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Allergology International. 2011;60:171-189
DOI: 10.2332!
allergolint. 11-RAI-0334

REVIEW ARTICLE

Japanese Guideline for

Allergic Rhinitis
Kimihiro Okubo1, Yuichi Kurono2, Shigeharu Fujieda3, Satoshi Ogino4, Eiichi Uchio5,
Hiroshi Odajima6, Hiroshi Takenaka7 and Kohtaro Baba8
ABSTRACT
Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, itis the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it
becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a
treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of
Allergology in 1993. The current 6thedition was published in 2009, and is widely used today.
To incorporate evidence based medicine (EBM) introduced from abroad, the most recent collection of evidence!
literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan
2009. The revised guideline includes assessment of diagnosis!
treatment and prescriptions for children and
pregnant women, forbroad clinical applications. An evidence-based step-by-step strategy for treatment is also
described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic
Rhinitis and its Impact of Asthma (ARIA), this guideline is widely used for various clinical purposes, such as
measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome,and anaphylaxis and for
pregnant women.

KEY WORDS
allergen immunotherapy, mechanism, pharmacotherapy, pollinosis, surgery

1. DEFINITION AND DISEASE NAMES
Allergic rhinitis is a type I allergic disease of the nasal
mucosa, characterized by paroxysmal repetitive
sneezing, watery rhinorrhea, and nasal blockage. The
disease names, most commonly used in publications,
include allergicrhinitis, nasal allergy, nasal hypersensitivity, and pollinosis. Allergic rhinitis is classified
into perennial and seasonal. Pollinosis is seasonal allergic rhinitis caused by pollen antigens, frequently
complicated by allergic conjunctivitis.1

2. CLASSIFICATION OF RHINITIS
Rhinitis generally indicates nasal mucosal inflammation (Table 1). Histopathologically, nasal mucosal inflammation is anexudative inflammation. Suppurative
and allergic inflammation are particularly common.
1Department

of Otorhinolaryngology, Nippon Medical School, Tokyo, 2Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, 3Division of Otorhinolaryngology
Head & Neck Surgery, Department of Sensory and Locomotor
Medicine,Faculty of Medical Science, University of Fukui, Fukui,
4School of Allied Health Sciences, Osaka University Graduate
School of Medicine, 7Osaka Medical College, Osaka, 5Department
of Ophthalmology, Fukuoka University Hospital, 6Department of
Allergology International Vol 60, No2, 2011 www.jsaweb.jp!

Both are characterized by leakage of serum components from vessels, edema, cell infiltration,and hypersecretion.
Infectious rhinitis is classified into acute and
chronic rhinitis. Hyperesthetic non-infectious rhinitis,
that is nasal hypersensitivity complicated by sneezing
and watery rhinorrhea, or all nasal symptoms including sneezing, watery rhinorrhea, and nasal blockade,
is classified into allergic and nonallergic rhinitis. Nonallergic rhinitis includes vasomotor rhinitis andrhinitis with eosinophilia syndrome. Vasomotor rhinitis is
symptomatically similar to allergic rhinitis. However,
it cannot be identified as an allergy by tests. The major cause of vasomotor rhinitis is dysautonomia of the
nasal mucosa. However, this definition is not recognized in international classification and vasomotor
rhinitis is classified as idiopathic rhinitis.2 Rhinitis
Pediatrics,...