar pollinosis.

Background and Objective From mid February to the end of March, each year ∼30% of Japanese have Japanese cedar pollinosis. Moreover, 10–50% of patients with this pollinosis exhibit nasal manifestations in the preseason. These patients have a predominance of neutrophils but not eosinophils in nasal swabs and high carriage of Staphylococcus aureus. We hypothesized that S. aureus or other bacteria and associated neutrophilia were involved in preseasonal symptoms. Methods Cytology and bacterial colony growth were assessed in nasal swabs in the groups of asymptomatic patients in the preseason (PreAsP) (n = 53) and symptomatic patients in the preseason (PreSyP) (n = 60), and in group of symptomatic patients in season (InSyP) (n = 72). Results In the preseason, high neutrophilia was present in only 20% of the PreAsP group but in 47% of the PreSyP group (p < 0.01). Nasal carriage of S. aureus in the PreAsP and PreSyP groups were 79%, 75%, respectively, whereas, for Moraxella catarrhalis, these were 9% versus 25% (PreAsP versus PreSyP group; p < 0.05). In patients with positive results for S. aureus and M. catarrhalis, the degrees of neutrophilia (-, ∓, +, 2+, 3+) in the PreSyP group were larger than in the PreAsP groups (p < 0.01). In the PreSyP group, the magnitude of neutrophilia was greater (p < 0.05) in subgroups with more colonies of S. aureus than in subgroups with fewer colonies. Conclusion Nasal symptoms in the preseason are associated with neutrophilia and nasal colonization with S. aureus and M. catarrhalis. Patients with symptoms in the preseason had improved symptom scores when given prophylactic treatment early in season but had more-severe symptom scores late in season than asymptomatic patients in the preseason. Neutrophil-associated tissue damage related to bacterial colonization may underlie these associations.

Assessing the Onset of Allergic Rhinitis by Nasal Cytology and Immunoglobulin E Antibody Levels in Children

Background It is difficult to identify the onset of allergic rhinitis in infants because making a conclusive diagnosis can be challenging. Objective We used a combination of cell differentials in nasal swabs and immunoglobulin E (sIgE) antibody values to food and inhalant allergens to make the diagnosis and identify relevant allergens for investigation of the onset of allergic rhinitis. Methods We studied 302 children, 2 to 120 months old, who visited our clinic for rhinorrhea. Nasal swabs were taken from all children, and neutrophils (N), eosinophils (Eo), and mast cells (Mc) were identified by nasal cytology and their numbers were estimated. Levels of sIgE antibodies to various food and inhalant allergens were determined in patients with nasal Eo and Mc. Results Percentages of participants with Eo-Mc and Eo-Mc-N at 2–14 (n = 84), 15–24 (n = 57), 25–60 (n = 73), and 61–120 months of age (n = 88) were 20, 23, 58, and 65%, respectively. There were no significant differences between the 2–14 and 15–24, and 25–60 and 61–120 months age groups, but there was a significant difference between the 15–24 and 25–60 months age groups (p = 0.00013). The percentages of participants with sIgE antibodies to food and inhalant allergens as solitary or main allergen were 12%/0% at 2–14 months old, 10.5%/7% at 15–24 months old, 1.3%/42.4% at 25–60 months old, and 0%/56.8% at 61–120 months old, respectively with a significant difference between 15–24 and 25–60 months old groups (p = 0.00025) for inhalant allergens. Conclusion Allergic rhinitis associated with inhalant allergens in infants <15 months of age is rare, but it is tempting to postulate that symptoms of rhinitis in these infants may be associated with sIgE antibodies to food allergens. Transition of sIgE responses from food to inhalant allergens occurred after 15 months of age, and sIgE antibodies to inhalant allergens were predominant after 25 months.

Are respiratory viruses involved in preseasonal symptoms or severity in Japanese cedar pollinosis

Background Respiratory virus infections are involved in asthma exacerbations. However, there are no reports of the relationship between respiratory virus infections and Japanese cedar pollinosis. Objective We studied the relationship between respiratory viral infection and the appearance of preseasonal symptoms and the severity of seasonal symptoms in Japanese cedar pollinosis. Methods In 36 patients with asthma and with no symptoms (PreAsyP) and 54 patients with asthma and with symptoms (PreSyP) before the cedar pollen shedding commenced (preseason), and 37 patients with mild-to-moderate severity (InMild/Mod) and 45 patients with severe to extreme severity (InSev/Ext) after cedar shedding commenced (in season), the occurrence of respiratory viruses and nasal smear cytology were examined. Results In total, seven infections with respiratory viruses were detected among the subjects. Human rhinovirus (HRV) C infection was detected in one subject in each of the PreAsyP and PreSyP groups, and one HRVA infection occurred in the InMild/Mod group. In the InSev/Ext group, one HRVA, one HRVC, one respiratory syncytial virus, and one human metapneumovirus were detected. There was no significant difference in the rate of detection of viral infections between the PreAsyP and the PreSyP groups (p = 0.077), and between the InMild/Mod group and the InSev/Ext group (p = 0.24, Wilcoxon rank sum test). When cells types in nasal smears were identified and their abundance examined, the rate of neutrophilia in the subjects in the PreSyP group was 54%, which was statistically higher (p < 0.01) than the subjects in the PreAsyP group (25%). Interestingly, in the subjects in the InSev/Ext group, the proportion of eosinophils (40%) was larger (p < 0.05) than in the subjects in the InMild/Mod group (19%). Conclusion These results provided no evidence that respiratory virus infections contributed to preseasonal symptoms and severity in season of Japanese cedar pollinosis. Nasal neutrophilia was related to preseasonal symptoms, whereas nasal eosinophilia was related to severity of symptoms during the pollen season.

Clinical Efficacy of Oxatomide on Japanese Cedar Pollinosis. Results of Kanagawa Multicenter Study for 3 Years.

Atsushi Shinkawa, Hirosato Miyake and Makoto Sakai (Tokai University), Isamu Takeyama (St. Marianna University School of Medicine), Tetsuya Shitara (Kitazato University), Hirokuni Otsuka and Yasuo Hattori (Nippon Medical School, Dai-ni Hospital), Yoichi Ishizuka (Teikyo University School of Medicine, Mizonokuchi Hospital), Tetsuaki Kubota (Showa University School of Medicine, Fujigaoka Hospital), Hiroyuki Zusho (Kanto Rosai Hospital)

Quantification of Eosinophilia in Allergic Nasal Secretions

1. 鼻汁採取量が10mg以上のものと以下のものとは好酸球増多の grading で有意の差があった. 従って量の多い場合は10mg以上採取する必要があった.2. 鼻汁を分割してそれぞれの標本につき鼻汁重量と好酸球数とを調べたところ, 重量補正によっても好酸球数に標本間で差があった. 又全白血球中の好酸球の分布は視野によりまちまちであり標本間に差があった.3. これに比し程度判定法は標本間に差が少なかった.4. 程度判定法, 1視野平均 (400倍拡大率検鏡下) 好酸球数, %法の三方法を比較すると程度判定法と1視野平均好酸球数とがよく一致し, 判定法としてはこの二方法のいずれかがよいと考えられた. 後者は時間と労力を要するのに比し, 前者は客観性に欠ける面があった.5. 採取鼻汁で3枚のスメアを作り程度判定を行うのが臨床的には適当であった.