World Allergy Forum: Aetiology & Treatment of Nasal Allergy
Introduction - Terumasa Miyamoto
It was said that pollinosis did not exist in Japan. In 1960, however, the first case of pollinosis caused by ragweed pollen was reported. The patient had never been out of Japan. Therefore, she must have been sensitized by ragweed pollen in Japan. In fact, ragweed is a naturalized plant which came from the USA about 100 years ago and has grown rather widely in Japan.
In 1964, cases of Japanese cedar pollinosis were reported. Since that time, pollinosis has been well recognized and pollinosis cases have increased considerably in number in the Japanese population. The prevalence of Japanese cedar pollinosis is now over 10% of the total population, followed by Japanese cypress, orchard grass, ragweed, mugwort, etc. At the present time, over 50 various pollens are recognized as causes of pollinosis and among these, about 20 may be related to occupational exposures, such as sugar beet, strawberry, pyrethrum, chrysanthemum, peach, pear, apple, Japanese apricot and cherry.
Pollinosis is not the only cause of allergic rhinitis in Japan. Symptoms may be caused by house dust, house dust mites, molds and pets as well as a wide variety of indoor, outdoor and occupational allergens. The prevalence of allergic rhinitis has become well over 10% in Japan, although the prevalence of sinusitis has become considerably less recently. The prevalence of bronchial asthma has increased several-fold during the last several decades.
Recently, it has been postulated that allergic rhinitis and asthma are one disease, affecting preferentially either the upper or lower respiratory tract, or both the upper and lower airway concomitantly. It is known that upper airway diseases - allergic rhinitis and rhinosinusitis, can influence asthma, and that allergic rhinitis occurs in up to 90% of patients with asthma, suggesting a close relationship between the upper and the lower airway diseases.
In this World Allergy Forum, three distinguished speakers are invited, and they will present pathophysiology, new therapies and pharmacogenetics, and future therapeutic directions, under the main title of the "Aetiology and Treatment of Nasal Allergy".
I am quite convinced that their presentations
will be useful not only to doctors interested in nasal allergy,
but also to specialists with an interest in all aspects of allergic
Introduction - Felicidad G. Cua-Lim
It is an honor and a privilege to co-chair the World Allergy Forum (WAF) at the 51st Japanese Congress of Allergology in Fukuoka, Japan. As far back as I can remember, I have always maintained my highest esteem and admiration for our colleagues in this highly technologically-developed country where intelligence and innovative talents abound. I am humbled to be with Professor Terumasa Miyamoto, whose wisdom and support guided me through the challenging years with the APAACI. Professor Sohei Makino backed me in all my endeavors. To both of them and to all my Japanese friends and allies, my eternal gratitude.
The topic of today's WAF is on the Aetiology and Treatment of Nasal Allergy. New therapies are always a welcomed and much appreciated topic. The advent of new generation H1 antagonists with anti-allergic and anti-inflammatory properties has caused dissent among our colleagues. Which should be the first line? With the publication of an editorial "Glucocorticoids enhance IgE synthesis. Are we heading toward new paradigms?" by Salvi et al, and the work of Durham et al on local production of IgE, the therapeutic problem has become even more complex. As if there is not enough perplexity, we now have a position paper (Johansson et al) which categorizes allergic rhinitis into IgE-mediated and non-IgE mediated allergic rhinitis. I believe we will be amply enlightened in this forum.
Our ultimate goal is to provide optimum patient health. Allergists have an important place in the management of allergic rhinitis. Needless to say, identifying the causative allergens so we can adopt measures to avoid or lessen their harm, selecting appropriate pharmacotherapy, continuing medical education of physicians, and patient education to achieve compliance, are all vital strategies in the management of this common and debilitating disease.
Future therapeutic directions are exciting subjects to explore. We can define and refine the application of existing therapies in light of new knowledge. An understanding of the immunological mechanisms involved in allergy is enabling us to work towards more selective inhibition of the mediators of the allergic inflammatory reaction. Constant exchange of ideas, new discoveries and innovations are exciting, stimulating and highly competitive. However, will the new approaches and modalities of management be cost-effective and affordable? From the perspective of a developing country, while allergic rhinitis is not to be sneezed at, poverty is not to be ignored.
We are here to learn, to exchange views and update our knowledge. We thank our sponsors and speakers for this laudable event and all those who have traveled near and far to make the WAF a powerful medium of inspiration for excellence.
Thank you very much.