A 5-year-old boy initially had an asthmatoid attack at exercise occurring within an hour after meals since May 1989. The episodes were prevented by avoidance of bread, noodles and other wheat products. He was d iagnosed as exercise induced ashmatoid reaction from ingestion of wheat, depending on positive prick test and IgE RAST. This case was speculated to be a variant of food dependent exercise induced anaphylaxis (FEA), and he turned out to be FEA later.

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We studied daily life, especially physical training therapies and autonomic nervous symptoms, in children with bronchial asthma. Quentionnaire data were obtained from 532 allergic pediatric outpatients in five institutes. Light clothing was the most frequent and cold bathing was only 19.1% in frequency in their physical training therapies. Their family members had different opinions of light clothing. Orthostatic dysregulation (OD) was found in 40.4% patirnts. Based on the OD test, they had most frequently the difficulty of waking up in the morning in the major symptoms and becoming easily fatigued in the minor symptoms. The OD symptoms were not significantly correlated with their physical training therapies.

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This study was designed to compare the effect between low concentration-continuous inhalation and high concentration-intermi-ttent inhalation of isoproterenol. Changes of pulmonary function and heart rate were evaluated by cross over design in high concentration short-term inhalation (HCSTI) and low concentration long-term inhalation (LCLTI) in 9 children with acute asthma attack. The total dose given and inhalation equipment used were the same in the two inhalation methods. %FEV_1.0 increased quickly after HCSTI, but decreased to the preinhalation level 60 minutes later. On the other hand, %FEV_1.0 increased continuously during LCLTI. Although the maximal %FEV_1.0 at 5 minutes after HCSTI was higher than that at 30 minutes during LCLTI, it was not statistically different from %FEV_1.0 at 60 minutes. Heart rate increased after HCSTI, but did not change during LCLTI. Low concentration-continuous inhalation did not have an immediate effect, but gave continuous improvement in pulmonary function without rise of heart rate.

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Clinical features and a questionnaire follow-up study of nine children with food-dependent exercise-induced anaphylaxis (FEA) were reported. They were 7 boys and 2 girls, whose ages at onset ranged from 9 to 16 years. The causative foods were shelfish in 5 cases, wheat in 3 cases, but not identified in one case. The intervals between meal ingestion and exercise ranged from 0.5 to 4 hours. From questionnaire data obtained the prognoses were different in shelfish allergy group and the other allergy groups. In shelfish allergy group, all patients have been eliminated responsible foods and cosequently no limitation of exercise was needed at school. Only one episode of FEA has been recurred by accidental ingestion of shrimp. 3 out of 5 continued strenuous exercise. On the other hand, in wheat and other allergy groups, complete elimination of antigens at school was almost impossible, so that all patients had experienced recurrence of anaphylaxis at school, in spite of limitation of exercise during and after school hours. The present study showed that it was necessary for management of school children with FEA, to give appropriate informations to teachers coaches, and nurses at school.

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Children with bronchial asthma aged between 1 and 16 years were observed for 2 weeks, and subsequently received repirinast at a daily oral dose of 8mg/kg for 26 weeks.
1. According to the impression of the affected children and the results of the evaluation of overall improvement and usefulness, repirinast was highly useful. The improvement rate increased along with the progress of the study, and the percentage of patients showing mild or better improvement fluctuated around 90% from week 12 of the study.
2. Compared with the observation period, the clinical score was significantly reduced throughout the entire study period (the treatment score was reduced from week 4).
3. 46.5% of the patient received repirinast for 26 weeks. Among them, 12 patients were symptomatically stable, and no increase in the treatment score was observed.
Based on these results, the clinical efficancy of repirinast (Romet^® fine granule for children) was confirmed. However the final number of evaluable patients was considered to be 12, in this study, no use of any concomitant drug was intented, improvement was evaluated during a limited period of 4 weeks, and the dose of repirinast was subsequently reduced.

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We studied autonomic nervous symptoms in asthmatic patients. Questionnaire data were obtained from 335 outpatients bronchial asthma. They ranged in age from four years to 21 years in pediatric allergic clinics of five institutes. Orthostatic dysregulation (OD) was found in 40.3% patients, and OD positive children distributed most frequently from 8 years to 10 years in age. Mean age in patients with OD symptoms was older than in patients without OD symptoms, but there was no difference in gender between either the patients. The distribution of asthma severity was significantly difference between both the OD-positive and OD-negative groups. Serum IgE levels did not significantly differ between the patients, even though, they were divided into severely groups either by ages and gender. The dysfunction of autonomic nervous system, especially OD, may be contributed to the pathogenesis of bronchial asthma.

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A dried food (juice) containing freeze-dried egg white and a placebo were obtained. The usefulness of the dried food in pediatric allergy practice was evaluated in 50 infants and children who had eliminated consumption of eggs and egg products due to confirmed or suspected egg allergy. The purpose of the challenge test with the dried food was to assess the degree of immediate-type hypersensitivity and/or tolerance to egg.
This test was carried out using the single open food challenge method. Because the amount of the dried food administered as the test dose depends on the degree of hypersensitivity, 1 to 10mg of dried food (0.38-3.8mg freeze dried egg white) was set as the initial dose. If no reaction occurred within 30 minutes, the dose was increased 5-fold to 10-fold in subsequent tests until 7, 700mg was reached. No reaction at 7, 700mg was defined as negative test to egg. Results were as follows.
1. Immediate-type reaction was found in 25 patients, and the amount of dried food administered by onset of apparent immediate reaction ranged from 10 to 7, 700mg.
2. Non-immediate type of reaction was revealed respectively in 2 and 3 cases, and biphasic reaction of immediate and late types was observed in 2 patients.
3. Negative test to egg was observed in 18 patients.
4. No patient experienced esystemic anaphylactic reaction due to those challenge test.
5. Placebo-food was adopted, when in presumption of uncertain result, and was used in 23 for single blind and in 13 cases for double blind placebo-controlled food challenge tests.
Though there were some aspects of this procedure of this test with dried food containing freeze dried egg white that should be improved, it was thought that when by the above-mentioned method, this food was adapted for clinical evaluation of hypersensitivity to egg, particularly for purposes of assessing the degree of hyper-sensitivity and/or tolerance to egg.

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With the object of clarifying the features of body conposition of infant case of allergy, % body fat was determined by the impedance method, expressed as a SD score of % body fat based on a standard value, and a heght SD score was also examined in 63 cases of allergy.
1. In case of bronchial asthma, a SD score of body fat rate tended to decline with an advance of the disease serverity.
2. In case of atopic dermatitis, a hight SD score significantly declined with an advance of the disease severity, and a SD score of body fat rate showed an increasing tendency in advanced cases.
In case of atopic dermatitis, body height tends to decrease with an advance of the disease, and % body fat tends to increase in advanced cases. It is suspected that such physical features as seen in cases of atopic dermatitis are more strongly caused by abnormal secretion of growth homone due to stress of sleeplessness, or effect of external steroid preparations rather than by nutritional disorders due to elimination diet or absorption disorder in the intestinal tract. Therefore, patients, paticularly in advanced case of atopic dermatitis, comprehensive treatment is needed with paying attention to the above points.

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