Japanese Guideline for Allergic Rhinitis 2014

Abstract

Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of Allergology in 1993. The current 7th edition was published in 2013, and is widely used today. To incorporate evidence based medicine (EBM) introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2013. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA), this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

Sex-Related Allergic Rhinitis Prevalence Switch from Childhood to Adulthood: A Systematic Review and Meta-Analysis

“…Bearing in mind the limitations of classifying rhinitis according to the type of allergens [41], the Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative has proposed a new classification, “intermittent” or “persistent” rhinitis, based on the duration and severity of symptoms [41,42]. This classification has been considered in guidelines by many countries, including Korea and Japan [41,43], to make AR more comparable with Western countries.…”

Regional Difference of Causative Pollen in Children with Allergic Rhinitis

“…The symptoms of which interrupt the daily and school lives of children and the disease may create an economic burden (123). Therefore, the accurate diagnosis and appropriate treatment of AR are becoming very important.…”

Are Respiratory Viruses Involved in Preseasonal Symptoms or Severity in Japanese Cedar Pollinosis?

“…7–9 During the pollen shedding season, these patients had strong symptoms, and eosinophilia in a nasal smear. They had positive results for immunoglobulin E (IgE) antibodies only to Japanese cedar pollen, with class 2 or more reactivity, as assessed by using fluorescence enzyme immunoassay, but had negative results for specific IgE antibodies to house-dust mite, orchard grass, ragweed, mugwort, and Alternaria.…”

“…Classification of symptom severity was done by using the Japanese Guideline for allergic rhinitis. 7–9 Frequency of sneezing attacks and of blowing the nose per day were classified into the following: none, −; 1–5, +; 6–10, ++; 11–20, +++; and >21, ++++. The degree of nasal obstruction was classified as follows: none, −; feeling of obstruction but did not required mouth breathing, +; strong obstruction that required mouth breathing sometimes during the day, ++; serious obstruction that required mouth breathing most of the day, +++; and serious obstruction for the entire day, ++++.…”

“…5,6 Approximately 30% of Japanese experience cedar pollinosis, the most severe form of pollinosis in Japan. 7–9 Moreover, 10 to 50% of these patients have nasal symptoms during the coldest period of winter, the cedar pollinosis preseason.…”