Background/Purpose: Anaphylactic shock is a serious and life-threatening condition, and affected patients should be quickly and effectively treated with an EpiPen. Although the correct use of an EpiPen is greatly affected by a user's proficiency level and the instructions accompanying the EpiPen, there has been almost no investigation into the knowledge of the EpiPen and the actual situation of the accompanying instructions for use. Therefore, we conducted this nationwide survey to elucidate these issues.

Methods: A questionnaire survey was conducted among pharmacists registered as members of the system of a research company outside the university and working at pharmacies with experience in handling EpiPen prescriptions.

Results: Many of the pharmacists surveyed knew that the EpiPen is the first-line treatment for anaphylactic shock. However, they did not have sufficient knowledge of administration routes and candidates for second-line treatment. Both their occasions and experiences of dealing of EpiPen were found to be low.

Consideration: It is desirable to learn at conferences regarding allergology/clinical allergy and seminars for medical professionals including pharmacists in order to acquire the skills and knowledge to consult with patients with allergic diseases, including action plans presented by doctors in preparation for recurrence of anaphylaxis.

Objective: Assess the current state of food allergy management strategies and the perceptions of them among food service providers.

Methods: The study surveyed establishments that participated in a food allergy management workshop or- ganized by the Tokyo Metropolitan Government in February 2018. The survey inquired about the implemen- tation status of food allergy management strategies, the frequency of accidental ingestions and near misses, and the necessary actions for advancing food allergy management.

Results: The survey yielded a response rate of 78% (257/331); 81% of the operators reported having implemented some form of food allergy management strategies. However, only 51% had created a manual for food allergy management and 55% had labeled 7 specified ingredients. 29% of the operators reported experiencing accidental ingestions or near misses, with 34% of those incidents requiring medical attention. 49% of the operators identified the “establishment of industry standards” as a crucial step in advancing food allergy management.

Conclusion: The survey results indicate that establishments have not fully implemented adequate and effective food allergy management strategies. There is a need to enhance the awareness and understanding of food allergies among businesses and to establish appropriate and sufficient food allergy management measures in the future.

Background: The sensitizations to various fungal allergens influence to exacerbation of bronchial asthma. Aspergillus (Asp) and Alternaria (Alt) were one of important fungal allergens for asthma.

Aim and Methods: To investigate the influence of sensitization to Asp or Alt in adult asthmatics managed via our asthma coordinated-care system, we recruited 119 patients (91 women) who were measured IgE for Asp (IgE-Asp) and IgE for Alt (IgE-Alt) at three times during two years,

Results: In 119 patients, we detected positive IgE for Asp (IgE-Asp(+)) in 19 patients and positive IgE for Alt (IgE-Alt(+)) in 11 patients. 9 patients showed positive both of them. During two years, 7 patients became positive IgE-Asp and 3 cases became negative. And also, 3 cases became positive IgE-Alt and 3 cases became negative. At baseline, serum IgE, IgG₄, and inhaled corticosteroid (ICS) dose of the group with IgE-Asp (+) or IgE-Alt (+), were significant higher than those of negative group. Among three groups, there was no significant change about other parameters at baseline, exacerbation frequency, or the change of parameters during two years.

Conclusion: The sensitizations to Asp or Alt were present in 19 asthmatics (16%) managed via our coordinate-care system. During 2 years, there was not significant change at exacerbation frequency among three groups, but the levels of IgE, IgG₄, or ICS dose were significantly higher at IgE-Asp (+) or IgE-Alt (+) group than negative group. In the asthma management, it was considered necessary to pay attention to the sensitization to Asp or Alt.

A woman in her 20s presented to our clinic with a lower gastrointestinal infection. When we administered intravenous antibacterial and vitamin infusions, she developed anaphylaxis. We performed skin tests to investigate the cause, and an intradermal test was positive for a 1% intravenous vitamin complex. We then performed a component-specific test, which was positive for thiamine disulfide phosphate, a vitamin B1 derivative. We therefore diagnosed anaphylaxis due to thiamine disulfide phosphate. No previous reports have described cross-reactivity between vitamin B1 derivatives. In our case, however, the patient tested positive for fluthiamine hydrochloride, suggesting cross-reactivity. Intravenous vitamin complexes are used in daily clinical practice and should be administered with caution because of the possibility of anaphylaxis, although it occurs infrequently.

A 72-year-old woman who was undergoing treatment for bronchial asthma and psoriasis vulgaris experienced malaise three months earlier and visited our hospital on account of abnormal lung shadows. Chest computed tomography revealed ground-glass opacities in the peripheral lung fields and eosinophilia in the bronchoalveolar lavage fluid, which suggested eosinophilic pneumonia. Antineutrophil cytoplasmic antibody was negative. Her lower limbs had multiple palpable papules mixed with well-treated psoriasis and the histopathology of the skin biopsy revealed eosinophil infiltration around small vessels, suggesting the occurrence of eosinophilic granulomatosis with polyangiitis (EGPA). We were able to evaluate minor skin lesions mixed with psoriasis through collaboration between the pulmonologist and the dermatologist. In the diagnosis of EGPA, it is important to carefully examine the whole body and not overlook minor findings before starting steroids.