ARTICLE
Auteur(s) : Haruko Nishie1, Mariko
Kato1, Masutaka
Furue2
1Department of Dermatology, Fukuoka National
Hospital, National Hospital Organization, 4-39-1 Yakatabaru,
Minami-ku, Fukuoka 811-1394, Japan
2Department of Dermatology, Graduate School
of Medical Sciences, Kyushu University, 3-1-1 Maidashi,
Higashi-ku, Fukuoka 812-8582, Japan
Japanese cedar (JC) pollinosis is a common disease in Japan, and
the prevalence is increasing dramatically [1]. The influence of
pollen on atopic dermatitis (AD) has been much studied and it is
reported that many AD patients can have symptom flares from
February to May [2, 3], when the airborne JC pollen reaches a high
level in Japan. In addition, a symptom flare is likely to be seen
among AD patients who also have JC pollinosis [2]. However, to the
best of our knowledge, there have only been a few reports
discussing precisely this point. Thus, we examined the frequency of
symptom flares of AD during the JC pollen season through a
questionnaire on our Website.
We put out a questionnaire for AD patients with the title,
“About changes in atopic dermatitis symptoms during the Japanese
cedar pollen season”, for 2 months from March 1st
to April 30th 2007, which was maintained by our
department (http://www.kyudai-derm.org/atopy/). The list of
questions and details of the results are shown in table 1.
Table 1 A questionnaire shown on our Website and
details of the answers
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Q1. How old are you?
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n = 188
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0-10
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11-20
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21-30
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31-40
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41-50
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51-60
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61-70
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71≤
|
|
20
|
38
|
67
|
46
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12
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3
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2
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0
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10.6%
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20.2%
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35.6%
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24.5%
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6.4%
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1.6%
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1.1%
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0%
|
|
Q2. What is your gender?
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n = 188
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Male
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Female
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|
75
|
113
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39.9%
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60.1%
|
|
Q3. Do you have Japanese cedar pollinosis?
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n = 188
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Yes
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No
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137
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51
|
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72.9%
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27.1%
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|
Q4. Do your atopic dermatitis symptoms change during
the Japanese cedar pollen season i.e. about from February
to May? (Only for the patients who answered “Yes” on
Q3)
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n = 137
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Yes
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No
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|
130
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7
|
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94.9%
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5.1%
|
|
Q5. How does your erythema change during that season? (Only
for the patients who answered “Yes” on Q4)
|
|
n = 130
|
Better
|
No Change
|
Worse
|
|
0
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8
|
122
|
|
0%
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6.2%
|
93.8%
|
|
Q6. Where do you have worse erythema? You can choose more than one
answer. (Only for the patients who answered “Worse” on
Q5)
|
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n = 122
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Face and Neck
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Extremities
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Trunk
|
|
95
|
61
|
54
|
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77.9%
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50.0%
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44.3%
|
|
Q7. How does your itch change during that season? (Only
for the patients who answered “Yes” on Q4)
|
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n = 130
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More
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No Change
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Less
|
|
124
|
6
|
0
|
|
95.4%
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4.6%
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0%
|
|
Q8. Where do you have more itch? You can choose more than one
answer. (Only for the patients who answered “More” on
Q7)
|
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n = 124
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Face and Neck
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Extremities
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Trunk
|
|
93
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70
|
63
|
|
75.0%
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56.5%
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50.8%
|
|
Q9. Do you have asthma?
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n = 188
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Yes
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No
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|
34
|
154
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18.1%
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81.9%
|
|
Q10. Do your asthma symptoms change during the Japanese cedar
pollen season i.e. about from February to May? (Only
for the patients who answered “Yes” on Q9)
|
|
n = 34
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Better
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No Change
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Worse
|
|
1
|
24
|
9
|
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2.9%
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70.6%
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26.5%
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We obtained 188 responders. Of the 188 AD patients, 137
(72.9%) had also JC pollinosis. Based on our Website questionnaire,
most of the patients with JC pollinosis (130 of 137, 94.9%) had
experienced symptom flares of AD during the JC pollen season, and
the symptom flares tended to occur on uncovered areas such as the
face and neck, with frequencies as high as 77.9% (95 of 122) for
erythema and 75.0% (93 of 124) for itch. These results suggest a
close correlation between the exacerbation of AD and JC pollinosis
and/or pollen.
Because the barrier function of the skin is damaged, AD patients
can be sensitized more easily, and eczematous lesions can arise
quickly due to attached allergens. This theory can explain not only
the high complication rate associated with JC pollinosis but also
the symptom flares, which occur mainly on uncovered areas during
the pollen season.
In our study, 18.1% of AD patients also had asthma, and 26.5% of
these had experienced symptom flares of asthma during the pollen
season while 70.6% had symptoms that did not change. Although the
questions were not limited to the patients with JC pollinosis,
these results may suggest a closer correlation between AD and JC
pollinosis than between AD and asthma or asthma and JC
pollinosis.
There are limitations in our Website study. Responders were
considered to be AD patients by self-reporting, and we cannot prove
that all of them were doctor-diagnosed. The theme of the
questionnaire may have made the responder population biased towards
patients with JC pollinosis and against patients without JC
pollinosis. We did not evaluate the presence of symptom flares in
AD patients without JC pollinosis, and the presence of symptom
flares in asthma patients was evaluated without being limited to
the asthma patients with JC pollinosis.
In conclusion, JC pollen can be an exacerbating factor in AD,
and it may make symptoms worse, especially on uncovered areas
directly exposed to pollen. The relationship of JC pollinosis with
AD may be closer than with asthma, which should be examined further
through future studies.
Acknowledgements
Financial support: This work is partly supported by a grant from
The Ministry of Health, Labour and Welfare.
Conflict of interest: none.
References
1 Kaneko Y, Motohashi Y, Nakamura H, Endo T,
Eboshida A. Increasing prevalence of Japanese cedar
pollinosis: a metaregression analysis. Int Arch Allergy Immunol
2005; 136: 365-71.
2 Aihara M, Takahashi S, Oosuna I, Yasuda H,
Tsubaki K, Ikezawa Z. A study of aggravation of atopic
dermatitis during Japanese cedar pollen season – correlation with
grades of dermatitis on face and Cry j 1 specific IgE. Arerugi
1999; 48: 1172-9.
3 Yokozeki H, Yakayama K, Katayama I,
Nishioka K. Japanese cedar pollen as an exacerbation factor in
atopic dermatitis: results of atopy patch testing and histological
examination. Acta Derm Venereol 2006; 86: 148-51.
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