Excess limitation could be adapted on vaccination, since several clinicians might be afraid of adversed events after vaccination. The factors, which clinicians should consider on vaccination, are the immunological status of vaccinees and the type of vaccine, such as live vaccine or inactivated vaccine. Infants and children, pregnant women, the elderly, and individuals with chronic diseases are immune-altered and could be administered with live and inactivated vaccines, except pregnant women, who could not be administered with live vaccine. Only the immunocompromised individuals are contraindicated with live vaccines. Since influenza vaccine produced in Japan is well purified, anaphylaxis could not be induced in children with egg-allergy theoretically. In inactivated vaccines, priming with two or three doses via three to eight weeks interval is important for induction of specific immunity. The best way that protects immunocompromised individuals, who could not be administered with live vaccines, is elimination of vaccine preventable diseases by high vaccination rate, which overwhelms the herd-immunity.

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The methods of avoidance of indoor allergens including house dust mites, fungi, pets and pollen are summarized.
Careful attention to bedding is most important for the avoidance of house dust mite allergens. Washing bedding with water hotter than 55°C would be very effective. Bedding should be dried in the sun on both sides at least once a week and thereafter vacuum-cleaned for more than 20 seconds per one square meter. A drier for bedding can be used. Covers for bedding should be washed at least once a week. House dust mite-impermeable covers or house dust mite-free bedding are also very useful. Drying rooms and wiping dew condensations are important for fungi avoidance. Potted plants with beautiful leaves are not good inside because of their ability to induce fungi growth.
Allergic children should not have pets. If the family of an allergic child needs to keep pets, pets should not be kept inside the house. When the family members or visitors come home from houses with pets, they should take care of pet allergens on their clothes. In order to prevent pollen from entering houses, timing of opening windows and care of clothes on arrival home should be considered.
Cleaning their houses is important for the avoidance of all kinds of allergens. Carpets or rugs should be taken away; wooden floors are much better. Use a vacuum cleaner for more than 20 seconds per one square meter at least once every 3 days. Open the windows while vacuum-cleaning. Clear away clutter to allow easy cleaning.
Several studies have been reported regarding home-based environmental interventions for allergic patients. Intensive interventions, such as education for environmental remediation to caretakers of patients on frequent home visits, usage of allergen-impermeable covers, a vacuum cleaner equipped with a high-efficiency particulate air (HEPA) filter and a HEPA filter air purifier, are effective.
In order to conduct allergen avoidance, it is very important to identify the allergens for each child, to know the characteristics of the allergens, to consider how to avoid the allergens, and to educate caretakers of the child on the methods of avoidance.

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We successfully treated a female pediatric patient with bronchial asthma respiratory failure by intravenous infusion of magnesium sulfate (MgSO₄), thus avoiding tracheal intubation. At 2 years and 11 months old, the patient suffered from wheezing and dyspnea. She was diagnosed with bronchial asthma respiratory failure and then hospitalized. She received an intravenous steroid infusion, a continuous intravenous infusion of aminophylline, and continuous nebulized inhalation of isoproterenol. However, her respiratory status did not improve, and agitation and hypercapnea occurred. Although we initially considered performing tracheal intubation, to avoid such an invasive procedure, we first attempted an intravenous infusion of 50 mg/kg MgSO₄ over 20 min. Her consciousness and respiratory state improved immediately. After 1 h, the concentration of carbon dioxide in arterial blood, heart rate, and respiratory rate decreased from 54.9 to 46.5 mmHg, from 157 to 126 beats/min, and from 48 to 40 breaths/min, respectively. No adverse effects of MgSO₄ were observed. MgSO₄ is considered to lead to an increase in the degree of calcium extrusion from smooth muscle cells and to inhibit smooth muscle contraction. MgSO₄ has potential as an effective rapid-acting agent and is worth administering to avoid tracheal intubation particularly for children who exhibit a poor response to initial therapy.

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Background; Intervention to swallowing abnormalities may be effective against intractable infants wheeze, but change of airway hypersensitivity before and after the treatment is not reported. We observed change of the airway hypersensitivity in two cases whose swallowing abnormalities were considered as a cause of wheeze.
Case 1; A one year and eight months old boy was admitted because of wheezing. Swallowing abnormalities was found on examination of Videofluorography.
He was treated with thickened food and asthma medications. Seven months later Videofluorography showed that swallowing abnormality was not recognized with thickened food, and the respiratory threshold of acetylcholine(RT-Ach) was improved from 156μg/ml to 2,500 μg/ml.
Case 2; A 8 months old boy with wheezing. Swallowing abnormalities was found on examination of Videofluorography. He did not use the asthma medications after admission.
One year later Videofluorography showed that swallowing abnormality was not recognized with thickened food and the RT-Ach was improved from 78 μg/ml to 625 μg/ml.
Conclusions; Airway hypersensitivity with infantile wheeze due to swallowing abnormality might be improved by intervention with thickened food to swallowing abnormality.

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Objective: We evaluated the actual control conditions of pediatric asthma patients in long-term management with JPAC and we developed modified JPAC by adding new three questions about daytime symptoms, particularly exercise-induced asthma (EIA) to reveal the symptoms which guardians cannot notice.
Method: We conducted JPAC surveys on 0 to 18 year-old asthma patients and their guardians at our outpatient clinics. Added three questions were asked patients directly.
Results: In 341 cases, JPAC was performed in the first month and the scores were checked three times in series once a month in 129 cases. The treatment steps tend to be elevated in three months. The control conditions were significantly improved. Regarding the daytime symptoms, particularly for EIA, the answers of “no symptoms” were induced from 146 patients who have done any exercises in the first month, however, existence of the EIA was suspected for 15.8% of the patients by the direct hearing of new three questions.
Conclusion: Utility of JPAC was reaffirmed and our modified JPAC was also found to be useful in this investigation.

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Inhalation therapy has been one of the most important approach of treatment and management for asthma patients at pediatric age. Because, pathogenesis of asthma has been proved to be allergic inflammation in airway, and the consensus that treatment with inhaled corticosteroid (ICS) is the most useful strategy against inflammation has been achieved in these 10 to 20 years. It is important to obtain adequate inhalation techniques to attain maximum benefits from inhalation therapy for asthmatic patients at pediatric age, especially for infants. We explain how to utilize the section of Inhalation Devices (section10) in JPGL2008, and also described additional tips when using inhaler devices.

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In the therapy of childhood asthma, not only drug therapy but also environmental control or psychological therapy are necessary. The purpose of asthma therapy is focused on achievement of QOL(quality of life) in asthmatic children. During the period of childhood, allergic symptoms are changeable by growth and development. Psychological factors are also changeable by aging. In order to success the treatment of asthma, it is important to intervene for psychological aspects.
Diagnostic measures of finding psychological problem in asthma, it is necessary to intervene carefully and find out the relationship between the asthma attack and events of usual life. Several questionnaires are used for diagnosing the relation between asthma and psychological problems. Intervention to psychological aspects in asthmatic children may lead to better prognosis of asthma treatment.

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Food-dependent exercise-induced anaphylaxis (FEIAn) is a relatively rare disease. However, once the diagnosis of FEIAn and the causative food would be determined, the quality of life (QOL) of the patient must be remarkably improved. For the accurate diagnosis of FEIAn the elimination test of the suspected food from the diet is not sufficient and the applying the provocation test should be desirable in all patients except for the severest cases. However, there was no standardized provocation test. Moreover, the positive rate of the previous method was so low that it was not always easy to elucidate the causative food.
In April 2009 we proposed the standard protocol of the provocation test of FEIAn in the guideline of oral provocation test for food allergy 2009 from the study group of food allergy in Japan Pediatric Allergy Society. We hope that this standard test would contribute to the accurate diagnosis of FEIAn and the improvement of the QOL of the patients.

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