Originally, rapid ACTH test is a check for the dysfunction due to adrenocortical disorders and adrenocortical function of the patients which is using steroid drugs.
We studies the adrenocortical function in asthmatic children by using improved-rapid ACTH test.
Improved-rapid ACTH test infuses saline with ^1-24ACTH in one hour correctly and observed for 2 hours after that (total is 3 hours from start.).
The results were as follows;
1) The more asthmatic children is severe, the smaller rising incline index in 11-OHCS per 1 hour.
2) In severe asthmatic children, there are many cases which serum 11-OHCS in last 1 hour decrease. And in mild asthmatic children, there is no case which serum 11-OHCS in last 1 hour decrease.
Our results suggested that adrenocortical function of severe asthmatic children is decreased and improved-rapid ACTH test is useful for the check of severity in asthmatic children.

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Among 727 patients with primary immunodeficiency diseases who were registered to the All Japan Immunodeficiency Registry up to December 6, 1986, 23.4% of all were reported to have developed eczema or atopic dermatitis. Almost all patients with Wiskott-Aldrich syndrome and hyper IgE syndrome, one third of severe combined immunodeficiency and chronic mucocutaneous candidiasis and 10-20% of various antibody deficiency syndromes were the sufferers of eczema.
Bronchial asthma was not so common complicasion as eczema and only 3.6% of all patients were reported to have had episodes of bronchial asthma. The incidence seemed slightly high in the patients with selective IgA deficiency (11.1%).
Among all patients 284 cases (39.1%) were also reported serum IgE levels and 34.9% of them showed hyperimmunoglobulinemia E.
All patients with hyper IgE syndrome, 76.7% of Wiskott-Aldrich syndrome, and approximately half of thymic hypoplasia, chronic granulomatous disease and complement deficiency were reported the elevated levels of serum immunoglobulin E.

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A child of squid allergy is reported. We detected specific IgE antibodies to squid in his serum with a microliter solid-phase radioimmunoassay using extract of squid (including 50% glycerin, Torii & Co. Ltd, Tokyo) as an antigen, which have been used for scrach or prick testing in Japan.
Furthermore, we demonstrated cross-allergenicity between squid and octopus with inhibition technique.

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Azelastine possesses H₁-blocking potency and is a inhibitor of IgE mediated chemical mediator release.
We studied the effect of azelastine in asthmatic children by treadmill exercise.
The results were as follows;
1) There was no change in maximum % fall in FEV_1.0 after exercise comparing between pre and post-medication.
2) % fall in FEV_1.0 at 60 minutes after exercise was statistically significant (% fall in FEV_1.0 on pre-medication was -17.35±7.23 (mean±S. E.) & that on post-medication was 3.21±10.89%) (p<0.02).
3) There was a significant reduction of IgE and eosinophile by medication.
Our results suggest that azelastine is effective in asthmatic children and may have inhibiting effect of exerciseinduced late asthmatic response (EILAR).

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It has been well known that atopic children are likely to develop allergies to species of animals, however pets are kept in 37.1% of unselected asthmatic children.
This study was designed to assess the clinical significance of pets and the effect of avoidance using clinical athma score, serum IgE and specific IgE antibodies (RAST).
The avoidence of pets improved athma significantly in 2 (18.2%) and mildly in 2 (18.2%) out of 11 cat allergy, and mildly in 2 of 9 (22.8%) dog alleegy.
RAST Score decreased in 2 of 2 (100%) improved cases, 2 of 4 (50%) mildly improved and 5 of 14 (35.7%) unimproved groups. There was no significant change in serum IgE in both improved and unimproved asthmatics.
Diagnosis of pet allergy depends on detail history and RAST, and the advice to remove the family pet is a major decision of environmental control among asthmatic children, if it is proved to be specific allergen.

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The examination of urinary theophylline and theophylline metabolism were studied in 7 asthmatic children. High-pressure liquid chromatography was devised to quantitate theophylline metabolites in the 24-hr urine of 5 patients and in the time course of 2 patients who had been receiving 20mg/kg of theophylline orally in a day. Mean values for the theophylline-derived urine products were unchanged theophylline 15.3±4.07, 3-methylxanthine 14.0±1.86, 1, 3-dimethyluric acid 38.9±6.62, and 1-methyluric acid 31.8±6.65 (%). Metabolites were exprssed as internal standard equivalents on a molar basis. There was a direct correlation between urinary 3-methylxanthine and 1-methyluric acid and a inverse correlation between 1, 3-dimethyluric acid and 1-methyluric acid+3-methylxanthine, 1, 3-dimethyluric acid and 1-methyluric acid, unchanged theophylline and 1-methyluric acid+1, 3-dimethyluric acid, unchanged theophylline and 3-methylxanthine in urine, respectively. In the case of 2 patients in time course measurerent, the urine content of theophylline and 1-methyluric acid+1, 3-dimethyluric acid were inversely related. The urinary unchanged theophylline and 3-methylxanthine were also inversely related. There were some relations between the concentration of urinary unchanged theophylline and those of serum theophylline. This might reflect the capacity in theophylline metabolism because it was different among patients. From this we suggest it would be useful to determine the most appropriate administration of theophylline.

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Serum IgE, IgE RAST and antigen specific (hen's egg, cow's milk, soybean and Deramatophogoides farinae) IgG·IgG4 levels were measured both in the serum of the pregnant mother, and in their cord blood.
A full history from all the mother paticipatory in the study was taken by means of a quesionnaire. This included questions related to details of any allergy and types of food eaten during pregnancy.
Results:
1) Antigen specific maternal IgG and IgG4 antibodies cross the placenta together with other gammaglobulins, entering the circulation of the foetus.
2) Neonates borned mothers with high IgE values of positive IgE RAST have high titers of specific IgG·IgG4 antibodies.
3) Neonates with a cord blood serum IgE values greater than 1.5U/ml have high values of specific hen's egg IgG antibodies.
4) The mothers who drunk more than 201ml of cow's milk a day during pregnancy show high values of specific anti cow's milk IgG·IgG4 in their cord blood serum.

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A 15-year-old girl of physical anaphylaxis is reported. She presented with a 5-year history of physically-induced urticaria precipitated by cold exposure or exercise. Her sensitivity appeared to be increased in severity. After running for five minutes on a cold day, she developed generalized urticaria and angioedema, and had dyspnea. She visited our hospital 4 hours later. Examination of the blood showed a white cell count of 19400/mm³, with a marked increase of neutrophils, a hemoglobin of 14.5Gm/100ml, a hematocrit of 42.8%, which were higher than in healthy state. Total protein level in serum was lowered, and plasma histamine was within normal range.

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The prognoses of 103 asthmatic patients, who had been admitted with asthma attacks from April, 1979 to March 1975 as children, were examined by questionnaire in 1986, except for two of them who had died. The final prognosis was: cured: 22.3%, markedly improved: 30.1%, mild: 17.5%, moderately severe: 17.5%, severe: 9.7% and dead 2.9%. This prognosis depeded on the severity of the patient's asthma at the first visit to our hospital. Comparing of the severity of asthma in present study with that study, which were examined in 1979 to the patients who had been admitted with asthma attacks, no significant difference were observed in spite of recent advance of asthmatic therapy.
We would like to emphasize the concept of “high risk childhood asthma”. High risk childhood asthma was defined as follows, asthmatic children who was severe resisting the agressive therapy for the first year since the patient's first visit.

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We recently utilized continuous intravenous isoproterenol infusion in the treatment of respiratory failure in a 10-yr-old severely ill asthmatic boy. He had been frequently recieved intravenous aminophyllines since early life, bad not experienced cardiac complications. The patient responded to this therapy within 30nin. The maximum isopreterenol dosage administered was 0.167μg/kg/min and total dose was 1.52mg in the 32 hours.
With tapering of isoproterenol, respiratory failure relapsed 2 times.
Two hours after the isoproterenol was stopped, the patient experienced a vague chest pain. At that time ECG revealed ST segment elevations.
Serum creatinine phoshokinase level elevated to 460IU/L and cardiac-specific CPK isoenzyme (CPK2=CPK-MB) was noted. We thought thet these findings were related to the effects of isoproterenol or the combination of isoproterenol and aminophillin on the myocardium. CPK returned to normal within two days and ECG also within 3 weeks.
It's conclusive that this case was so called catecholamine myocarditis.
This case suggests that careful cardiac monitoring is essential in the management of the patient receiving isoproterenol for the treatment of respiratory failure secondary to status asthmatics.

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A specific IgG antibody to Dermatophagoides pteronyssinus (D. P. IgG) in three groups, MCLS, bronchial asthma and non allergic children was measured by ELISA kit (Shionogi).
Mean of D. P. IgG was high in Bronchial asthma children. MCLS children, non allergic children in sequence. It was elevated over +2SD in only two patients with MCLS.
D. P. IgG was higher in MCLS children with coronary aneurysm than in ones with no coronary aneurysm children. Specially, children of under three years of age were high average.
It may he likely to conclude that D. P. IgG is related with coronary aneurysm of MCLS with under three years of age.

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Specific IgG antibody levels in sera were measured concerning 55 children with food allergy who showed allergic symptoms after ingestion of Cow's milk and/or Hen's egg. Correlation among age, symptoms, transition by elimination diet and specific IgE were studied. Specific IgG antibody levels to β-lactoglobulin (βLG) in children with milk allergy, especially in young children under one year old suffered from gastrointestinal disorders, showed higher antibody levels at the initial time, and these decreased rapidly as clinical symptoms improved by elimination of milk. In about a half of these children, specific IgE antibydy levels were low. (RASTs were negative.) These results suggest that IgG antibodies to βLG may be produced as the sequence of sensitizing antibody.
But, RASTs were positive in most of children with egg allergy at the initial time although IgG antibody levels to OA were higher in only one third of these children. IgG antibodies to OA showed a tendency to decrease gradually during elimination of egg, but showed no relation to clinical course between the “improved” group and the “not improved” group. The measurement of specific IgG antibodies in children with milk allergy was very valuable on a diagnosis and marker on value of treatment effects.

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Respiratory threshold to inhaled methacholine in children from 3 to 6 years of age was measured by using an Astograph (developed by Takishima) in conjunction with 2 other methods named P-V lissajou's method and P-V phase angle difference method.
In addition to the respiratory resistance (Rrs) curve traced by Astograph, the components of Rrs i. e., mouth pressure (P) and mouth flow (V) were observed during oscillation in P-V lissajou's figure visualized on an oscilloscope and the simultaneous recording of these 2 waves.
Provoked bronchoconstriction was judged by increased angle of inclination of P-V lissajou's figure over 5 degree in association with the increased phase angle difference between P and V waves.
The details of these measurements and the criteria for determining a threshold to methacholine were described.
The distribution of respiratory threshold to methacholine was obtained in normal children from 3 to 15 years of age and then in randomly selected asthmatic children under 6 years and over 6 years of age. It was found that there was no difference of distribution between those 2 groups, indicating that bronchial sensitivity was already high in young children under 6 years of age.

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We studied the efficacy of high frequency vibration for treatment of 81 attacks of 45 asthmatic children. The patients were divided into 3 groups by % FEV_1.0 measured before inhalation: group 1; 70<%FEV_1.0, group 2; 40%<%FEV_1.0<70%, group 3; %FEV_1.0<40%. The bronchodilator was administrated by the following three methods: IPPB only, IPPB with 10Hz vibration and IPPB with 100Hz vibration. For 27 cases with severe attacks, arterial blood gas were measured just before and after the inhalation.
In group 2 (40%<FEV_1.0<70% before inhalation), IPPB with 100Hz vibration was more effective than other methods. In all three groups, IPPB with 10Hz vibration was no more effective than IPPB only. With all three inhalation methods, there were no differences in changes in arterial blood gas tensions.
We conclude that the use of IPPB in combination with 100Hz vibration is more effective than IPPB only in modertate asthma attack.

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Using the ELISA method, we measured specific IgG antibodies in egg-white, cow's milk, soybean, rice, wheat, and dermatophagoides f arinae for 86 persons who had no past history of allergic diseases.
The variations in the antibody titer of each antigen by ages are as follows:
Egg-white and Cow's milk
The peaks both appeared at the age of one and then gradually decreased.
Soybean
Low titer at all ages.
Rice
The peak appeared from birth to the age of one and then gradually decreased.
Wheat
Rather high titer, without remarkable changes during childhood, and then low in adults.
Dermatophagoides farinae
The results showed a tendency for antibody titer to increase up to the age of two or three and go down until adulthood.
The results suggest that the antigen specific IgG antibody was produced even in children who had no past history of allergic diseases and that each antigen showed different variations of antigen specific IgG antibodies depending of the ages of subjects.

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