[in Japanese]

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Background: Recently, it has become a social problem that hydrolyzed wheat protein in facial soap can induce wheat allergy including wheat-dependent exercise-induced anaphylaxis (WDEIA). We described the clinical characteristics of the patients related. Methods: We collected 12 cases who had had a medical examination from January to October in 2010. Result: All the patients were female and mean age was 36.0±9.9 years. All of them had had no prior symptoms history of wheat allergy, they gradually developed wheat anaphylaxis or WDEIA in an average of 2 years after they started to use a soap product in question which contains hydrolyzed wheat proteins. Most patients suffered immediate contact allergic reactions after or at the time of washing their face with the soap product. 10 of 12 patients showed a low level of IgE to CAP-recombinant ω-5-gliadin. Episodes of anaphylaxis were prevented by avoiding both intake of wheat-containing foods and usage of the soap product. Conclusion: We concluded that their wheat anaphylaxis is likely to be caused by epicutaneous sensitization of the hydrolyzed wheat proteins in the soap product. It was important that physicians should know the possibility of sensitization from non-dietary antigen.

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Buckground: Pompholyx-like reactions may develop for aggressive atopic dermatitis treatments in the incipient phase despite of improvement of other skin symptoms. Methods: Eighty-nine patients admitted to National Center for Child Health and Development for treatment of atopic dermatitis between April 2007 and March 2009 were recruited. Results: Pompholyx-like reactions were seen in thirteen out of eighty-nine patients between 4 and 32 (mean 16.7±10.4) days following admission. The mean age of patients with these reactions was 6.2±6.1 years (range of 3 months to 23 years). At the time of admission, practical issues of scoring atopic dermatitis: the SCORAD was assessed. The values of SCORAD index with pompholyx were ranging from 16-91 (mean 50.8±17.9), and the index except under one-year old were significantly higher than unaffected patients. These patients were evaluated into their medical record, for evidence of Pompholyx-like lesions: a bilateral vesicular eruption confined to the skin of the palms, soles, or sides of the fingers. Topical corticosteroids are used to treat Pompholyx-like reactions, all them achieved remission between 4 and 50 days (mean 18.5±12.0). In general, pompholyx is more common in summer. However, it seems that there were no significant differences in the pompholyx-like reactions incidence between in summer and in winter. Conclusion: The factor for the occurrence of pompholyx-like lesions remains unexplained. Although the original symptoms of eczema were improved, pompholyx-like eczema breakout, therefore, patients often feel uneasy. We should be aware of this clinical condition.

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Background: Although clinical management methods for asthma have developed dramatically, it is not sure that the newly-developed methods have come to the attention of all doctors. Methods: We sent questionnaires to all members of the Gifu Medical Association (general practitioners, pediatricians, and respiratory physicians) in 2000, 2004, and 2010. Results: A majority of doctors felt that the number of asthmatic outpatients (adults and children) had decreased by 2010 compared with 2000. The ratio of the diagnostic/treatment guideline users increased between 2000 and 2010 for management of both adult and pediatric asthmatic patients. The percentages of doctors who prescribed inhaled corticosteroid (ICS) to more than half of their adult asthmatic patients were 46.1% in 2000 and 77.6% in 2010; those prescribing ICS to more than half of their pediatric asthmatic patients were 4.3% and 31.3% in 2000 and 2010, respectively. The percentage of doctors who used a peak flow meter did not drastically increase from 2000 to 2010. Discussion: Our survey indicates that the number of asthmatic patients visiting a clinic or hospital has recently decreased, probably due to the reduced frequency of emergency visits for asthma attacks as a result of the prevalence of ICS and the guidelines. On the other hand, it was revealed that the objective evaluation methods for asthmatic condition have been not widely used. Greater promotion of the usefulness of a peak flow meter and asthma control test (ACT) is considered necessary for the optimum management of asthma.

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As a result of ingesting wheat- and soybean-based food products in school meals, an 8-year-old boy repeatedly experienced dyspnea and urticaria while exercising. Based on the symptoms, he was assumed to have been experiencing a food-dependent exercise-induced anaphylactic reaction. Based on the Japanese pediatric guideline for oral food challenge in food allergy 2009, examination using various combinations of food products (wheat and soybeans), medicine (aspirin), and exercise was performed. However, the examination failed to elicit any symptoms. Although we eliminated the food products from the examination, dyspnea caused by exercising after ingesting only wheat products was observed again. Thereafter, we performed a provocation test using wheat products, but symptoms were observed only on increasing the amount of ingested food and the momentum of exercise, without administering aspirin. The possibility that wheat is a more potent inducing factor than aspirin in increasing the momentum of exercise and amount of ingestion in food-dependent exercise-induced anaphylaxis was suggested.

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