A substantial number of chronic rhinosinusitis (CRS) patients still have a poor prognosis. Nasal polyps immediately recur after surgery in cases of CRS that present with severe eosinophilic infiltration. We refer to such a pathophysiology as eosinophilic CRS (ECRS) in Japan. Current consensus in Europe and the United Sates discerns two major phenotypes: chronic rhinosinusitis with nasal polyp (CRSwNP) and chronic rhinosinusitis without nasal polyp (CRSsNP). Thus, the simple differentiation based on whether nasal polyps are present or absent does not encompass the molecular diversity in patients with CRS. Therefore, identification of endotypes might permit individualization of therapy that can be targeted against the pathophysiologic process of a specific endotype. In 2016, the first report of existence of inflammatory endotypes based on a cluster analysis of 14 biomarkers in CRS was presented. Interestingly, it is indicated that not only CRSwNP but CRSsNP also has various diseases. In the future, taking postoperative prognostic categories, it will be expected to figure out what kind of endotype are relapsing and refractory.

The stromal cells in the tumor microenvironment (TME) are known to interact closely with tumor cells and affect tumor cell behavior. Cancer-associated fibroblasts (CAFs) are one of the most crucial components of the TME which promote progression of tumors. CAFs are heterogeneous population which originate several cell types such as normal fibroblasts, bone marrow derived mesenchymal stem cells, bone marrow derived hematopoietic stem cells, epithelial cells, and endothelial cells. It has been reported that CAFs construct the TME which promote proliferation of tumor cells, angiogenesis, tumor cell invasion, and immunosuppression in several types of malignancies including head and neck squamous cell carcinoma (HNSCC). Moreover, the abundance of CAFs in TME correlates with the poor prognosis in several types of cancers including HNSCC. Based on these knowledge, new therapeutic strategies targeting CAFs have been investigated. In this review, we will discuss the latest findings on the significance and role of CAFs in TME as well as potential therapeutic implication of CAFs.

We report a patient who presented with side effects following initial dose of sublingual immunotherapy (SLIT) for Japanese cedar pollinosis. A 46-year-old woman was diagnosed as having Japanese cedar pollinosis, according to having typical nasal symptoms in the pollen dispersal season between February and April, and elevated specific IgE level (class 6) to Japanese cedar using radioallergosorbent test (RAST). She desired to undergo the SLIT, because she had always suffered from not only nasal symptoms but also many food allergens, and consequently expected to even a little more prevent increasing food allergens. Although she had bronchial asthma, her respiratory function maintained within normal level. Indication of SLIT was carefully determined with allergy specialists. The SLIT for the initial two weeks of bulking phase was applied in hospital under sufficient therapeutic preparation for anaphylaxis and careful observation by allergy specialists during the pollen non-dispersal season. She showed rash from neck to chest skin, uncomfortable feeling in the oral, pharynx and larynx area, dyspnea, and hypotension (88/75 mmHg) in 2–5 minutes after the initial dose of SLIT (40 JAU/0.2 mL). Impaired consciousness was not observed. The symptoms completely disappeared after 30 minutes. We comprehensively considered her as anaphylaxis reaction (grade 3), according to criteria reported previously in Japan. The anaphylaxis reaction had not been observed since second day of the SLIT. Lessons learnt from our experience emphasized the importance of careful judgement to indication of SLIT and therapeutic preparation for anaphylaxis under close supervision in the initiation of therapy, when patients had many allergic diseases.