Aim: The aim of this study was to clarify whether there are more regulatory T (Treg) and regulatory B (Breg) cells, and higher levels of IL-10-related transcription factors in subcutaneous immunotherapy (SCIT)-treated pollinosis patients than in non-SCIT-treated patients. Methods: Japanese cedar pollinosis patients undergoing SCIT had received treatment for at least 2.8 years. Peripheral blood mononuclear cells were used for flow cytometer analyses and mRNA measurement. Results: The numbers of type 1 regulatory T (Tr1)-like cells and Breg cells, and expression of E4BP4 mRNA by peripheral blood mononuclear cells in SCIT-treated patients were higher than those in non-SCIT-treated patients. Conclusion: Tr1-like cells, Breg cells and E4BP4 may be involved in the effectiveness of SCIT.
Objective: To confirm the relevance of upper and lower airway inflammation in eosinophilic chronic rhinosinusitis (ECRS), the effects of endoscopic sinus surgery (ESS) on lower airway functions and inflammation need to be examined in ECRS patients. Methods: Chronic rhinosinusitis patients with nasal polyps (25 non-ECRS, 28 ECRS) were enrolled. The 12 patients in the ECRS group had comorbid asthma, in contrast to none in the non-ECRS group. We divided ECRS patients into 2 groups of ECRS with and without asthma. Clinical markers, including fraction of exhaled nitric oxide (FeNO), respiratory functions, and the Asthma Control Test (ACT) questionnaire, were investigated before and after ESS. Results: The FeNO levels in the ECRS with asthma group decreased after ESS. The mean FeNO levels in this group were 56.3 ppb before ESS and 24.9, 25.1, 25.0, and 15.5 ppb 1, 2, 3, and 4 months, respectively, after ESS. The mean forced expiratory rates in 1 second before and after ESS were 67.6% and 73.0%, respectively. The mean maximal expiratory flow rates at 50% of the vital capacity before and after ESS were 45.8% and 58.0%, respectively. Significant differences were observed in respiratory functions before and after ESS. The mean ACT scores in the ECRS with asthma group before and after ESS were 17.5 and 23.5, respectively. The ACT scores were significantly higher after than before ESS. Conclusions: The present results indicate that ECRS and bronchial asthma are common eosinophilic airway inflammatory diseases, and ESS for eosinophilic sinusitis may improve lower airway function.
Vestibular migraine (VM) is characterized by recurrent, episodic vertigo associated with migrainous headache. These symptoms are similar to those of Meniere's disease (MD), which often coexists with VM. The term "VM/MD overlapping syndrome (VMOS)" has been suggested for the clinical syndrome characterized by simultaneous occurrence of different types of vertigo associated with VM and MD. Diagnosis of VM is often missed in patients presenting with vertigo, because it is still not well-recognized by otorhinolaryngologists. The medical records of 29 patients diagnosed as having VM at the Department of Otorhinolaryngology of our hospital were reviewed retrospectively to evaluate the diagnostic steps. These 29 patients accounted for 4.3 of all patients who visited our hospital with the chief complaint of vertigo over a 32-month period. Of the 29 patients, while 19 primarily had VM or VMOS (primary VM group), 10 developed VM or VMOS subsequently, during follow-up for MD or benign paroxysmal positional vertigo ("subsequent" VM group). Significantly fewer patients with "subsequent" VM, as compared to primary VM, complained of concomitant headache (Fisher's exact test, p 0.03); in total, 14 and 3 patients in the primary and "subsequent" VM groups, respectively, complained of headache without being prompted, whereas the remaining patients of both groups answered "yes" only when they were asked if they suffered from headache. Furthermore, significantly fewer patients with differing onset times in life of their vertigo and headache complained of headache unless they were asked the leading question by the doctor (Fisher's exact test, p 0.02). These results indicate the importance of asking patients with recurrent vertigo if they also suffer from headache. Vertigo patients are less likely to complain of headache spontaneously Cases of vestibular migraine seen in the field of otorhinolaryngology:
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