Nasal Allergy/Hey Fever

At the Yellowstone National Park     Photograph: August, 2017
　

The human body can over-react to certain antigens; we call this an Allergy. The common one is the so-called  "Ceder Pollinosis" which symptoms are: Rhinitis: sneezing, running nose, stuffy nose Conjunctivitis: Itchy eyes, watery eyes. Ｔhere are numerous causes for allergic symptoms; not only Japanese ceder but also pollen from other plants, ticks, house dust and mold. The list is quite varied and one can, if unlucky,  have allergies throughout the whole year. Even walking from one air-conditioned room to another without one can cause similar symptoms as a result of abrupt air temperature changes. When treating for allergies, the paramount important task is to determine the exact cause of the patient’s allergy; what causes it and to what degree he or she is prone to. Once we know our enemies, we can then start planning our fight against them to avoid the cause.

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About the examination

Say, you are suffering from the Cedar Pollen allergy, but your symptoms still continue past May, then chances are you are allergic to the orchard grass pollen. If you start your allergy season in the fall, you may have the rugweed allergy. As mentioned above, it is vital that you know what allergy you have and how seriously your body reacts to them. Getting to know your body is also helpful from the doctor's standpoint, too. For example, say your blood test revealed that you are allergic to cedar, and we know that your allergy level is not that high. If then we find that despite the low density of the cedar pollen one day and yet you are suffering, we can determine that perhaps the medication you are taking is not working.

There are 2 basic methods for testing your allergies. The first is either injecting a small portion, or scratching on your skin various known substances (called antigens) that are known to be allergy creating. With this test, your skin will start reacting in about 15 minutes; that is when the doctor examines the skin. The second method is the blood test. There are pros and cons with these 2 types of tests. The scratch test is simple and we can test various substances in a relatively short period of time; and it costs less. The problem is for people who are super sensitive as they react to just about anything applied to their skin, thus, making the diagnosis difficult. Also, with this examination, some people may feel uncomfortable with a very itchy skin. The blood test can determine specific allergy causing targets and can even indicate the patient's reaction levels. The drawbacks are that it takes a few days for the analysis to be completed and the cost is higher. For those with insurance and wanting to test the 7 to 10 major allergy-causing candidates, the total cost is about \4,700 to \6000. 

Treatment　　Describe common treatments.

Avoiding the Cause
If a person is only allergic to cedar pollen, the symptoms will only appear in the spring season. Other times pollen do not fly. If he or she is allergic to ticks and house dust, frequent dusting of the tatami mat, or carpet, rug, bed, and stuffed animal toys would be recommended. While is is impossible to completely rid of these causes for allergies, we can certianly try our best to avoid them; less causes, less symptoms.

Medicine
Anti-allergy and antihistaminic agents, shots, and nose drops are commonly used to fight allergies. There are numerous medicines available, but while some may work fine for someone, it may only cause side effects for others.

Currently, there are quite a few drugs, each with their own advantages and disadvantages, and some of them are completely ineffective. At our hospital, all medicines are taken and used by the director himself, and among them, carefully selected medicines are prescribed according to the case and symptoms. Not all drugs are the same.
For subcutaneous immunotherapy (hyposensitization therapy) and sublingual immunotherapy, please see below.
 
Warning
There is an Anti-Allergy shots that only requires one single shot to control allergies throughout the whole single season. But the problem with this shot is that it uses a powerful hormone drug, which may cause bad side effects such as menstrual irregularities and skin deformation. For these reasons the Oto-Rhino-Laryngological Society of Japan does not recommend use of this particular vaccination; this Clinic agrees and does not offer to our patients.

Subcutaneous immunotherapy (SCIT), Hypo-sensitization therapy    《more details - in Japanese》
The allergy antigen (causing matter) is gradually injected into the body, a minute portion at first and gradually increased to create the body immunization The therapeutic effect is outstanding, so it is suitable for those who want to thoroughly treat cedar pollinosis, those who have perennial allergies, and those who also have asthma.
t takes about 2-3 months to reach the maintenance dose with 1-2 visits (injections) per week, but once the maintenance dose is reached, injections can be done once a month. It is the most successful treatment method in our hospital, and in more than half of the cases, the symptoms are almost suppressed without medication. Our hospital has one of the largest number of treatment cases in Japan.

Sublingual immunotherapy (SLIT)    《more details in Japanese》
The above is a simple method of subcutaneous immunotherapy. Take daily sublingually for 3 years. The results are not as good as subcutaneous immunotherapy, but it is very effective. Compared to subcutaneous immunotherapy, injections are painless and safer, but more expensive.

Operation　　《more details》
Removing parts of the mucous membrane by operation, or applying laser are done to reduce allergy symptoms. Laser treatment is common, but the treatment effect cannot be expected just by irradiating. Our hospital has one of the largest number of treatment cases in Japan and a vast amount of know-how.

Pitfalls in judging therapeutic efficacy
We need to be very cautious in deciding the effectiveness of any treatment. The exposure level of antigens can be vital. For example, a person who has to work outdoors during the day may have more problems, simply because he or she will have a bigger chance of being exposed to allergy causing bodies. Even a seemingly successful treatment may have been conducted in a season that had an unusually low pollen count. Or, the evaluation of the treatment was done after the peak season for allergies. All these may contribute to inaccurate diagnosis of any given treatments. To reiterate, the key is knowing to what we are allergic to, and how we are in contact with these allergy causing materials. At our clinic, we check the pollen count in the Kanto region every day to objectively judge the effectiveness of treatment.

A common mistake when taking medicine is, ``This medicine used to work, but recently it suddenly stopped working, probably because my body gradually got used to it."  This is simply because symptoms appeared at the time of a large amount of pollen scattering. And the medicine was changed, the pollen did not disperse and the symptoms subsided. Few days after that, a large amount of pollen scattering again and the symptoms appeared again.

It is very important to choose a medicine that is effective rather than meaningless straying.