「鼻相談室」第2回目の質問は花粉症対策についてです。
なんでも猛暑の影響で、来年春の花粉飛散量はドエライことになるらしいですよ。

来年の春にそなえて、今からやっておくと効果的な花粉症対策があったら教えてください。

＜花粉症の予防対策（平成16年秋）＞
　平成16年の夏が記録的な猛暑であったため、平成17年度はスギ花粉の大量飛散が予想（*1）されます。
　スギ花粉症の症状は、スギ花粉の吸入量に比例して悪化します。平成16年春のスギ花粉飛散量はまれにみる低レベルであったため、花粉症の症状がでなかった、もしくは非常に軽かった方も多いかと思います。しかし、平成17年の春はスギ花粉の大量飛散が予想されているため、平成16年に症状のでなかった方も重症の症状がでる可能性があります。そこで、早めの予防策が必要となります。

　基本的な予防策は、まず花粉を避けることです。マスクなどで、花粉を鼻から吸入することを避けることが第一歩です。スギ花粉の吸入がなければ、理論的にはスギ花粉症は起こりません。

　しかし、現実問題として社会生活をおくりながらスギ花粉を避けるのは難しいことです。そうなると薬や、手術（レーザーやアルゴンプラズマ療法）の力を借りることになります。一般的に行われている予防法としては、下記の3つがあります。

1. レーザーやアルゴンプラズマ療法
   　レーザーやアルゴンプラズマ療法により、アレルギー反応の起こる下鼻甲介という鼻の中の粘膜を熱変性させてやり、スギ花粉を吸入してもアレルギー反応を起こしにくい粘膜にしてあげます。特に鼻づまりの強いタイプの人に効果的です。
   　一時的（2週間程度）に鼻づまりや鼻水が増え不快な期間がありますが、その後は、花粉に強い粘膜になりますので花粉症の症状（特に鼻づまりに関して）が発現しにくくなります。
   　あくまでも対処療法であるため、花粉の飛散量と症状を考慮して薬を使う必要があります。
   
   　一部で使われている「レーザーで花粉症が治る」というのは非常に誤解を招きやすい表現であり適切ではありません、正しくは「レーザーで花粉症の症状を軽くすることができる」です。　あくまでもレーザー治療は花の中の粘膜の一部をアレルギーの起こりにくい粘膜変に変性させてあげる治療です、根本的に治す方法ではないので誤解のないようにしてください。
   　ただし、正しい理解のもとで治療を受けると鼻づまりに関しては非常に高い効果を示します。
   
   　レーザーやアルゴンプラズマの医療機器は高価なため設備のあるクリニックは限られていますので、インターネットなどでクリニックを探す必要があります。
   　また、同じ医療機器を用いても、手術（レーザー、やアルゴンプラズマ療法は正確な分類では手術に分類されます。ただし痛みも少なく、簡単なため処置のひとつと思っている患者さんも多いです。）する先生の技量によって治療成績に差がでますので、経験豊富な先生を探すことが必要です。
   　データー上はレーザー、アルゴンプラズマ療法ともに同様の治療成績ですが私の経験上、アルゴンプラズマ療法のほうが効果的である印象を持っています。
   
   　治療を受ける時期としては、予防的観点に立てば11月から1月の間がよいと考えられます。
   　花粉症のシーズン中に症状（特に鼻づまり）が薬でコントロールできない場合はシーズン中にお受けになっても有効です。鼻水が出ている状態での治療にはアルゴンプラズマ療法のほうがレーザー治療より効果的（*2）です。
   ＞＞高周波凝固術（アルゴンプラズマ療法）について詳しくはこちら
   
   
2. 内服薬による予防的治療法
   　予防専用の特別な薬があるわけではありません。一般的に花粉症治療に用いられている第2世代抗ヒスタミン薬（一般的にアレルギーのお薬と言われているもの）をスギ花粉の飛散が開始（*3）する2〜4週間前（症状のでる前）から飲み始めます。
   　症状がでてから薬を飲み始めるのに比べて、症状が軽くすむことが多いとのデータが出ています。特に鼻水、くしゃみが強いタイプの人に効果的です。
   　耳鼻咽喉科の専門医のいるクリニックなら、ほとんど受けることのできる（先生によってはこの治療に反対意見を持っていて治療を行わないクリニックもあるかもしれません）治療です。
   
   
3. 特異的減感作療法
   　現在治癒が期待できる唯一の方法です（レーザーでアレルギーが治るという雑誌の記事や一部報道がありますが基本的にレーザー治療は対処療法です）。
   　原理は抗原（アレルギーの原因物質）を低濃度から注射をして、徐々に濃度を上げていき体をアレルギー反応の起こりにくい状態に変化させてあげる治療法です。
   　有効症例には非常によい治療法ですが、以下のような欠点があるため、治療に対する理解と熱心さがないと途中で治療を挫折してしまいます。
   （1）治療期間が長い（少なくとも2〜3年）
   （2）最初は週に1〜2回定期的な通院が必要
   （3）治療成績が50％程度と高くない
   （4）稀ではありますが命にかかわるような重篤な副作用が起こる
   　来年の花粉症予防という観点では効果はあまり期待できません。
   　治療に対する知識、重篤な副作用に対応できる設備を要することから、特異的減感作療法を行っている施設は限られていますので治療をお受けになりたい場合は、治療を行っているクリニックを探す必要があります。

　以上、代表的な予防方法でしたが、選択肢として特に鼻づまりで困る人はレーザーやアルゴンプラズマ療法、鼻水・くしゃみで困る人は内服薬による予防、両方でお困りの人は、レーザーやアルゴンプラズマ療法に加えて内服薬による予防を併用されてはいかがでしょうか。また、長期的に花粉症を克服したい人は特異的減感作療法を試されてはいかがでしょうか。
（目的別に選ぶ花粉症予防法）

目的	予防法
鼻づまりをなんとかしたい	レーザー治療又はアルゴンプラズマ療法
くしゃみ・鼻水をなんとかしたい	内服薬
くしゃみ・鼻水・鼻づまりをなんとかしたい	レーザー治療又はアルゴンプラズマ療法 と内服薬の併用
根本的に花粉症を克服したい	特異的減感作療法

*1 猛暑と花粉症
　一般的にスギ花粉の花粉飛散量は、前年夏の気温・日射量依存していると言われており、前年夏の気温が高く日射量が多かった場合、スギ花粉の量は多くなり、気温が低く日射量が少なかった場合は、スギ花粉の量も少なくなります。これは、前年夏の気温・日射量がスギの雄花の着花に大きな影響を与えるためと考えられています。ともあれ、記録的な猛暑を記録した平成16年の夏の翌年に当たる平成17年春はスギ花粉の大量飛散が予測されます。

*2 鼻水とレーザー治療
　一般的に花粉症治療に使用されることの多いCO2レーザーは、そのレーザー光線が水（鼻水）に吸収されるため鼻水が出ているときには不向き（鼻水を丁寧に吸引すれば問題はありませんが）です。それに対してアルゴンプラズマ療法は、プラズマ照射時にアルゴンガスを噴射（アルゴンガスは吸入しても人体に害はありません）していますので鼻水が吹き飛ばされうまく処置できます。

*3 スギ花粉の飛散時期
　スギ花粉の飛散開始は、「一測定点で、1月以降にスライドガラスの1平方センチメートル内にスギ花粉が1個以上捕集される日が、原則として2日以上続いた最初の日とする」とされています。これはその年の1月の最高気温を毎日足していった値によるとされており350℃〜400℃に達した時が目安になるとされています。では、いつごろ花粉の飛散が開始するかというと、過去のデーターからみて、東京都の場合は2月5日〜20日の間ぐらいです。年によって2週間程度の差があるため、東京都の場合は1月中旬から予防的に薬を飲み始めるとよいでしょう。

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