After resolution of pepsin-treated ovomucoid (OM) with gel filtration and reverse phase HPLC, we determined the OM fractions which showed IgE-binding activity by means of direct radioallergosorbent assay (RAST) using polyvinyl 96-well plate. Fifteen subjects with high IgE antibody titers to OM were divided into two groups with positive (n=8) and negative (n=7) results to double-blinded placebo-controlled food challenge with freeze-dried egg white antigens. The sera from positive challenge group showed significantly high IgE-binding activity to fraction No. 23 and No. 38 from gel filtration (Bio Gel P-30 column), however those from negative group showed significant binding to none of fractions. No. 23 fraction which was recognized most frequently by patients' sera was subjected to further analysis with reverse phase HPLC (C18 column). No. 18 fraction showed binding activity to IgE antibodies from patients with positive challenge results. N-terminal amino acid sequence of the fraction No. 18 corresponded to the peptide which began with No. 134 of amino acid residues of OM. In conclusion this peptide was derived from the third domain of OM and may have an important role in egg-white hypersensitivity.

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Cultures for Staphylococcus aureus (S. aureus) were taken with food stamp agar (TGSE, Nissui) from unaffected and eczematous skin regions of 30 children (mean age±standard deviation=4.6±6.8 years, male:female=16:14) with atopic dermatitis. Skin regions of exsudative lesions and lichenification as affected sites were selected for collection of culture. We counted a number of colonies on the 10cm² of the agar surface and determined the susceptibility of the bacteria against methicillin for assessment of MRSA. After the subculture in the liquid medium, we examined the production of coagulase and enterotoxins (SEs) and toxic shock syndrome toxin-1. Significantly more colonies were isolated from exsudative and lichenification lesions than from non-eczematous skins. There were no significant differences for other variables between affected and unaffected skins. The types of coagulase and SEs of S. aureus isolated from different skin sites were identical in 90% of the patients. It was suggested that the higher colonization density had an important roles in deterioration of atopic dermatitis. Since the amount of enterotoxins with superantigenic activity is correlated with the bacterial colonization density, enterotoxins may be involved in the pathogenesis of atopic dermatitis.

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Using 196 serum samples obtained from both children patients who showed allergic symptoms and normal donors, the usefulness of LUMIWARD immunoassay system was investigated for diagnosis of allergic diseases throughout comparison with skin test and CAP RAST.
On fundamental test results, excellent performances were obtained on both reproducibility tests and dilution tests. The interference substances had no effect on the measured values in the assay system. The minimum detectable concentrations were 0.04IU/ml on specific IgE antibody and 0.11IU/ml on total IgE. On 858 tests from 145 patients, the correlation of 8 allergens between LUMIWARD and CAP RAST showed high performance, that concordance rate, positive concordance rate and negative one were 91.8, 90.3, 92.8%, and the correlation coefficient was 0.916.
On the clinical evaluations, LUMIWARD showed a little sensitivity and more excellent specificity than the skin test. In regard to the appearance frequency of qualitatively positive sera by age group, only egg white- and/or milk-specific IgE in food allergens were detected on the positive zone at age 0. All allergen-specific IgE had peak frequency at age 2 and decreased gradually at age 6. The IgE against cat epithelium and house dust mite increased in order of age, especially mite-specific IgE reached 70% in frequency at age 6. In the retrospective study of 6-aged patients who showed positive to egg white, seven of nine had been positive to egg white at age 0. One of residual 2 samples showed low concentration IgE (0.04-0.35IU/ml) against egg white, though it deemed to be negative. At age 0, one sample was positive and two sample had low concentration on milk-specific IgE. On mite-specific IgE, all of nine samples showed negative but four samples had low concentration of IgE.
These observations suggested that LUMIWARD had the clinical usefulness in detecting IgE antibodies in allergic subjects and earlier diagnosis on childfood.

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Nineteen pediatric patients aged 0-7years with moderate or severe asthma and recurrent infections were enrolled in an open-label trial of high-dose intravenous immune globulin (IVIG), 400mg/kg/day for 5 days. We evaluated the symptoms in each patient at 2 weeks prior to the trial, and at 1 month, 7 months and 2 years from the trial.
Seventeen of the 19 cases completed this trial at 7 months and six at 2 years.
The 17 cases recorded their daily symptoms, ADL (Activities of Daily Living) and medicines taken. The number of asthma attacks and the ADL score were both decreased after the last infusion and further improved after 7 months. Other symptoms were also improved, but moderately. Severity of asthma was improved to 70.6% (12/17) after 7 months and still 50.0% (3/6) after 2 years. The number of admissions was also decreased from 1.5 times in 7 months, just after the trial, to 0.3 times in 6 months between 1.5 and 2 years after.
The clinical symptoms improved in 58.8% (10/17) after the last infusion and in 76.5% (13/17) after 7 months. Clinical symptoms considering the medicine scores were improved in 64.7% (11/17) after 1 month and 82.3% (14/17) after 7 months.
Twelve of the 19 cases complained of fever, vomiting, headache and/or nausea but only for a while during the first couple of days.
Occurrence of pneumoniae and bronchitis was reduced from 94% (16/17) before the trial to 18% (3/17) after 1 months, and to same degree up to 7 months.
Clinically, the children under 3 years old improved better than those over 3 years old. Especially the children whose eosinophil count levels were high under 3 years old improved remarkably.
According to this investigation, each IgG subclass in immune globulin was considered to act immunologically as a regulator.

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It is important to provide the childhood emergency system at night to prevent of asthma death or life-threatening asthma attack. In Himeji, Himeji Medical Clinic for Emergency is in charge of first, and Himeji Red Cross Hospital is in charge of secand medical care as emergency life care center at night of all the year. During 1997, the number of childhood outpatients of Emergency Center was 12, 382, and 12.4% of them had asthma attack. Only 42 patients (2.7%) were admitted to our hospital. Seventynine percemt of them were judge to be hospitalized soon after inhalation.
It seems that the linking of childhood emergency system at night in Himeji is relatively smooth managemented.

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External chest compression (squeezing) is a technique to assist expiration. The effectiveness of squeezing on inhalation therapy in asymptomatic periods for asthmatic children was studied. Urinary DSCG excretion during 4 hours after DSCG inhalation using an ultrasonic nebulizer with and without squeezing was measured, since urinary excretion of DSCG parallels its lung deposition. The effect of squeezing on DSCG inhalation was not statistically significant. However, the urinary excretion of DSCG was increased 1.4-2.1 times with squeezing for three out of six cases. In a case of an eight-year-old girl, the urinary excretion of DSCG was not increased with squeezing; however, cough with sputa was induced. For two other cases, the effect of squeezing on inhalation therapy was not recognized. One of the two cases, a three-year-old boy, was not able to inspire deeply due to the much compression on chest wall without synchronized breathing. The effectiveness of squeezing on inhalation therapy in asymptomatic periods was shown at least in some cases.

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The causes of asthma death were studied on 137 patients, 85 male and 52 female, age ranged from 0 to 28 years old, from 1990 to 1997. Eight cases were excluded because of non-asthma death such as car accident. Twenty six cases (19.1%) have mild asthma, 30 cases (22.1%) moderately severe, 41 cases (30.1%) severe, and 39 cases (28.7%) unknown or undescribed. Seventy eight cases (58%) died in hospitals but 5 and 6 cases with age of 13 years old or above died more frequently on the way to hospital and in the ambulance cars respectively. The contributory factors to asthma death were delay by patients and/or families in seeking help in 69.3% and unexpected sudden exacerbation in 67.9%. The delay in seeking help when condition begin to deteriorate was made by their families in 48.9% and by patients in 47.4%, and strong dependence on beta-stimulant by metered dose inhaler (MDI) was seen in 29.2%. The possible causes of deaths were overtreatment with drugs in 19 cases, and 12 of them were beta-stimulants by MDI. Eight of them were reported to be fenoterol by MDI.

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Two children with anaphylaxis caused by fish consumption were reported. The radioallergosorbent test of all fishes examined was positive, and IgE immunoblotting demonstrated that Gad c1, which molecular weight was about 13Kd. may be the responsible allergen of these patients. The patient with fish allergy may react to many fish species, becuase Gad c1 can be found in almost all fish species. The knowlege of the characteristics of fish allergy helps make its diagnosis.

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