To survey current status of pediatric allergic rhinitis in Japan,106 pediatricians who were interested in allergology were reguested to reply to mailed questionaire from April to July,1993. More than 80% of the pediatricians reported that the incidence of the patients with the chief complaint of allergic rhinitis was less than 10%, and most other patients were complicated with bronchial asthma. In children pollinosis was not so frequent, less then 20% in infants and toddlers and 20-60% in school children. Diagnosis of allergic rhinitis was usually established by clinical history and symptoms, and allergologic examinations such as the numbers of eosinophil in peripheral blood or nasal smear, serum IgE levels, skin tests, IgE-RAST and provocation test were not commonily but occasionally carried out particularly by the practitioners. Topical or systemic use of so-called anti-allergic drugs, such as cromolyn, for allergic rhinitis was very popular in Japan and no reported physicians neglected them. Topical use of cortiocosteroid hormones was also occasionally used in childhood patients, but most pediatricians avoided systemical administration in allergic rhinitis. Immunotherapy was not the popular choice for allergic rhinitis in children, and more then 80% of the pediatrician reported that only less than 5% of their patients were being treated by immunotherapy.
Division of Oto-rhino-laryngology, Chiba Children's Hospital The long-term efficacy of surgical treatment of pediatric allergic rhinitis was evaluated. The subjects of the study were 37 children, aged from 6 to 15 years (mean=10.8 ys), and who were afflicted with serious year-long nasal obstruction, which had not been improved by medication and hyposensitization. We followed these patients from 1 month to 4 years and 8 months postoperatively. The following results were obtained: 1. Physical examination revealed remarkable improvement in nasal obstruction and nasal discharge. 2. The responses to questionnaires also showed significant improvements in nasal obstruction and nasal discharge. Sneezing was not appreciably improved. 3. The efficacy of surgical treatment for nasal obstruction and nasal discharge was sustained over 3 years postoperatively. 4. Besides the symptoms described above, significant improvements were observed in the ability to concentrate, olfactory function, snoring and so on. Among 16 children with bronchial asthma,7seldom had postoperative asthma attacks. 5. Our study shows the long-term efficacy of surgical treatment for nasal obstruction in pediatric allergic rhinitis, when symptoms are not responsive to nonoperative treatment.
In the present study, we investigated the cellular response of lymphocytes to house dust mite (Dermatophagoides pteronyssinus) and its fractionated antigens in pediatric nasal allergy. In response to crude antigen, lymphocytes derived from patients showed elevated proliferation and cytokine production in comparison with healthy subjects (p <0.01). Moreover, pediatric patients exhibited a more potent reaction than adult patients. By stimulation with fractions, patients showed a significant response at 95 and 15 KD (p<0.01). Futher, the group of pediatric patients had a tendency to react with fractions from 20 to 30 KD compared with the group of adult patients. These results may reflect the active immunological state in the pediatric atopic period.