For T5SS in the diary, T6SS and QOL in JRQLQ, unit differences of 1.5 (0.3 per item), 3.6 (0.6) and 8.2 (0.5), respectively, were considered clinically meaningful by JCCP patients. The MCID for symptoms recorded in the diary was stable irrespective of the dispersed pollen level.

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Descending necrotizing mediastinitis is a severe infection of the mediastinum. Lemierre's syndrome manifests as thrombophlebitis in the cervical veins, which is caused by a neck infection. A 50-year-old woman had a fever with a 13-day history of neck pain. CT showed a deep neck abscess with vertebral vein thrombosis and mediastinal abscesses. Multiple small pulmonary nodules were found, suggesting septic pulmonary embolism. Emergency surgery for bilateral cervical and mediastinal drainage was performed, and antibiotics and anticoagulation agent was administered. Edoxaban was required to clear vein thrombosis and pulmonary embolization.

Matrix metalloproteinase 9 (MMP9) gene has been shown to be involved in the pathogenesis of allergic rhinitis (AR) and asthma. Previous studies suggested that single-nucleotide polymorphisms (SNPs) of the MMP9 gene conferred a risk for childhood asthma. However, whether the SNPs confer a risk for AR has not been previously investigated. The objective of this study was to investigate whether SNPs of the MMP9 gene are associated with risk of seasonal AR (pollinosis), perennial AR and allergen sensitization. A total of 670 school children were recruited in Japan and genotyped for functional polymorphism in the promoter (-1590C/T: rs3918242) and three amino-acid substitutions (R297Q: rs17576; P574R: rs2250889; R668Q: rs17577). Serum levels of total and specific IgE were determined. Disease status and other clinical characteristics of the subjects were investigated using a questionnaire. Associations between the MMP9 SNPs and both AR and serum IgE levels were evaluated. -1590C/T showed significant association with cedar pollinosis (corrected P (Pcor)¼0.039). R668Q was in strong linkage disequilibrium (LD) with -1590C/T and showed significant association with cedar pollinosis (Pcor¼0.023) and serum cedar pollen-specific IgE level (Pcor¼0.022). A haplotype associated with -1590T and 668Q showed a significant association with cedar pollinosis, orchard grass pollinosis and cedar pollen-specific IgE (Pcor¼0.0012, Pcor¼0.0059 and Pcor¼0.0041, respectively). R297Q and P574R were in weak LD with the rest of the SNPs and did not show significant association with disease. Compared with wild-type MMP9 protein (279R-574P-668R), a variant enzyme (279R-574P-668Q) that showed association with pollinosis had lower activity. However, lower enzyme activity was not associated with disease risk because another variant (279Q-574R-668R) showed lower enzyme activity but was not associated with pollinosis. The -1590T allele and its corresponding haplotype was associated with higher promoter activity and with pollen-specific IgE levels and pollinosis, suggesting that -1590C/T may have more impact on sensitization and disease development than R668Q. Our results suggest that the MMP9 gene confers susceptibility to cedar pollinosis in Japanese children. The MMP9 gene may be associated with pollinosis through sensitization processes. Journal of Human Genetics (2012) 57, 176-183; doi:10.1038/jhg.2011.148; published online 12 January 2012 Keywords: allergic rhinitis; association; cedar pollinosis; haplotype; matrix metalloproteinase; MMP9 gene; serum IgE; SNP INTRODUCTIONThe main symptoms of allergic rhinitis (AR) are nasal congestion caused by mucosal edema; runny nose caused by hypersecretion; and repetitive sneezing. Pollinosis is a seasonal type of AR caused by an allergic reaction to pollen. Japanese cedar pollen is the most common causative allergen for pollinosis in Japan. According to a recent study, the prevalence rates of AR and cedar pollinosis in 2006 were 27.2 and 8.0%, respectively; both of which were higher than the rates in 1996. 1...

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