Cypress Pollen Season Research Articles

The efficacy of a novel smart watch on medicine adherence and symptom control of allergic rhinitis patients: Pilot study

BackgroundAllergic rhinitis (AR) is a common allergic airway disorder that is often poorly managed. There is an urgent need to enhance medication adherence in order to improve treatment outcomes in patients with AR. The efficacy of wearable smart watches in improving medication adherence is currently unclear. ObjectivesThis study aimed to evaluate the efficacy of a novel smart watch in improving medication adherence and symptom control in patients with AR. The reliability of self-reported medication use was also investigated. MethodsThis randomized, open-label, parallel controlled, pilot study enrolled adult patients with AR caused by cypress pollen. Patients were randomized in a 1:2 ratio to an intervention group and control group. Smart watches were only distributed to patients in the intervention group. During the cypress pollen season, all patients were required to take oral antihistamines daily and use nasal corticosteroids and antihistamine eye drops as needed. Daily AR symptom scores and medication usage were recorded in both groups. The smart watch was able to identify medication-taking behaviors of patients via artificial intelligence (AI) and relay this information to physicians, who sent short message service reminders to patients who forgot to take oral antihistamines for more than 2 days. ResultsDuring the pollen season, the adherence rate to oral antihistamines in the intervention group (n = 17) was significantly higher than that in the control group (n = 38) (63.3% ± 28.5% versus 43.2% ± 30.2%, P = 0.02). The daily symptom score of the intervention group was lower than that of the control group (2.4 ± 1.1 versus 3.9 ± 1.0, P < 0.001). There was no significant difference in the on-demand medication score between the 2 groups (1.3 ± 0.4 versus 1.5 ± 0.5, P = 0.13). The consistency rate between self-reported nasal corticosteroid usage and the gold standard (ie, human observation of medication usage in the videos recorded by the smart watch) was 20.0% (0%, 53.7%), and the consistency rate between self-reported antihistamine eye drop usage and the gold standard was 24.3% (2.1%, 67.1%). ConclusionsThis pilot study showed that the application of smart watches in patients with AR was associated with improved medication adherence and symptom control. Furthermore, the reliability of self-reported medication usage was limited.

Polymorphisms in Cha o 1 and Cha o 2, major allergens of Japanese cypress (Chamaecyparis obtusa) pollen from a restricted region in Japan.

Japanese cedar pollinosis is a major seasonal allergy in Japan, and Japanese cypress pollinosis is a growing concern because the cypress pollen season follows the cedar pollen season and cross-reactivity among allergens occurs between these closely related species. Allergens purified from pollen under unspecified collecting conditions can potentially heterogenous allergens profiles and batch to batch variability, and amino acid sequence variants in allergens possibly exist among trees. Polymorphisms have not been investigated for the cypress pollen major allergens, Cha o 1 and Cha o 2. Our aim was to examine the homogeneity of allergen amino acid sequences. DNA sequences of Cha o 1 and Cha o 2 from pollen collected from Chiba and Ibaraki prefectures and from needles of 47 plus trees located at seed orchards in Chiba Prefecture were examined by amplicon sequencing and amino acid substitutions were deduced. Sequence analysis of the pollen samples revealed that eight and seven residues of Cha o 2 were polymorphic, respectively. Thirteen residues in Cha o 2, including those residues identified in pollen, were deduced to be polymorphic for the plus trees. Cha o 2 expressed by the 47 plus trees included amino acid differences when compared with that of isoallergen Cha o 2.0101. No substitution was deduced in Cha o 1 for pollen taken from the two prefectures. One conservative amino acid substitution was deduced in Cha o 1 for the plus trees. Of the 47 plus trees examined, 38 were deduced to express only the isoallergen Cha o 1.0101 isoform, whereas eight trees were heterozygous and a single tree was homozygous for the non-synonymous mutation, which indicates relative uniformity of Cha o 1. Cha o 2 was found to be a heterogeneous allergen which suggests that studies using pollen from different trees may not give the same results.

Appropriate protocol of treatment modulation for seasonal allergic rhinitis caused by cypress pollens

Objective: To investigate appropriate protocol of treatment modulation for seasonal allergic rhinitis (AR) patients, in order to promote the implementation of personalized medicine. Methods: Total of 124 AR patients allergic to cypress pollens were recruited from January to February 2020 in Department of Allergy in Peking Union Medical College Hospital, 43 males and 81 females with an average age of (41±9) years. The patients were divided into two groups with block randomization method. In the first group, treatment was modulated every two days according to the average daily rhinoconjunctivitis symptom score of the last two days (short-term symptom-score group); while in the second group, therapy regimen was adjusted every week based on the Allergic Rhinitis Control Test (ARCT) score of the last week (long-term ARCT group). The treatment level was up-regulated when the cypress pollen count increased and stayed at a high level (step-up pharmacotherapy stage); and treatment was down-regulated while the pollen count decreased (step-down pharmacotherapy stage). Daily symptom scores, medicine scores, and ARCT scores of the two groups were recorded and compared. Results: During the whole cypress pollen season, the daily rhinoconjunctivitis symptom score of short-term symptom-score group was significantly lower than that in long-term ARCT group(2.4±1.0 vs 2.7±1.0, P<0.01), and the difference between the two groups was more pronounced in the step-up pharmacotherapy stage than that in the step-down pharmacotherapy stage, while there was no statistical difference between the daily medicine scores of the two groups (P>0.05). During the pollen rising period, the ARCT score of short-term symptom-score group was significantly better than that of long-term ARCT group (21(19, 22) vs 20 (17, 21), P=0.049); while in the pollen peak period and decreasing period, the ARCT scores of the two groups showed no statistical difference (P>0.05). The proportion of incompliance with doctor's advice was higher in long-term ARCT group compared to that in short-term symptom-score group (30.1% vs 6.7%, P<0.001). Conclusion: The protocol of treatment modulation for seasonal AR patients allergic to pollens should be developed flexibly according to the variation trend of pollen allergen exposure, so as to implement the idea of personalized medicine.

Exposure to Cypress Pollens and Subsequent Symptoms: A Panel Study

Objective: The objective of this panel study was to document the relationship between exposure to cypress pollen and allergic symptoms. Methods: The study group included 47 patients with allergy to cypress pollen who completed a daily diary and a weekly evaluation of quality of life (QoL) during the cypress pollen season. Different patients were included in three consecutive pollen seasons: 2014–2015, 2015–2016, and 2016–2017. Daily cypress pollen counts were obtained from the National Aerobiological Network. Air pollution and meteorological data were recorded on a daily basis. The pollen-symptoms relationship was quantified by calculating odds ratios for an increase of 1 log of grains of pollen/m³, taking into account potential confounding factors. The QoL score was expressed with a beta coefficient that increased with 1 grain of pollen/m³. Results: There was a marked increase in rhinitis and ocular symptoms during the pollen season, with a plateau effect at high levels of exposure, but no relationship with bronchial symptoms. The QoL score had a linear and significant relationship with the cypress pollen count. We did not detect any threshold level. Conclusion: This panel study demonstrated a significant association between exposure to cypress pollens and allergic symptoms, with a plateau effect for high exposures.

Efficacy of Montelukast as Prophylactic Treatment for Seasonal Allergic Rhinitis

The evidence supporting the prophylactic treatment of seasonal allergic rhinitis before the start of pollen dispersal is still lacking. We conducted a study to investigate the efficacy of prophylaxis with montelukast for seasonal allergic rhinitis and to evaluate its influence on the inflammatory condition of the lower airway. Our final study population was made up of 57 adults who were randomized to a prophylactic treatment group and a control group. The prophylaxis group was made up of 31 patients-10 men and 21 women, aged 18 to 54 years (mean: 36.9)-who were administered montelukast for 2 weeks before the cypress pollen season and subsequently throughout the remainder of the season. The control group was made up of 26 patients-11 men and 15 women, aged 24 to 63 years (mean: 39.2)-who took montelukast during the pollen season only. During the pollen season, the mean daily rescue medication score was significantly lower in the prophylaxis group (3.22 vs. 3.89; p = 0.001). However, there was no statistical difference in the two groups' mean daily rhinoconjunctivitis symptom scores. Also, the fraction of exhaled nitric oxide in the prophylaxis group tended to be lower than that of control group, but again the difference was not significant (29.8 vs. 42.1 ppb; p = 0.189). We conclude that antileukotriene prophylaxis started 2 weeks before the cypress pollen dispersal was effective in reducing the need for rescue medication during the pollen season and showed a trend toward alleviating the eosinophilic inflammation in the lower airway induced by the pollen.

Identification of Cha o 3 homolog Cry j 4 from Cryptomeria japonica (Japanese cedar) pollen: Limitation of the present Japanese cedar–specific ASIT

BackgroundAbout one-third of the Japanese population suffers from Japanese cedar pollinosis, which is frequently accompanied by Japanese cypress pollinosis. Recently, a novel major Japanese cypress pollen allergen, Cha o 3, was discovered. However, whether a Cha o 3 homolog is present in Japanese cedar pollen remains to be determined. MethodsWestern blot analysis was performed using Cha o 3–specific antiserum. In addition, cloning of the gene encoding Cry j 4 was conducted using total cDNA from the male flower of Japanese cedar trees. Allergen potency and cross-reactivity were investigated using a T-cell proliferation assay, basophil activation test, and ImmunoCAP inhibition assay. ResultsA low amount of Cha o 3 homolog protein was detected in Japanese cedar pollen extract. The deduced amino acid sequence of Cry j 4 showed 84% identity to that of Cha o 3. Cross-reactivity between Cry j 4 and Cha o 3 was observed at the T cell and IgE levels. ConclusionsCry j 4 was discovered as a counterpart allergen of Cha o 3 in Japanese cedar pollen, with a relationship similar to that between Cry j 1–Cha o 1 and Cry j 2–Cha o 2. Our findings also suggest that allergen-specific immunotherapy (ASIT) using Japanese cedar pollen extract does not induce adequate immune tolerance to Cha o 3 due to the low amount of Cry j 4 in Japanese cedar pollen. Therefore, ASIT using Cha o 3 or cypress pollen extract coupled with Japanese cedar pollen extract is required in order to optimally control allergy symptoms during Japanese cypress pollen season.

Effects of double-dose antihistamine or combined therapy in allergic rhinitis

Objective:To compare the efficacy and side effects of combined therapy with single-dose oral antihistamine and intranasal corticosteroid to monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis. Method:Eighty-two patients with seasonal allergic rhinitis caused by cypress pollen were enrolled in a randomized, parallel-group studycomparing 2 weeks therapy of either 10mg oral ebastine plus 200 μg intranasal mometasone furoate once daily (combined group) or 20 mg oral ebastine once daily (double-dose group) during the pollen season. Daily rhinoconjunctivitis symptom score and rescue medication use were recorded in both groups. After the treatment period, questionnaires were used to survey the side effects of medicines and dosage form preference of the patients. The levels of IL-6, IL-8 and TNF-α in the peripheral blood were measured before and after the therapy. Result:During the cypress pollen season, the daily rhinoconjunctivitis symptom score of the combined group (n=42, 3.7±0.4) was significantly lower than that of double-dose group (n=40, 4.5±0.5), P<0.001. The daily rescue medication score of the combined group (1.3±0.6) was also significantly lower than double-dose group(1.7±0.7), P<0.001. The daily medication cost of combined group was 7.08±0.33 Yuan, which was less than that of double-dose group (7.28±0.51 Yuan, P=0.002). There was no statistical difference in the rate of adverse reactions between the two groups. The peripheral levels of IL-6, IL-8 and TNF-α in two groups did not show significant difference at the end of therapy . Conclusion:The combined therapy with single-dose oral antihistamine and intranasal corticosteroid was superior to the monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis in our study.

スギ花粉舌下免疫療法のヒノキ花粉飛散期の臨床効果

スギ花粉舌下免疫療法のヒノキ花粉飛散期の臨床効果

過去26年間のスギ花粉飛散パターンのクラスター分析

Pollinosis caused by the pollen of Sugi (Cryptopmeria japonica) trees is the most significant allergic disease occurring in the spring in Japan. For pollinosis patients and medical staff, it is important to know when the pollen dispersion would reach maximum or when the pollen count would decrease as well as knowing what would the total density of pollen grains be. These sorts of information could be useful for the purpose of disease prevention and deciding on the therapeutic regimen. In this study, we presented the sugi-dispersal patterns and cited several examples of the dispersal pattern. Airborne pollen grains were collected using a Durham sampler. Total annual pollen counts/cm2 were examined. The sugi-dispersal patterns were classified into several groups by cluster analysis using variables of ten days pollen counts distribution from February to April for the past 26 years. (1987-2012). The annual pollen count revealed an alternate rhythm consisting of an "on" year (high pollen count) and an "off" year (low pollen count). The results of the cluster analysis showed eleven off-years classified as one group (group 1), and fifteen on-years classified into three groups (groups 2A, 2B, and 2C). The dispersal pattern in group 1 was almost symmetrical with the pollen count rapidly decreasing until late-March. On the other hand, the patterns in group 2 were asymmetrical. In group 2A and 2B a high rate of dispersion was indicated after maximum dispersion, whereas in group 2C the high rate of dispersion was indicated before maximum dispersion. In group 2A, a major dispersion of almost 3000 grains was noted in late-March, and immediately proceeded to the cypress (Chamaecyparis) pollen season without any decrease seen in pollen dispersion. The periods of dispersion of over 10 pollen grains/cm2 per day were 38, 47, 47 and 51 days in groups 1, 2A, 2B and 2C, respectively. That in group 2 was significantly longer than that in group 1, but there was no significant differences between groups 2A, 2B and 2C. In conclusion, in the dispersal pattern whereby a major dispersion was seen in late-March and proceeded to the cypress pollen season such as in group 2A, patients' symptoms might be prolonged or be more serious. This new concept of dispersal pattern could very well be useful for clinical management of pollinosis.

Characterization of Japanese cypress pollinosis and the effects of early interventional treatment for cypress pollinosis

SummaryIn Japan, pollen from Japanese cedar (Cryptomeria japonica) and Japanese cypress (Chamaecyparis obtusa), species that have been planted in approximately 4.5 and 2.6 million ha, respectively, is spread wide through aerial dispersion in spring. Consequently, Japanese cedar/cypress pollinosis (JCCP) is the major phenotype of allergic rhinitis (AR) in Japan, and significantly impairs the quality of life (QOL). Compared with Japanese cedar pollinosis, the pathogenesis and management of Japanese cypress pollinosis remain unclear. Cha o 1 and Cha o 2 are major allergens in Japanese cypress pollen, and have considerable homology with Cry j 1 and Cry j 2, respectively, in Japanese cedar pollen. Several other components were recently identified in Japanese cypress pollen, and may facilitate allergic inflammation via IgE‐independent mechanisms. Allergen‐specific CD4+ Th2 cells producing interleukin (IL)‐4, IL‐5, IL‐13 and IL‐31 are believed to play central roles in the pathogenesis of AR. The major human T cell epitopes in Cha o 1 and Cha o 2 have been identified. Compared with those in Cry j 1 and Cry j 2, both common and unique T cell epitopes in the cypress allergens have been characterized. Peripheral blood mononuclear cells (PBMCs) produced these Th2‐type cytokines in response to a crude extract of Japanese cypress pollen. Among these cytokines, induction of antigen‐specific IL‐5 and IL‐31 production is closely associated with the onset and exacerbation of Japanese cypress pollinosis, respectively. Allergen‐specific immunotherapy using a standardized extract of Japanese cedar pollen is effective in controlling both naso‐ocular symptoms and QOL during the period of cedar pollen dispersion, although the significant efficacy tends to be reduced during the period of cypress pollen dispersion, especially when the pollen dispersion is high. IL‐5 production by PBMCs in response to the crude extract of Japanese cypress pollen did not differ significantly between patients with and without the immunotherapy, suggesting that unique component(s) in Japanese cypress pollen can induce IL‐5 production, which is not fully suppressed by immunotherapy with the standardized extract of cedar pollen. The Practical Guideline for Management of Allergic Rhinitis in Japan recommends that patients who experience severe symptoms of pollinosis every year should receive early interventional treatment. Although early interventional treatment with a histamine H1 receptor antagonist (H1RA) is effective for Japanese cedar pollinosis, especially at the beginning of the season, this treatment has limitations for Japanese cypress pollinosis when exposure to the pollen is high. Combined therapy with a leukotriene receptor antagonist and/or intranasal corticosteroids may be required to fully control the worsening of JCCP during the cypress pollen season.

The effects of large-scale atmospheric fields on the cypress pollen season in Tuscany (Central Italy)

This research was performed for the purpose of analysing the relationships between large-scale meteorological information, in particular the North Atlantic Oscillation (NAO) index and the Sea Surface Temperature (SST), and the timing and magnitude of the Cupressaceae pollen season in the Pistoia district of Central Italy. The results demonstrated that in specific periods of the year, the NAO index, by partially determining the distribution of the main meteorological variables over the study area, is negatively correlated with the start and the end, as well as the peak day of pollen concentration. Pollen data were also correlated with the SST of the North Atlantic Ocean east of the Azores for the September–December period of the previous year, which is significant for exploring possibilities in terms of predicting the timing and magnitude of the cypress pollen season. The analysis of such meteorological variables and indices could be used to improve the existing forecasting systems of the phenology of the cypress pollen season. Moreover, the possibility of using meteorological information freely available on internet could cut costs and reduce spatial and temporal representativeness limitations relating to weather monitoring in loco.

Effects of high‐dose sublingual immunotherapy on quality of life in patients with cypress‐induced rhinitis: a placebo‐controlled study

SummaryThe efficacy of specific immunotherapy and particularly of sublingual immunotherapy (SLIT) in subjects allergic to Cupressaceae pollen is well defined, but no study assessed its effects on quality of life (QoL). We evaluated the effectiveness of SLIT with a standardized, high‐dose extract of Juniperus ashei in patients with cypress‐induced rhinitis, using QoL as the major outcome measure. Thirty‐four patients, 20 males and 14 females, mean age 33.8 years, with allergic rhinitis (AR) from cypress pollen were randomly assigned to receive an allergen extract standardized in index of reactivity (IR) of J. ashei (19 patients) or a placebo (15 patients). The schedule was pre‐coseasonal, with a build‐up phase in 12 days and a maintenance treatment with 300 IR a day up to the end of the cypress pollen season. All patients registered in diary cards their symptoms, drug consumption and side‐effects. The QoL was measured before and after SLIT by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) by Juniper during the peak of the cypress pollen season. QoL significantly improved in respect to baseline in actively (P=0.017) but not in placebo‐treated patients, and there was a significant difference in favour of actively treated patients during the pollen season (P=0.02). Actively and placebo‐treated patients had comparable symptom–medication scores in the period from 15 February to 15 March, corresponding to the peak pollen season, but placebo‐treated patients showed an uneven drug consumption compared with actively treated patients. Side‐effects were relatively common, but mostly with local short‐lasting symptoms, and no systemic reaction was reported. These findings show that SLIT with high doses of J. ashei in subjects with cypress‐induced rhinitis significantly improves QoL and confirm previous observations on the disagreement between QoL – which assesses patient's perception – and medical parameters used in trials.

Identification of human T cell epitopes in Japanese cypress pollen allergen, Cha o 1, elucidates the intrinsic mechanism of cross‐allergenicity between Cha o 1 and Cry j 1, the major allergen of Japanese cedar pollen, at the T cell level

Pollens from species of Cupressaceae family are one of the most important causes of respiratory allergies worldwide. In Japan, many patients with pollinosis have specific IgE to both pollens of Japanese cypress (Chamaecyparis obtusa) and Japanese cedar (Cryptomeria japonica). The sequences between Cha o 1 and Cry j 1, the major allergens of Japanese cypress and Japanese cedar pollens, respectively, are 80% identical. This study was undertaken to identify T cell epitopes in Cha o 1, and to elucidate the mechanism of cross-allergenicity between Cha o 1 and Cry j 1, at the T cell level. T cell epitopes in Cha o 1 were identified by the reactivity of T cell lines, generated from 19 patients, to stimulation with overlapping peptides. The subsets of T cell clones specific to rCha o 1 were determined according to their ability to produce IL-4 and IFN-gamma. Peptide specificities of two T cell clones were determined by stimulation with the peptides from Cha o 1 and Cry j 1. Four dominant and six subdominant T cell epitopes were identified in Cha o 1. While four T cell epitopes, p11-30, p211-230, p251-270 and p331-350, were common to Cha o 1 and Cry j 1, 4 T cell epitopes, p61-80, p71-90, p311-330 and p321-340, were considered to be unique to Cha o 1. The subsets of T cell clones were predominantly of T helper2-type. One T cell clone recognized p16-30, which is common to Cha o 1 and Cry j 1, but another recognized p321-330, which is unique to Cha o 1. Presence of both T cells reactive to T cell epitopes common to Cha o 1 and Cry j 1 and T cells specific to T cell epitopes unique to Cha o 1 in patients with pollinosis contributes to prolonged symptoms after the cedar pollen season in March and the following cypress pollen season in April.

Juniperus oxycedrus: A new allergenic pollen from the Cupressaceae family

Background: Cupressaceae allergy is a worldwide pollinosis caused by several species. Some species in limited geographic areas pollinate in fall and winter. Juniperus oxycedrus matches these features. Objective: We sought to define the immunochemical, allergologic, and environmental aspects of J. oxycedrus pollen. Methods: Pollen extract from J. oxycedrus was prepared and characterized by biochemical analysis and human specific IgE binding by means of ELISA and immunoblotting. A 3-year phenological study was conducted to define the pollinating period of J. oxycedrus. Forty consecutive patients allergic to cypress were recruited in two areas and divided into two groups according to their exposure to J. oxycedrus pollen. Clinical evaluation, skin prick tests, and specific IgE determination with J. oxycedrus, J. ashei, and Cupressus arizonica extracts were carried out on both groups. Results: J. oxycedrus pollen extract was obtained, and it showed specific IgE binding and wide cross-reactivity with other Cupressaceae species. The extract caused a positive skin test response in all the patients tested, with about 80% of them having detectable specific IgE. Symptoms related to J. oxycedrus pollen exposure were recorded in 72% of the directly exposed patients and occasionally in 9% of the nonexposed patients. In the Mediterranean coastal area considered, J. oxycedrus was the first Cupressaceae species that started to pollinate at the beginning of November and ended in the first part of December. Conclusions: J. oxycedrus represents a newly characterized pollen species of the Cupressaceae family that cross-reacts with other members of the same family. Subjects with cypress allergy have in vivo and in vitro positive test responses for J. oxycedrus and can show symptoms when exposed to its pollen. Finally, the most important feature of J. oxycedrus is its early pollinating period in southern Europe (Italy), causing a further extension of the cypress pollen season in areas where other Cupressaceae species are present. (J Allergy Clin Immunol 1998;101:755-61.)

Heterogeneity of atopy. I. Clinical and immunologic characteristics of patients allergic to cypress pollen

The heterogeneity of pollen-allergic persons is well known but poorly characterized. Cypress is one of the major pollen-producing plants of the Mediterranean area. A study was undertaken to characterize the symptoms presented by patients allergic to cypress pollen and the heterogeneity of the IgE immune response between patients allergic only to cypress pollen and those who are polysensitized. Eighty-nine patients allergic to cypress pollen were studied, 26 being allergic only to cypress pollen. The IgE response was assessed by skin prick tests and the titration of serum total IgE and cypress-specific IgE by RAST. Clinical reactivity was assessed by symptom scores during the cypress pollen season and skin tests. Pollen counts were obtained. The clinical reactivity was similar in both patient groups. Rhinitis was present in all patients, conjunctivitis in 73.7-88.5%, and asthma in only 7.4-19.2%. The age of onset of symptoms caused by cypress pollen allergy was significantly greater in patients allergic to cypress pollen only. Total serum IgE was within the normal range in the cypress pollen group and significantly lower than in the polysensitized groups. Cypress pollen RAST was higher in the polysensitized group. We concluded that conjunctivitis is particularly common in cypress pollen allergy. Patients allergic only to cypress pollen may be unique in their way of expressing serum total IgE levels.