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The incidence of Japanese cedar pollinosis is increasing significantly in Japan, and a recent survey suggested that about 40% of the population will develop this disease. However, spontaneous remission is rare. The increased incident rate of Japanese cedar pollinosis is a huge issue in Japan. Allergen immunotherapy is the only fundamental treatment that modifies the natural course of allergic rhinitis and provides long-term remission that cannot be induced by general drug therapy. Sublingual immunotherapy for Japanese cedar pollinosis has been developed and has been covered by health insurance since 2014 in Japan. The indication for children was expanded in 2018. Clinical trials of sublingual immunotherapy for Japanese cedar pollinosis have demonstrated its long-term efficacy and safety. It is recommended for patients who wish to undergo fundamental treatment regardless of the severity of the practical guidelines for the management of allergic rhinitis in Japan. For sublingual immunotherapy, a long-term treatment period of 3 years or longer is recommended to obtain stable therapeutic effects. In recent years, evidence based on basic research and clinical trials has demonstrated sublingual immunotherapy-induced immunological changes and efficacy in patients; however, biomarkers that objectively predict and judge these therapeutic effects need to be established.

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In Japan, chronic rhinosinusitis CRS is classified according to the presence or absence of nasal polyps, degree of eosinophilic inflammation, involvement of pathogenic of fungi, etc. Recently, the JESREC Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis study established diagnostic criteria for eosinophilic chronic rhinosinusitis ECRS , a phenotypes of CRS. It is expected that treatment guidelines based on the differences in the rhinosinusitis phenotypes will be developed in the future. Although, there is still no gold standard for the treatment of CRS, numerous facilities are devising various protocols to treat CRS. In order to better understand the current treatment approaches for CRS, we created a questionnaire to be completed by all university hospitals in Japan. Questionnaires were sent to facilities at university hospitals and completed anonymously by % of the facilities. The items surveyed focused on determining both the surgical indications and the surgical management of CRS. The postsurgical treatments used for ECRS and for non-eosinophilic chronic rhinosinusitis NECRS were significantly different. Also, the treatment for ECRS varied among the facilities, and, in particular, the dosage and the duration of oral corticosteroid use varied. Proper management of CRS is very important. This survey revealed that the treatment policies for CRS between institutions are not unified. It is expected that an appropriate treatment method will be selected based on either the phenotype or endotype of the disease in the near future.