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, 2011 http://www.allergy.go.jp/allergy/guideline/04/index.html The Lancet 3 fluticasone: 1 P montelukast 3 4 4 27 1/20
8 20 symptom free 2 NEJM 2005 11 3 Clinical Practice fluticasone 1 2 fluticasone 1 1 7 5 2.85 6 IgE 100U/ml 1819 Bostock 1 A Mycobacterium Toxoplasma 1 3.1 IgE 2,5,6,7,11,13,16,20 3 2 2/20
3 2 3 5 1 2 mast cell IgE CD4+T montelukast( ) benefit NNT NNH number needed to harm NNH Benefit 0.23 0.22 azelastine 0.16(1 / ) 0.20 2 / (omalizumab) 0.08 0.07 montelukast 0.07 montelukast ( 199.7 / ) omalizmab IgE 1 70503 cromolyn 2 Nasal filter nasal filter http://www.breathepurenap.com/ nasal filter 3/20
nasal douching http://entnelson.co.nz/advicesheets/normal-saline-nasal-douching-advice-sheet/ normal saline nasal douching 500 600ml 1 3 nasal douching 1 neurotrophin NGF (nerve growth factor) BDNF (brain-derived neurotrophic factor: ) 0.1 30 60 The Lancet Allergic rhinitis 53 4/20
The Lancet, vol378,dec.17/24/31,2011 1. 2. 3. 1 4. 2 5. 6. 7. 8. fluticasone 9. 10. 11. 3.1 12. IgE 13. 2,5,6,7,11,13,16,20 14. 6 IgE 100U/ml 15. A Mycobacterium Toxoplasma 16. 17. 18. 19. 8 20 20. 7 5 21. 1 22. 23. IgE 24. 25. 26. IgE entopy 27. neurotrophin 28. neurotrophin NGF,BDNF 29. 5/20
30. 1 2 31. 32. 2.85 33. OAS 34. IgE 35. IgE 36. 37. nasal filter 38. 39. 40. 41. 42. 43. 44. montelukast( ) 45. montelukast 46. 1 47. montelukast 48. NNT montelukast 49. 2 50. 51. 52. 0.1 53. 30 60 6/20
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 1 19 7/20
The ARIA(Allergic Rhinitis and its Impact on Asthma)guideline QOL fluticasone disease course 2. 4 1819 Bostock 4 1 ISAAC (International Study of Asthma and Allergies in Childhood) Phase Phase 2 Phase 3 5 8/20
Phase 1 1992 1998 6 7 0.8 14.9 median 6.9 % 13 14 1.4 39.7 median 13.6 % 5 Phase 3 6 7 1.8 24.2 13 14 1.0 45.0 median 14.6% 6 7 67 14 13 14 45 25 3.88 2.12 80 20 467 54 12 3 6 13 24 4 3 13 13 44 3 aero-allergens odds ratio 18.9 95 CI9.3 38.4 odds ratio 3.1 95 CI1.1 9.3 IgE 2 5 6 7 11 13 16 20 no older siblings 9/20
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
25 30 40 67 80 Eustachian tube 70 50 QOL 200 15 16 36 QOL 20 QOL 11/20
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
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 2.85 13/20
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
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
(saline douching) rhinosinusitis b. QOL ARIA 3 meta-analysis fluticasone: secondary care 79 15 Chromones( ) 1 3 16/20
Decongestants 10 rhinitis medicamentosa 1 2 1 on-demand therapy montelukast Churg-Strauss syndrome Decongestants pseudoephedrine Van Cauwenberge IgE monoclonal antibody omalizumab: c. Benefit 0.07 0.23 azelastine 0.16(1 / ) 0.20 2 / montelukast 0.07 17/20
(omalizumab) 0.08 0.22 NNT number needed to treat 1 15.2 4.4 6.3 1 / 5.0 2 / montelukast 14.3 omalizumab 12.3 4.6 Harm 0.02 0.02 0.03 1 / 0.05 2 / montelukast 0.01 omaolizumab 0.08 0.07 NNH (number needed to harm 1 ) 51 48 32 1 / 22 2 / monteolukast 167 omalizumab 13 14 d. IgE douching 2 2 18/20
decongestant 1 e. birch 6 14 205 open control group 3 2.52 95 CI 1.3 5.1 7 16 25 147 2.5 95 CI 1.1-5.9 10 n189, 511observations 4.6 95 CI 1.5-13.7 3 5 0.1% 60 30 3 19/20
local oral changes f. nasal-valve dysfunction 11 20 20/20