8 20 symptom free 2 NEJM Clinical Practice fluticasone 1 2 fluticasone IgE 100U/ml 1819 Bostock 1 A Mycobacterium Toxoplasma
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1 The Lancet, vol 378, Dec.17/24/31,2011 Alexander N Greiner USA Peter W Hellings, Guiseppina Rotiroti Glenis K Scadding The Lancet, Dec. 17/24/31, The Lancet 3 fluticasone: 1 P montelukast /20
2 8 20 symptom free 2 NEJM Clinical Practice fluticasone 1 2 fluticasone IgE 100U/ml 1819 Bostock 1 A Mycobacterium Toxoplasma IgE 2,5,6,7,11,13,16, /20
3 mast cell IgE CD4+T montelukast( ) benefit NNT NNH number needed to harm NNH Benefit azelastine 0.16(1 / ) / (omalizumab) montelukast 0.07 montelukast ( / ) omalizmab IgE cromolyn 2 Nasal filter nasal filter nasal filter 3/20
4 nasal douching normal saline nasal douching ml 1 3 nasal douching 1 neurotrophin NGF (nerve growth factor) BDNF (brain-derived neurotrophic factor: ) The Lancet Allergic rhinitis 53 4/20
5 The Lancet, vol378,dec.17/24/31, fluticasone IgE 13. 2,5,6,7,11,13,16, IgE 100U/ml 15. A Mycobacterium Toxoplasma IgE IgE entopy 27. neurotrophin 28. neurotrophin NGF,BDNF 29. 5/20
6 OAS 34. IgE 35. IgE nasal filter montelukast( ) 45. montelukast montelukast 48. NNT montelukast /20
7 The Lancet, vol378,dec.17/24/31,2011 Alexander N Greiner USA Peter W Hellings, Guiseppina Rotiroti Glenis K Scadding 10 QOL IgE IgE meta-analysis ( ) 1 P disease course 5 1 Introduction rhinoviral infection odds ratio /20
8 The ARIA(Allergic Rhinitis and its Impact on Asthma)guideline QOL fluticasone disease course Bostock 4 1 ISAAC (International Study of Asthma and Allergies in Childhood) Phase Phase 2 Phase 3 5 8/20
9 Phase median 6.9 % median 13.6 % 5 Phase median 14.6% aero-allergens odds ratio CI odds ratio CI IgE no older siblings 9/20
10 4 6 IgE 100IU/ml A Mycobacterium Toxoplasma gondii endotoxin lipopolysaccharides hygiene hypothesis occupational rhinitis a. IgE IgE grain elevator : b. IgE anhydrides c. IgE di-isocyanate 5. odds ratio 10/20
11 Eustachian tube QOL QOL 20 QOL 11/20
12 ARIA guideline dendritic cell T peptide T lymphopoietin T helper2 (Th2) CD4 T IL4, 5, 10, 13 IL4 B IgE class switch IgE mast cell IgE early nasal response TNF leukotrienec4 prostaglandin D2 CD4+T CD4+T IL5 IL5 eosinopoiesis IgE IgE B IgE IgE entopy eosinophilia IgE eosinophilia Entopy 12/20
13 IgE RAST IgE entopy rhinopathy Eosinophilia neurotrophins NGF(nerve growth factor) BDNF(brain-derived neurotrophic factor: ) pan-neurotrophin receptor p75 tyrosine kinase A B BDNF NGF BDNF BDNF NGF T regulatory T lymphocytes T homeostasis CD4+CD25+ T T 1 Tr1 IL10 Th2 Th2 T Tr1 IL10 TGF transforming growth factor 8. nasal obstruction (congestion) 1 2 hyposmia odds ratio /20
14 nasal-ocular reflex birch oral allergy syndrome OAS OAS 2/3 1/3 Churg-Strauss syndrome Wegener s granulomatosis, Sarcoidosis IgE skin prick test IgE RAST: radioallergosorbent test 15 RAST RAST IgE house dust mite 14/20
15 cystic fibrosis, primary ciliary dyskinesia, Non-allergic rhinitis with eosinophilia : entopy(local nasal IgE) Churg-Strauss syndrome, Wegener s granulomatosis, Sarcoidosis, Relapsing polychondritis, SLE, nasal valve dysfunction, HRT Acromegaly NSAID 10 a. house dust mite nasal filter placebo-control study 15/20
16 (saline douching) rhinosinusitis b. QOL ARIA 3 meta-analysis fluticasone: secondary care Chromones( ) /20
17 Decongestants 10 rhinitis medicamentosa on-demand therapy montelukast Churg-Strauss syndrome Decongestants pseudoephedrine Van Cauwenberge IgE monoclonal antibody omalizumab: c. Benefit azelastine 0.16(1 / ) / montelukast /20
18 (omalizumab) NNT number needed to treat / / montelukast 14.3 omalizumab Harm / / montelukast 0.01 omaolizumab NNH (number needed to harm 1 ) / 22 2 / monteolukast 167 omalizumab d. IgE douching /20
19 decongestant 1 e. birch open control group CI CI n189, 511observations CI % /20
20 local oral changes f. nasal-valve dysfunction /20
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