The history and organization of Center for Pollen Forecast in Kyoto Prefecture are explained. Important factors in pollen forecasting to prevent symptoms are pointed out. We made certain that the pollen forecast contained appropriate medical information.

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Stands of Sugi, Cryptomeria japonica, and Hinoki, Chamaecyparis obtusa, produce 10¹⁴ pollen grains per ha per yr in a productive year and 10¹¹-10¹² grains in an unproductive one. Little year-toyear fluctuation in pollen production by stands of pioneer and secondary trees is evident, the maximum/minimum ratio within a stand being about 2. In comparison, alder stands produce 2-5×10¹³grains in both productive and unproductive years. Pollen production rates of Sugi stands increase with increasing age of the stand until 50 yr, showing a constant upper limit for several hundred years thereafter. With regard to year-to-year fluctuations in pollen production rates for Sugi stands, annual rates alternate from high to low every year. This rhythm may be interrupted by the accidental effects of unusually hot dry weather in late June and July. The amount of pollen dispersed into the air can be predicted from the number of male flower buds that fall before flowering in autumn and winter. Control of pollen production in forests by silvicultural techniques while paying attention to the environmental conservation of forests is considered extremely difficult.

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The present situation and future aspects in epidemiological studies of Japanese cedar pollinosis are discussed. First of all, diagnostic criteria for epidemiological studies have not been established. A study group supported by the Ministry of Health and Welfare produced a criterion in March 1992, however, we produced other criterion compensating for the former's defects. Our criterion is as follows; any nasal and/or conjunctival symptom continuing for three weeks or more in March and/or April, and positive serum IgE against Japanese cedar pollen. A tentative study was performed. According to the former criterion, prevalence rates of “definite pollinosis” were 8.3% in adults and 5.6% in children, while those of “definite and probable pollinosis” were 16.8% and 12.1%, respectively. Prevalence rates according to our criterion were 14.1% and 9.0%, respectively.
Symptomatic criteria were defined as corresponding epidemiological criteria e x cept for serum examinations, and validity of symptomatic criteria was tested. Sensitivities for all criteria were 100% theoretically. Specificities for “definite pollinosis” of the study group criteria were 96.8% in adults and 97.0% in children. Those for “definite and probable pollinosis” were 88.3% and 90.3%, respectively. Those for our criteria were 89.2% in both sample groups. If the validity of these criteria are stable in other study samples, prevalence rates can be estimated by only questionnaire surveys.
Risk factors of Japanese cedar pollinosis are not epidemiologically established although many candidate factors have been discussed in clinical fields. Methodological problems for case-control study are the following. Three types of case should be concerned; symptomatic patient, sensitized person including symptomatic patient, and sensitized but asymptomatic person. When the case involves a symptomatic patient, bias and confounding originating from the following types of control are a concern; a) not sensitized and asymptomatic people, b) asymptomatic people without serum examination, c) not sensitized people with or without allergic-like symptoms. The largest problem for cohort study is the need to start in childhood because sensitization during early life is assumed.

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One of the most important issues in pollen forecasting is the relationship between the degree of pollen dispersion and the progress of symptoms in Japanese Cedar Pollinosis. Nevertheless, there has not been a scientific analysis or report of this relationship to date. Recently, a study was performed to determine how the progression of symptoms of Japanese Cedar Pollinosis depended on pollen dispersion between 1989 and 1994 (six years). This research was oriented towards pollen forecasting, based on clinical materials from Kyoto Prefectural University of Medicine and five other institutions in Kyoto with coincident conditions of pollen dispersion. The results showed that the critical point occurs when the pollen dispersion integral reaches approximately 30 grain/cm2; subsequently, symptoms progress rapidly to the moderate stage of pollinosis. From this moderate stage, symptoms become milder when a pollen dispersion falls below 30 for more than one week. However, the symptoms do not become milder when the pollen dispersion peak exceeds 30 grain/cm² within one week. The results of the present study may be useful in pollen forecasting and in early treatment of pollinosis during the dispersion season.

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We have been conducting a survey on pollen dispersion from Japanese cedar (Cryptomeria japonica) for the last 5 years at five locations in the Kinki area: Kyoto City, Maizuru City (northern Kyoto Prefecture), Kinomoto Town (northern Shiga Prefecture), Moriguchi City (Osaka Prefecture), and Kobe City. The “Warmth Index” was used to evaluate weather conditions that influence pollen dispersion patterns, since the index reflects general weather conditions and is closely related to the growth of plant. The onset of the first full-scale pollen dispersion for each year was almost identical. Since these onsets, dispersion patterns showed late pollen dispersion at Maizuru and Kinomoto where the Warmth Index was low. That total count of cedar pollen was highest in Kinomoto, and lowest at Moriguchi. These results might be reflected by the density of the cedar forest around the each location. The results suggest that the long-distance pollen dispersion from the warm area in Japan plays a key role in early pollen dispersion of Japanese cedar in the Kinki area, and that late pollen dispersion is influenced by vegetation of Japanese cedar in the local area and weather conditions, including the Warmth Index.

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Pollinosis caused by Japanese cedar is occurs most frequently in this country. Japanese cedar begins to release pollen in February or March every year. Many patients with Japanese cedar pollinosis are known to show allergic reaction to the pollen of some other plants.
Here in, we report the incidence of positive reaction of Japanese cedar po llinosis patients to tests for IgE antibody to pollen antigens derived from trees other than Japanese cedar.
In 120 established cases of Japanese cedar pollinosis, anti-Mountain j uniper antibody was measured. Antibodies to 4 other trees (Grayalder, White oak, Japanese beech and Walnut) were measured in 80 cases. A Pharmacia CAP system was employed to measure specific IgE.
The positive rate was 81.2% for Mountain Juniper,14.8% for Gray alder,9.9% for White oak,8.6% for American beech,7.4% for Walnut.
Using sera showing high antibody titers against Japanese cedar and Mountain juniper, a White cedar antigen absorption test was performed. Anti-Japanese cedar and anti-Mountain Juniper IgE titer was obtained by absorbing White cedar antigen in sera at a dilution rate from 1: 1.5 to 1: 60000. At high concentrations of antigen, dilution rate of 1: 1.5, both antigen titer decreased less than 50%. However, at dilution rates at 1: 12 to 1: 1200, only anti-Juniper antibody titers was suppressed. This indicates that some antigens differented, among Japanese cedar, Mountain Juniper and White oak.

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We determined the specific IgE antibody titers of the Chamaecyparis obtusa and Japanese cedar in 93 patients, suffering from Japanese cedar pollinosis, who visited to Kyoto Prefectural University Hospital. The CAP-RAST assay yieled a positive rate of 64.2% for Chamaecyparis obtusa in all patients. In Kyoto, we caught the first grain of Japanese cedar early February, and that of Cupressaceae was observed in March. According to the change in pollen disperssion the positive rate of IgE for Chamaecyparis increased. However, between the common antigens between these two pollens, a discrepancy specific IgE values for each pollen was seen. We discuss the efficacy of specific IgE values for Japanese cedar in diagnosing spring pollinosis in Japan.

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We observed the number of causative pollens in allergic rhinitis in Kyoto from 1992 to 1994. Japanese cedar pollen was detected from February to the beginning of April. Cupressaceae pollens in April, Alnus Japonica and Fagaceae pollens from April to July, Pinaceae pollens from April to June and Gramineae pollens from May to September.
We counted the number of these pollens over 3 years. Japanese cedar count was 297/cm²; 1366/cm²; 220/cm², Cupressaceae count was 145/cm²; 2064/cm²; 61/cm², Alnus Japonica and Fagaceae were 548/cm²; 751/cm²; 693/cm², Pinaceae count was 1138/cm²; 1233/cm²; 1028/cm², Gramineae count was 388/cm²; 293/cm²; 103/cm². The dispersion pattern of Cupressaceae pollen was similar to that of Japanese cedar. However, the other pollens were constant during these 3years.

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The effect of Oxatomide in the initial treatment of Japanese cedar pollinosis was examined in 11facilities in Kyoto prefecture. This study examined the most appropriate starting time and period of administration for the highest effect of the initial treatment. The following results were confirmed by administre ring Oxatomide during the initial treatment for Japanese cedar pollinosis on 1991.
The effect of Oxatomide was obtained after administering for one week or more, including the highest effect after two weeks for sneezing and three weeks for nasal discharge. However, no effect on sniffling. These results suggest that two to three weeks is the best administration period for Oxatomide in the treatment of Japanese cedar pollinosis.
In addition, a close relation between pollen information facilities and practical medicine in the region, is necessary for the initial treatment of pollinosis.

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In patients with Japanese cedar pollinosis, clinical efficacy of emedastine difumarate (DAREN)was studied. Fifty-four cases received 4 mg/day for at least 2 weeks during the initial period of pollen season. Compared with patients who received no treatment, symptom scores of the DAREN treated cases were significantly lower. Especially during the first burst of cedar grains, the patients, who received DAREN for 2 weeks remained almost asymptomatic. Treatment for Japanese cedar pollinosis was administered according to information from the pollen forecast. It was effective that to have anti-allergic drugs from the first appearence of grains to a week before the first burst.

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