In Japan, sublingual immunotherapy has been used in pediatric patients with cedar pollinosis and mite-induced perennial allergic rhinitis since its approval in 2018 for national healthcare coverage in children. We conducted a mail-in survey on parents/guardians of children who started sublingual immunotherapy in 2018 to ascertain their concerns in starting sublingual immunotherapy as well as problems and changes in their awareness after starting the therapy. The common concerns in starting sublingual immunotherapy were 1) maintaining daily treatment, 2) long-term continuation, 3) potential of anaphylaxis, and 4) local side effects. More than 60% of the parents/guardians viewed the side effects after starting the therapy as 1) mild or 2) milder than expected for conditions related to both cedar and mites. Half of the parents/guardians responded that their impression has not changed compared with before sublingual immunotherapy. However, approximately 40% of parents/guardians responded that they felt greater relief compared with before the therapy regarding anxieties about 1) anaphylaxis, 2) long-term continuation, 3) local side effects, and 4) maintaining daily treatment. Sublingual immunotherapy is a treatment method that is still not well known. Thus, it is desirable, especially when starting therapy in pediatric patients, for the physician and medical staff to provide a thorough advance explanation to the patients and family on what the therapy entails. Furthermore, we believe it is essential for the healthcare providers to continue answering questions and anxieties that the patient or parent/guardian may have at any time after starting the therapy.

IgG4-related disease (IgG4-RD) is a chronic inflammatory disorder, characterized by organ enlargement and mass-forming or nodular/thickened lesions, and elevated serum IgG4 levels as well as abundant infiltration of IgG4-positive plasmacytes with fibrosis in various organs, including the head and neck region. Over 15 years after Mikulcz’s disease was recognized as a clinical and pathological entity distinct from Sjögren’s syndrome, the diagnostic criteria of IgG4-retaled dacryoadenitis and sialadenitis (IgG4-DS) has been revised. Only one lesion is also diagnosed by this new criteria, and labial salivary gland biopsy is able to be used for diagnosis in IgG4-DS patients. IgG4-DS typically affects middle-aged to elderly men, and the sex-ratio of patients with IgG4-DS is roughly equal. Ultrasonography may be useful for detection of IgG4-DS of salivary glands. The differentiation of IgG4-RD from not only malignant diseases but also common conditions mimicking IgG4-RD is important. IgG4-RD is also found to affect sinonasal lesion (including olfactory dysfunction), hypertrophic pachymenigitis, and thyroid gland. In particular, the diagnostic criteria of IgG4-related thyroid disease is revised recently, and further studies with more patients are needed. Among the organs involved in IgG4-RD, recent immunological studies suggest the existence of autoantibodies and target antigens. Further studies of the pathophysiology of IgG4-DS are warranted.

Pollen-food allergy syndrome (PFAS), also called “oral allergy syndrome”, is a class 2 food allergy that is induced by cross-reaction between pollen allergens and food allergens. It is mainly limited to the oral mucosa, but in some cases, PFAS induces allergic reactions in the nose, eyes, skin, and respiratory system, while also causing shock. PFAS is caused by allergens having high homology to various foods and pollen pan-allergens, and once it develops, it begins to induce allergic reactions to various foods and pollens. In Japan, PFAS is predominantly caused by pollens of the Betulaceae family, including PR-10/Bet v1 related proteins, and pollens of the Gramineae family, including profilins. However, single-sensitization to Japanese cedar pollen is not a risk factor for PFAS. Moreover, it is difficult to prove the existence of specific IgE causing food allergy in PFAS. Instead, it is recommended to measure pollen-specific IgE, which has cross-reactivity to food allergens. Although PFAS is generally prevented by avoiding eating foods that induce allergic reactions, in the case of PFAS caused by PR-10/Bet v1 related proteins and profilins, it is possible to eat cooked foods because heat deactivates antigenicity. However, precautions should be taken when PFAS is caused by foods containing Gly m 4 (soybean) and LTP because these allergens have heat-resistant properties. The measurement of Gly m 4 is already useful and applicable to insurance.

The number of patients with allergic rhinitis (AR) has markedly increased in Japan, with it now affecting nearly 40% of the Japanese population. AR is not a life-threatening illness; however, it can have a negative impact on patient quality of life. Medication and immunotherapy are the first-choice treatments for AR, with surgical treatment usually indicated when those therapies are found to be insufficient to resolve the patient’s symptoms. According to the Japanese Guidelines for Allergic Rhinitis, surgical treatment is recommended for the severe AR patients with nasal obstruction caused by remodeling of the submucosal tissues of the inferior turbinates due to dilation of the venous sinuses or fibrosis. A number of surgical procedures have been reported, including 1) surgery to contract and modulate the nasal mucosa (e.g., cryosurgery or laser surgery), 2) corrective surgery of nasal cavity to improve nasal ventilation (e.g., submucosal turbinectomy, inferior turbinectomy or extensive turbinectomy), and 3) surgery to improve rhinorrhea (Vidian neurectomy or posterior nasal neurectomy). A number of microsurgical techniques have also been reported due to the development of endoscopes and other instruments in recent years. However, it is important that such procedures do not impair the innate functions of the nasal mucosa such as humidification, warming and mucociliary transport. An appropriate surgical procedure should be selected for the treatment for AR patients who have continued symptoms despite medical management or in those who cannot tolerate medication.