We surveyed by questionnaire 169 medical students mean aged 24.7 years old with symptoms suggested allergic diseases in childhood and adulthood.
In childhood, asthmatic symptoms (AS) were reported by 18.3%, nasal symptoms (NS) were 34.9%, dermal symptoms (DS) were 26.6%, ocular symptoms (OS) were 20.1%, pollinosis symptoms (PS) were 9.5%, drug hypersensitivities (DH) were 4.1%, food hypersensitivities (FH) were 7.1%. In adulthood, AS were reported by 24.9%, NS were 43.2%, DS were 26.6%, (OS) were 32.0%, PS symptoms were 18.6%, DH were 3.6%, FH were 4.1%. The remission rates from all symptoms suggested allergic diseases were not low, AS were 16.1%, NS were 8.5%, DS were 8.9%, (OS) were 5.9%, PS were 0%, DS were 0%, FH were 25.0%. And the adulthood onset rates without any symptoms in childhood were low, AS were 26.1%, NS were 26.0%, DS were 20.0%, (OS) were 31.5%, PS were 28.1%, DH were 33.3%, FH were 0%.
These results might be suggest that the childhood allergy did not easily remit, but easily developed the adulthood allrgy.

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We present two cases of allergic bronchopulmonary aspergillosis or allergic bronchopulmonary penicilliosis. The first cas was a 15 year-old male with bronchial asthma. Chest roentgenogram showed an infiltration shadow in the bilateral upper lung fields, predominantly in the right upper lobe. Total serum IgE was 39000U/ml, RAST score to Aspergillus was 3, and peripheral blood eosinophil counts were 4984/μl. Type I skin reaction against Aspergillus was positive. Bronchoscopy showed mucoid impaction and Aspergillus grew in sputum cultures. Precipitating antibodies to Aspergillus were positive (16×) After corticosteroid administration, the symtoms and abnormal findings of chest roentgenogram were improved remarkably.
The second case was all year-old male, who also had bronchial asthma. The chest roentgenogram showed total atelectasis of right lung field and mediastinum deviated towards the right. Total serum IgE was 975U/ml, RAST score to Penicillium was 2 and peripheral blood eosinophil counts were 584/μl. The type I skin reaction against Penicillium was positive. Bronchoscopy showed mucoid impaction, accompanied with positive fungus culture for Penicillium species. After corticosteroid administration, those symptoms and abnormal findings of chest roentgenogram were improved for a short while.

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We investigated the allergic factors affecting wheezing before the age of first year and their relation to asthma at three years of age.
35 wheezing infants (recurrent episodes of afebril wheezing) underwent allergic testing before the age of first year (6.4±3.6 months old). Total serum IgE levels increased 43%. Allergen specific IgE levels elevated 49%. Eosinophyllia was noted 23%. Positive food challenge test (egg or milk) suggest food allergy was noted 49%. Only 26% had all negative. 91% of the infants had allergic family histories.
Evaluation of each factor according to relative risk suggest that the high allergen specific IgE levels, positive food challenge test, hospitalization because of severe wheezing and allergic family histories are asthmatic risk factors at three years of age.

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We performed multicenter study on the usefulness of spacer device for inhalation of β₂-stimulant with MDI in 28 asthmatic children.
There were no significant differences in improvements of clinical symptoms and pulmonary functions between inhalation with spacer group and that without spacer group, except significant difference in increase in V₂₅ thirty minutes after inhalation in former group.
Based on these results, it might conclude that there is no need to recommend the use of spacer device for the inhalation of β₂-stimulant with MDI in asthmatic children, except cases who are not able to inhale β₂-stimulant with MDI correctly or have adverse effects with effective doses.

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To evaluate the usefulness of PEF measurement on acute asthma attack in children following studies were performed.
1. Initially we evaluated PEF before and after β-agonist inhalation on acute asthma attacks (n=426) in 145 asthmatic children (males 86 cases, females 59 cases, age 6 to 17years-old) at outpatient clinic in our hospital, and those episodes were divided into three groups, which were admission group (n=122), admission within 24 hrs group (n=27), and non-admission group (n=277). Mean% PEF before (after) inhaled β-agonist were significantly different between three groups, with the mean of 31.6% (47.3%), 41.0% (71.6%), and 50.5% (81.6%) respectively.
2. Next, we investigated changes in % PEF and other parameters (FEV_1.0, V₅₀ and SpO₂) day by day in 87 admissions due to asthma attacks with no respiratory complications such as pneumonia and atelectasis in 81 asthmatic children (male 45 cases, females 36 cases, age 6-16 years-old). Percent PEF was tended to improve more faster than % V₅₀. Percent PEF before and after inhalation of β-agonist on the second day was 55.6% and 74.2% respectively, which were significantly higher than the first day of admission, while SpO₂ on the first and second day were 94.1% and 94.1% respectively, showing no significant improvement.
These results suggest that measuring PEF before and after inhaled β-agonist on acute asthma attack is useful to determine treatment plan, including prediction of exacerbation after sent home. However, not only PEF but also assessment of SpO₂ and peripheral airways obstruction should be measured for evaluating the recovery from severe attacks.

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To investigate the relationship between exacerbation of asthma and PEF variability, 32 institutionally hospitalized asthmatic children were enrolled in the study. Methods: PEF variability, asthma attack score, medication score were evaluated every one week for four weeks before 40 episodes of acute exacerbation, being required frequent inhalations of β-agonist, intravenous aminophylline, and/or systemic steroid during long-term hospitalization. Those parameters during most stable period were also evaluated to compare with 2 weeks before acute exacerbation. Subjects were divided into unstable group and stable group with or without asthma attack during 1 week before episode of acute exacerbation respectively. Results: 1. Averaged % PEF decreased and daily variability of PEF increased significantly in 1st week than in 2nd-4th week before acute exacerbation. 2. Averaged % PEF decreased and daily variability of PEF increased significantly in 2 weeks before acute exacerbation than in most stable periods. 3. Averaged daily variability of PEF was proportional to asthma attack score during 1 week before acute exacerbation. 4. Although no significant changes in % PEF and daily variability for 4 weeks before acute exacerbation were observed in stable group, averaged % PEF decreased and daily variability of PEF increased significantly in 2 weeks before acute exacerbation than in stable periods. Conclusions: These results suggest that information obtained by long term PEF monitoring is useful for predicting asthma exacerbation, and that measuring PEF and its daily variability even in stable period are also important to know individual PEF change.

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A comprehensive management from a psychosomatic point of view was carried out for a 12-year-old severe asthmatic patient who had experienced long-term hospitalization. Our conventional therapy could not bring him improvement for the first couple of months, although psychological care was given during this time by a psychologist. Then we rebuilt our strategy and introduced primary intervention of behavioral medicine with a initiative taken by physicians. As a result, we could establish a better patient (parents) -physician relationship and reinforced the comprehensive management. This intervention got a remarkable success in decreasing both the patient's anxiety and frequency of asthma attack, and eventually he was released from his long-term hospitalization.
We realized that psychosomatic therapy functions quite effectively when physicians themselves take part in the psychosomatic care, compared with when physicians put focus only on physical aspects of a patient by letting psychologists alone take care of his psychological aspect. Improvement of parents-patient relationship and parental cooperation with the therapeutic team seems to contribute to stabilizing his symptom after discharge. Formal cooperative system among physicians, comedical staffs and patients (parents) was not enough to realize effective comprehensive management. We should keep on our mind that it is necessary for the triad to establish close cooperation with one another as joint therapists of psychosomatic medicine.

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Study for cost managing asthma was implemented in order to recognize cost-effectiveness in treatment for pediatric allergic disease. One month-treatment cost of asthma outpatient treated at medical office, general hospital and university hospital, the age of 0 to 20, was studied. In the study, total outpatient cost was ¥22, 000 including that, physician's fee was ¥6, 000-¥7, 000 (¥4, 000 decreased at hospital), drug fee for treatment was ¥600, prescription drug fee was ¥11, 000, prescription fee was ¥1, 800, laboratory test fee was ¥2, 700. The contents of prescribed drug cost were 30% for DSCG, 28% for anti- allergic agents, 24% for theophyllines, 7% for oral β₂ stimulants, 4% for BDP, 2% for inhalant β₂ and 5% for others. For prescription drug fee, the difference by institution or the age of a patient was not observed, 2-3 times-difference by a severity of asthma was observed. A major point to consider a decrease in cost managing asthma is that, whether or not strong antiinflammatory inhalant steroid would be applied to mild asthma group treatment, and a consideration for long-time adverse effect and drug dependence, should be judged.

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Prediction and prevention of allergy is thought to be most important, for pediatric allergologists. And the determination of specific IgE in infancy is recently reported to be useful for the purpose of this prediction, besides the family history and the determination of cord blood IgE levels, proposed before.
I proposed, several years before, the standard values of serum IgE levels in infants and children, and proposed the prediction of future allergy with total serum IgE levels. At this time, I compared the specificity and sensitivity of the prediction with specific IgE values, to those with total serum IgE levels.
The prediction with specific IgE values for several kinds of antigen, used in ordinary clinical activities, was showed to be usuful to a certain degree. However, when the standard values of serum IgE levels, I proposed before, is applied, the prediction with total serum IgE levels was proved to be more precise, for the prediction of the future allergic sensitization.

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Allergenicity of food proteins is generally dependent on their heat-stability and resistance to digestive enzymes. Using the methods of ELISA inhibition assay and immunoblots, we assessed peptic-and pancreatic-digestibility of β-lactoglobulin (β-LG) and its antigenecity after the treatment with digestive enzymes in three types of commercially available heat pasteurized cow's milks (low temperature long time-treated milk (LTLT), high temperature short time-treated milk (HTST) and ultrahigh temperature-treated milk (UHT)). Digestibility of β-LG was resistant to both single and sequential peptic- and pancreatic-digestions in the LTLT and HTST, but not in the UHT. In the LTLT, boiling of the milk for 15min lead β-LG to lost of the digestive resistance. These results suggested that the UHT may be superior than the LTLT and HTST in the point of gastrointestinal digestibility of β-LG, and that consideration of cooking for menus composed of the cow's milks may improve digestibility of β-LG in the stomach and intestines.

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