Background: Although the prevalence of cedar pollinosis (CP) is increasing in Japan, some patients self-medicate with over-the-counter drugs after medical diagnosis, making it difficult for healthcare providers to grasp the actual situation. The aim of this study was to clarify the actual conditions of CP patients and assess the current status of sublingual immunotherapy (SLIT).

Methods: We conducted a nationwide Internet survey of adult patients with CP.

Results: A total of 5543 participants (mean age 45.4 years) self-reported having CP. Of these, 58.0% had received a physician's diagnosis, and 20.2% had not undergone allergy testing. In terms of severity, 14.8% were classified as "most severe" and 17.5% as "severe." Regarding treatment, 39.4% used over-the-counter medications and 38.3% visited medical institutions. The most frequently reported treatment-related issue was cost (36.2%). Additionally, 42.0% of patients were unaware of cedar SLIT.

Conclusion: Our survey revealed that approximately 20% of CP-diagnosed patients had not undergone testing. Awareness of SLIT was insufficient, indicating a need for greater dissemination of information about treatment options for CP.

Purpose: The research on macadamia nut oral food challenge (OFC) is limited. This study aimed to evaluate the clinical characteristics of macadamia nut OFC by evaluating data from our department.

Methods: This study retrospectively analyzed macadamia nut OFC data from medical record from January 2013 to June 2024, targeting loading doses of 1 gram and 10 grams. The relationships between OFC outcomes, patient demographics, and macadamia nut skin prick test (SPT) results were assessed.

Results: A total of 66 patients were included, with 33 patients in the 1 gram and 10 gram loading dose groups each. The OFC positivity was observed in 27% of patients at 1 gram and 12% at 10 grams. Among the positive cases, the anaphylaxis induction rates were 52% for the 1 gram group and 3% for the 10 gram group. Univariate analysis revealed that the macadamia nut SPT was not predictive of anaphylaxis. However, a history of immediate allergic reactions to macadamia nuts and the diameter of macadamia nut SPT swelling were associated with OFC positivity.

Conclusion: Macadamia nut OFC has the potential to induce severe allergic reactions, including anaphylaxis. Adequate preparation and precautionary measures should be put in place when conducting macadamia nut OFC to manage potential risks effectively.

Sublingual immunotherapy (SLIT) with Japanese cedar induces changes in specific IgE antibodies titer (sIgE) over time. We investigated whether other antigens could synchronize with the changes in Japanese cedar by cedar SLIT.

Methods: The study included 429 cases of cedar SLIT (started between 2017 and 2022, 5-66 years old, 208 men, 49 Cedatren^® and 380 Cedacure^®, 254 only cedar SLIT and 175 combined mites SLIT). For three years, sIgE in cedar [n=429], cypress [412], orchard grass [152], ragweed [127], birch [106], alnus japonica [110], mite (Der f 1) [classified as 144 dual SLIT and 96 only cedar SLIT], cats [101] and dogs [84], and total IgE [417] were followed. Antigens except cedar were followed in cases class 1 (≥0.7UA/mL) before SLIT. The change (log difference) for each antigen compared to before SLIT was calculated each year, and the correlation with cedar was analyzed.

Results: By cedar SLIT, other pollen sIgE and total IgE fluctuated over time in sync with cedar, and log difference was significantly correlated with cedar, but perennial antigens in mites, cats, or dogs did not related with cedar.

Conclusion: Cedar SLIT may induce non-specific IgE production, and influence sIgE production on other pollens in a synchronous manner. Cedar SLIT is expected to have beneficial effects on seasonal allergic rhinitis by other pollen antigens.

Background: Human β-defensin (hBD)-3 is an antimicrobial peptide that exhibits both antimicrobial and immunomodulatory activities, but its role in autophagy regulation remains unclear. Additionally, the role of autophagy in skin barrier regulation in atopic dermatitis (AD) is not well understood. This study aimed to investigate the role of autophagy in the skin lesions of AD patients and mouse models, as well as the effects of hBD-3 on autophagy and skin barrier function.

Methods: We assessed autophagy in epidermal keratinocytes from skin lesions of AD patients and an AD mouse model. We also examined the effects of hBD-3 on autophagy activation in epidermal keratinocytes and its ability to mitigate IL-4 and IL-13-induced tight junction (TJ) barrier disruption.

Results: Autophagy was suppressed in epidermal keratinocytes from both AD patients and the AD mouse model (in vivo). Interestingly, hBD-3 activated autophagy in these keratinocytes in vitro and alleviated IL-4 and IL-13-mediated TJ barrier disruption. Autophagy deficiency led to impaired skin barrier function and exacerbated inflammation in vivo. However, hBD-3 ameliorated skin inflammation and strengthened the TJ barrier in AD. Notably, hBD-3-mediated TJ barrier improvement was absent in autophagy-deficient AD mice (in vivo), highlighting the essential role of autophagy in the regulation of skin barrier function and inflammation by hBD-3 in AD.

Conclusion: This study suggests that hBD-3 plays a critical role in regulating the skin barrier and inflammation in AD through autophagy. hBD-3 holds potential as a therapeutic agent for skin diseases associated with autophagy dysfunction and skin barrier impairment, including AD.

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an autoinflammatory disease caused by somatic mutations in the ubiquitin-like modifier activating enzyme 1 gene located on the X chromosome. Due to its diverse clinical manifestations, it is often misdiagnosed as other conditions, particularly relapsing polychondritis (RP), with which it shares several clinical features, complicating the differential diagnosis. Unlike RP, however, VEXAS syndrome is characterized by dynamic and variable pulmonary lesions that can serve as a diagnostic clue. Here we report the case of a 75-year-old male patient who presented with ocular, skin, cartilage, and pulmonary lesions, as well as macrocytic anemia, during the treatment process for fever of unknown origin. The patient was initially diagnosed with eosinophilic pneumonia and RP. However, UBA1 analysis identified a missense variant, NM_003334.3: c.122T>C p.Met41Thr, leading to the diagnosis of VEXAS syndrome. When unexplained pulmonary lesions are observed in patients diagnosed with RP, the possibility of VEXAS syndrome should be considered.