Involvement of Staphylococcus aureus and Moraxella catarrhalis in Japanese cedar pollinosis

Nasal Symptoms Reduction and Decreased Neutrophilia in Japanese Cedar Pollinosis With Prophylactic Treatment With a Combination of Montelukast, Fexofenadine, and Fluticasone Nasal Spray

Background and Objective

We reported neutrophil-associated tissue damage in cedar pollinosis subjects with refractory nasal symptoms prior to pollinosis season. Because the leukotriene receptor antagonist, montelukast, can inhibit neutrophil recruitment and activation, we investigated its effects on symptom relief and nasal neutrophilia in pollinosis subjects in the preseason.

Methods

In the pollinosis preseason, symptomatic (PreSyP, n = 149) and asymptomatic subjects (PreAsP, n = 145) were prophylactically treated, and in season symptomatic subjects (InSyP, n = 134) were treated. Individuals were assigned to 1 of 2 treatment protocols: administration of cetirizine and fluticasone nasal spray (Cet-Flu) or montelukast, fexofenadine, and fluticasone nasal spray (Mo-Fex-Flu). Differences in symptom relief and inflammatory cell infiltration in nasal swabs were investigated.

Results

In pollen season, 59% of PreSyP subjects given Cet-Flu and 88% of those treated with Mo-Fex-Flu had none or mild symptoms ( P < .00001). In PreAsP subjects in season, 71% of Cet-Flu and 98% of Mo-Fex-Flu recipients had none to mild symptoms ( P < .0000001). The proportions of subjects in the PreSyP group with nasal swabs with neutrophils 1+ to 3+ before and after treatment by Mo-Fex-Flu were 59% and 18%, respectively ( P < .0001), and in PreAsyP, subjects with neutrophils 2+ to 3+ were 17% and 5%, respectively ( P = .034). In PreSyP, a significant reduction in the percentage of subjects with mast cells >1+ was seen following both Cet-Flu ( P = .027) and Mo-Fex-Flu ( P = .0014) treatments.

Conclusion

In PreSyP and PreAsP subjects, treatments with Mo-Fex-Flu were more effective than Cet-Flu to reduce nasal symptom scores. These effects were associated with reduction in the number of neutrophils and mast cells in nasal swabs.

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.