Japanese Journal of Allergology

Background: The prognosis of adult asthma, whether a long-term remission is available, is still unknown. In this paper we investigated the prognosis of adult asthma patients. Methods: We sent a questionnaire by mail to 1168 patients who had been taken care in our clinic until 1990-1992, but disappeared afterward. Those patients were asked their present status of clinical condition of asthma including symptoms, medication, etc. Results: Delivery of mail was failed in 370 patients because of changed address. 430 of 798 patients replied the mail and 86 patients out of 430 patients were in remission state with no symptom without any medications. The characterictis of these patients in remission are early hospital visit after developing asthma, mild in severity, mild in obstructive lung function and mild in bronchial hypersensitivity to acetylcholine at the first visit hospital. Conclusion: We concluded that some of adult asthmatic patients might become in clinical remission.

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Objective: To investigate immediate and delayed-type reactivity for fungi in atopic dermatitis (AD) patients and the effect of antifungal therapy. Methods: We examined immediate and delayed-type reactivity in AD patients for Candida albicans and Malassezia furfur by skin prick test (SPT), and estimated the effect of amphotericin B (AMPH) and itraconazole (ITCZ). Results: Twenty eight of 40 patients showed positive immediate-type reaction and 10 of 27 patients did delayed-type reaction for Candida albicans. As for Malassezia furfur, positive immediate-type reaction was shown in 30 of 40 patients and positive delayed-type reaction did in 4 of 27 patients. The RAST score of specific IgE to Candida albicans was low in the patients with positive delayed-type skin reaction for Candida albicans, while the score was high in the patients with the negative delayed-type skin reaction. Both of AMPH and ITCZ were effective to the patients with positive immediate-type reaction for Candida albicans in SPT. The skin reaction for Malassezia furfur was stronger in the patients treated with ITCZ effectively than in the patients treated not effectively. In addition, ITCZ was effective in all patients except one, who showed positive reaction for Malassezia furfur accompanied with negative reaction for Candida albicans in SPT. Conclusion: Fungal allergy is one of the aggravation factors of AD, and SPT is useful to evaluate fungal allergy and to choose effective antifungal therapy.

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Background: The prevalence of various subtypes of urticaria in Japan has not been analyzed. Methods: We have classified 260 (105 males and 155 females) out patients with urticaria based on the classification in "Guidelines for the diagnosis and treatment of urticaria and angioedema" prepared by the Japanese Dermatological Association with slight modification. Results: The urticaria in 200 out of 260 (76.9%) patients was idiopathic, and 101 (38.8%) patients showed more than one type of urticaria or angioedema. Among 146 patients with chronic urticaria, 90 (61.6%) were complicated by other types of urticaria; 59 (40.4%) by factitia, 29 (19.9%) by angioedema, and 12 (8.2%) by other types of urticaria. Deep pressure urticaria has been assumed as a rare type of urticaria in Japan, but was diagnosed in 5 patients with other types of urticaria. Conclusion: Most of the subtypes of urticaria could be diagnosed mainly by history and physical examinations. Correct diagnosis of the subtypes of urticaria should be the basis of better understanding and the treatment of this disease.

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Background: Most of food allergy (FA) cases during childhood start as infantile atopic dermatitis (AD) at the ages of a few months old. We tried to clarify the association between infantile AD and FA during infancy. Methods: We analyzed relationship between AD and FA during infancy among patients with 208 cases, who had visited our outpatient clinic with chief complaint of "eczema" from 1998 to 2000. Results: Among 208 cases, 148 cases (71%) were diagnosed as infantile AD, moreover 109 cases (74%) were diagnosed as FA among infantile AD. The most frequent food antigens among infantile AD were egg (72.3%), cow's milk (39.9%), wheat (12.2%) and soybean (7.4%), respectively, in addition to these food antigens, food allergy was widely recognized against peanuts, sesame, meats, buckwheat, fishes and potato. In terms of food antigen, 44 cases with single food allergy against egg were seen out of 46 single allergy cases, whereas 36 cases with double food allergy against both egg and cow's milk were seen in 63 multiple food allergy cases. Although the value of antigen specific IgE against egg and cow's milk was recognized for the diagnosis of food allergy during infancy, even cases with negative IgE against those foods were proved to be food allergy by food elimination and provocation tests. In contrast to egg and cow's milk, positive IgE against rice, soybean, and wheat did not always correlate with the results of the diagnosis of food allergy. Concerning risk factors of AD, family history of any allergy diseases and passive smoking were recognized in comparison with infantile eczema. Neither the nutrition method nor incomplete elimination of diet during pregnancy and lactation had anything to do with the development of AD. Conclusion: When infantile AD cases were not improved by environmental control, skin care and application of steroid ointment, it would be important for doctors to think of the possibility of FA.

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