Persons allergic to birch-pollen often experience oral and pharyngeal hypersensitivity to fruits and vegetables, caused by immunological cross-reactivity between pollen and foods. This phenomenon is referred to as the oral allergy syndrome (OAS). Such cross-reactive antigen reactions mainly involve Bet v 1, which is the major birch-pollen allergen, and partially involve birch-pollen profilin Bet v 2. Allergies to other pollens, such as mugwort, have also been reported to cause OAS, and the cross-reactive antigen reactions mainly involve profilin. In Sapporo, birch-pollen is widespread and OAS is widely prevalent. However, allergies to other mono-pollen (besides birch) are rare. It is therefore difficult to evaluate the association between allergy to other pollens and food hypersensitivity. Using multiple regression analysis, we evaluated the associations between allergy to inhalant allergens besides birch-pollen and food-induced oral and pharyngeal hypersensitivity. Allergy to birch-pollen was included as a covariate in all models.

　We interviewed 2364 patients (1358 female and 1006 male, aged 4-79 [mean age, 33.4 years]) with IgE to one or more inhalant allergens (birch-pollen, orchard grass-pollen, mugwort-pollen or Dermatophagoides pteronyssinus) regarding episodes of oral and pharyngeal hypersensitivity to various foods. IgE antibodies were examined using the CAP system. We evaluated the associations between allergy to inhalant allergens and foods causing oral and pharyngeal hypersensitivity based on patients' self-reports, using multiple logistic regression analysis adjusted for gender, age-class, and CAP class.

　Of the 2364 patients, 1487 (63%), 717 (30%), 474 (20%), and 1597 (68%) were positive for birch-pollen, grass-pollen, mugwort-pollen, and mite, respectively, using the CAP system. A total of 735 patients had episodes of oral and pharyngeal hypersensitivity to foods. The foods most frequently causing oral and pharyngeal hypersensitivity were apples (475 cases), peaches (421 cases), and cherries (344 cases). Mugwort-pollen allergy was associated with oral and pharyngeal hypersensitivity to melon, watermelon, tomatoes, and celery. Grass-pollen allergy was associated with hypersensitivity to melon. However, the association between grass-pollen allergy and hypersensitivity to melon was weaker than that between birch and mugwort-pollen allergies and hypersensitivity to melon. Negative associations were observed between grass-pollen allergy and hypersensitivity to soy-milk. A negative association was also observed between mite allergy and hypersensitivity to strawberries and cherries. Birch-pollen allergy was associated with hypersensitivity to many foods, particularly rose-family fruits and soy-milk.

　Allergy to several inhalant allergens other than birch-pollen was associated with oral and pharyngeal hypersensitivity to a range of foods.

　Objectives: In the diagnosis and treatment of rhinosinusitis, evaluation of the subjective symptoms is as crucial as that of the objective findings. The 22-item Sino-Nasal Outcome Test (SNOT-22) is used globally as a common measure of the symptoms of rhinosinusitis. Our goal was to translate and validate the SNOT-22 for a Japanese cohort.

　Design, setting, and participants: The Japanese version of SNOT-22 was developed using forward and backward translations by two interpreters. Three experienced Japanese otorhinolaryngologists confirmed the translations. To evaluate the validity of using this questionnaire, we conducted a prospective cohort study of 97 rhinosinusitis patients who had undergone endoscopic sinus surgery (ESS) at our institute; we also recruited twenty-two healthy volunteers.

　Main outcome measures: To evaluate the SNOT-22, the internal consistency, test-retest reliability, known-group differences, and responsiveness to treatment were analyzed. The clinical interpretability was assessed by calculating the minimum important difference (MID).

　Results: The internal consistency was high, with a Cronbach's α-value of 0.86. The test-retest reliability coefficient was 0.82, indicating good reliability for repeated measures. The total SNOT scores was 37.8±16.9 (average±SD) in the rhinosinusitis patients and 6.5±5.8 in the healthy volunteers, with a significant difference between the two groups (p<0.01). For the 85 patients who completed the SNOT-22 postoperatively, the average score improved significantly to 11.7±11.6, (p<0.01), indicating good responsiveness. The MID was 15.7 for the total score and the clinical efficacy rate in the patients who underwent ESS at our institute was 69.7%. These findings indicate the clinical interpretability of changes in the SNOT scores. Conclusion: The SNOT-22 is a reliable and valid tool to assess the quality of life in Japanese patients.

　Marfan syndrome is a dominantly inherited multi-system disorder of the connective tissue. Herein, we report a patient with Marfan syndrome who presented with recurrent pneumoencephalus.

　A 31-year-old female patient visited our emergency room with severe headache, and brain computed tomography revealed the presence of pneumoencephalus. Magnetic resonance imaging revealed the presence of a meningocele posterior to the sphenoid sinus due to a bone wall defect. She was admitted to the neurosurgery department and treated conservatively by intravenous administration of antimicrobial agents. The treatment was effective and the patient was discharged. Four years later, she presented with severe headache, as before, was admitted, and was again successfully treated conservatively. ¹¹¹In-DTPA cisternography revealed transclival cerebrospinal fluid rhinorrhea. On day 17 of the second admission, she was discharged without any neurological sequelae. However, 3 days after the second hospital discharge, she presented again with the same headache and was admitted. This time, endonasal endoscopic surgery was performed via a transsphenoidal approach, and no pneumocephalus or cerebrospinal fluid rhinorrhea was observed for at least 18 months after this operation. In this patient, it is presumed that the bone wall defect associated with Marfan syndrome and excessive pneumatization of the sphenoid sinus had led to weakness and thinning of the cranial bone, and that continuous pressure pulses of cerebrospinal fluid to the skull base caused a bony defect of the clivus and weakness of the dura mater. Thus, presumably, fragile meningeal diverticula developed, leading to recurrent spontaneous cerebrospinal fluid leakage and pneumoencephalus.