耳鼻咽喉科・頭頸部外科93巻9号

2021年08月発行

特集 副腎皮質ステロイド—どこに注意し，どう使う？

《ステロイド投与の実際》

好酸球性副鼻腔炎・中耳炎，多発血管炎性肉芽腫症

著者： 岡崎健¹ 都築建三¹

所属機関： ¹兵庫医科大学耳鼻咽喉科・頭頸部外科

ページ範囲：P.722 - P.727

文献概要

POINT

●好酸球性副鼻腔炎・好酸球性中耳炎に対する副腎皮質ステロイド（以下，ステロイド）の投与方法と期間は重症度に応じて決定するが，明確な基準はない。

●ステロイドは良好な治療効果を示すが，副作用も考慮して，全身投与が長期に及ぶ場合には局所投与に切り替える。

●好酸球性副鼻腔炎・好酸球性中耳炎の喘息合併例では下気道病変のコントロールも重要である。

●多発血管炎性肉芽腫症は全身疾患であり，ステロイドと免疫抑制薬の併用が推奨され，内科との連携が必須である。

参考文献

1）Tokunaga T, et al：Novel scoring system and algorithm for classifying chronic rhinosinusitis：the JESREC Study. Allergy 70：995-1003, 2015

2）Fujieda S, et al：Eosinophilic chronic rhinosinusitis. Allergol Int 68：403-412, 2019

3）Takabayashi T, et al：Formation of nasal polyps：the roles of innate type 2 inflammation and deposition of fibrin. J Allergy Clin Immunol 145：740-750, 2020

4）Fokkens WJ, et al：European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 58（Suppl S29）：1-464, 2020

5）Bachert C, et al：Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps（LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52）：results from two multicentre, randomized, double-blind, placebo-controlled, parallel-group phase 3 trials. Lancet 394：1638-1650, 2019

6）Laidlaw TM, et al：Biologics in chronic rhinosinusitis with nasal polyposis. Ann Allergy Asthma Immunol 124：326-332, 2020

7）都築建三・他：好酸球性副鼻腔炎に対する内視鏡下副鼻腔手術．頭頸部外30：141-146，2020

8）Toussaint M, et al：Corrigendum：Host DNA released by NETosis promotes rhinovirus-induced type-2 allergic asthma exacerbation. Nat Med 23：1384, 2017

9）Poetker DM, et al：Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps：an evidence-based review with recommendations. Int Forum Allergy Rhinol 3：104-120, 2013

10）Van Zele T, et al：Oral steroids and doxycycline：two different approaches to treat nasal polyps. J Allergy Clin Immunol 125：1069-1076.e4, 2010

11）Akiyma K, et al：Impact of preoperative systemic corticosteriods on the histology and diagnosis of eosinophilic chronic rhinosinusitis. Int Arch Allergy Immunol 179：81-88, 2019

12）Sieskiewicz A, et al：Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis：a preliminary investigation. Ann Otol Rhinol Laryngol 115：490-494, 2006

13）Grennan D, et al：Steroid side effects. JAMA 322：282, 2019

14）van Staa TP, et al：The epidemiology of corticosteroid-induced osteoporosis：a meta-analysis. Osteoporos Int 13：777-787, 2002

15）Suzuki Y, et al：Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research：2014 update. J Bone Miner Metab 32：337-350, 2014

16）野中 学：好酸球性副鼻腔炎の診断と治療．日耳鼻119：214-217，2016

17）Shah SA, et al：Regional deposition of mometasone furoate nasal spray suspension in humans. Allergy Asthma Proc 36：48-57, 2015

18）Potter PC, et al：Indications, efficacy, and safety of intranasal corticosteroids in rhinosinusitis. World Allergy Organ J 5（suppl 1）：S14-S17, 2012

19）Salib RJ, et al：Safety and tolerability profiles of intranasal antihistamines and intranasal corticosteroids in the treatment of allergic rhinitis. Drug Saf 26：863-893, 2003

20）Wentzel JL, et al：Leukotriene antagonists in nasal polyposis：a meta-analysis and systematic review. Am J Rhinol Allergy 27：482-489, 2013

21）宮崎純二・他：嗅覚障害患者に対する新しい効果的点鼻法．耳鼻臨床97：697-705，2004

22）小林正佳・他：嗅覚障害に対するステロイド薬の長期点鼻療法の安全性と有用性の検討．日耳鼻109：986-995，2005

23）Kobayashi Y, et al：Replacement of SFC-DPI with SFC-MDI exhaled through the nose improves eosinophilic chronic rhinosinusitis in patients with bronchial asthma. Int J Clin Pharmacol Ther 55：89-94, 2017

24）Konno W, et al：Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid. Auris Nasus Larynx 46：365-373, 2019

25）Saito T, et al：Therapeutic indications for sinonasal topical steroid treatment and its effects on eosinophilic chronic rhinosinusitis after endoscopic sinus surgery. J Laryngol Otol（in press）

26）Goshtasbi K, et al：Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery：updated meta-analysis. Int Forum Allergy Rhinol 9：1443-1450, 2019

27）Harvey RJ, et al：Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol 8：461-470, 2018

28）Iino Y, et al：Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx 38：456-461, 2011

29）Nonaka M, et al：IL-5 and eotaxin levels in middle ear effusion and blood from asthmatics with otitis media with effusion. Acta Otolaryngol 123：383-387, 2003

30）Iino Y, et al：Eosinophil chemoattractants in the middle ear of patients with eosinophilic otitis media. Clin Exp Allergy 35：1370-1376, 2005

31）Ohta N, et al：Expressions and roles of periostin in otolaryngological diseases. Allergol Int 63：171-180, 2014

32）Iino Y, et al：Eosinophilic inflammation in the middle ear induces deterioration of bone-conduction hearing level in patients with eosinophilic otitis media. Otol Neurotol 31：100-104, 2010

33）Esu Y, et al：Proposal of a treatment strategy for eosinophilic otitis media based on middle ear condition. Otol Neurotol 39：e671-e678, 2018

34）Iino Y, et al：Effectiveness of instillation of triamcinolone acetonide into the middle ear for eosinophilic otitis media associated with bronchial asthma. Ann Allergy Asthma Immunol 97：761-766, 2006

35）Seo Y, et al：Optimal control of asthma improved eosinophilic otitis media. Asia Pac Allergy 8：e5, 2018

36）厚生労働省：44 多発血管炎性肉芽腫症　https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000089937.pdf（accessed 2021-6-1）

37）Tsuzuki K, et al：Difficulty of diagnosing Wegener's granulomatosis in the head and neck region. Auris Nasus Larynx 36：64-70, 2009

38）Mukhtyar C, et al：EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 68：310-317, 2009

39）Ozaki S：Clinical trial for Japanese patients with myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis：the JMAAV study. Clin Exp Nephrol 17：700-704, 2013