Background: To clarify the status of admission to facilities for food allergy (FA) children.
Methods: Guardians of FA children who underwent oral food challenges at Sagamihara National Hospital from September to December 2018 were enrolled. We surveyed the experience of refusal to enter facilities, the reason for refusal and so on using a self-administered questionnaire.
Results: We distributed a questionnaire to 205 guardians, of which 168 responded (response rate 82%). The median age (range) at the time of the survey was 4.5 (0 to 12) years old, 2 (1 to 11) food items had been removed at the time of admission, and 56 (33%) had a history of anaphylaxis before admission. Twenty-nine patients (17%) were prescribed an adrenaline auto injector. Twenty patients (12%) had been denied entry, the median number of refusals (range) was 1.5 (1 to 30). History of anaphylaxis before admission (odds ratio 2.80 [1.08-7.22]) and having 5 or more causative foods (odds ratio 3.44 [1.27-9.32]) were associated with admission refusal. 〔‘ Factors related to children with FA〕, 〔Factors related to facilities〕, and 〔Factors related to facility staff〕 were extracted as the reasons for refusal.
Conclusions: In addition to the factors related to children with FA, the factors related to facilities and facility staff were related to admission refusal. Therefore, cooperation between medical care, local governments, and facility that comprehensively supports the living environment of children with FA is needed.
The case subject was a 19-year-old exchange student from Thailand who had undergone tuberculosis (TB) treatment twice. Upon observing a shadow in the right upper lung, the patient was referred for examination; however, acid-fast bacteria test results were negative. Furthermore, high levels of total IgE and anti-aspergillus IgE and IgG antibodies were found. Bronchoscopy revealed inflammation with stenosis in the right superior lobar bronchus, and there was an outflow of yellow viscous sputum upon suctioning. After applying a localized steroid spray, the patient expectorated a large amount of sputum containing Aspergillus fumigatus. Upon administration of steroids and itraconazole, the conglomerate mass shadow's inner portion disappeared, and dilated bronchi appeared. Even though the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) of Rosenberg and Patterson were not strictly satisfied, ABPA was diagnosed in conjunction with the course of treatment. It was determined that prior tubercle bacilli test results were negative, and thus the patient must have had ABPA from the onset. The symptoms eased, and the patient returned to Thailand. Although pulmonary tuberculosis and ABPA are different illnesses, they share similarities in symptoms and clinical findings. Therefore, past medical history should not be believed blindly, and it is imperative to diagnosis the condition accurately by performing appropriate tests. Furthermore, we had the opportunity to view the computed tomography images of the chest 18 years after the initial examination. In the entire lung region, findings of significant bronchiectasis were presented.
A 12-year-old boy visited our hospital with complaints of chronic cough and dyspnea. Chest X-ray and CT revealed diffuse granular shadow in the bilateral lung fields and “Tree-in-bud appearance” in the peripheral airways, respectively. Sinusitis was present, and restrictive disorder was predominantly found in pulmonary function. The patient was diagnosed with DPB, and long-term therapy was started with low-dose clarithromycin (CAM), The patient showed a dramatic response to CAM, with improvements of both the clinical symptoms and pulmonary function within 1-2 months. According to the relevant literature, in adult patients with this disease, pulmonary dysfunction starts from an obstructive pattern; however, this is not the case in pediatric patients. It was therefore suggested that the mechanisms underlying the development of pulmonary dysfunction in cases of childhood onset differs from those with an adult onset.
At the time of writing of this manuscript, four biologics were clinically available for treatment against severe asthma. The choice of four biologics has been taking into account of the results of several type 2 inflammationrelated biomarkers, and the comorbidities of asthma, such as eosinophilic chronic rhinosinusitis, allergic rhinitis, and atopic dermatitis.
In this study, we have experienced a case of severe asthma complicated by eosinophilic chronic rhinosinusitis and eosinophilic otitis media, resulting in the use of four biologics, and we observed differential response of upper and lower airways. As a clear algorithm has not been established for the use of four biologics, our experience of this case would provide important lesson for considering the therapeutic strategies against severe asthma.