Based on current knowledge that bronchial asthma is a chronic inflammatory disorder of the airway and the inflammation causes an associated increase in the existing bronchial hyper-responsiveness to a variety of stimuli, major strategy to manage asthma over a long time is suppression of airway inflammation, now. The proper management mentioned in recent guidelines with the good doctor-patient partnership can decrease the symptoms nearly completely, normalize the pulmonary function and assure the normal daily activity. However, there are asthmatic children who have restriction on school life and daily home life. In addition, nondecreasing asthma death in old children is urgent problem. I think that one reason of these is that over-expectation of the technical progress in medication of asthma as disease lessen the doctor's effort of supporting patient's holistic growth. Many intractable asthmatic children and their parents taught me that out-grow from asthma correlate with rise of his/her holistic growth. I became to believe the goal of pediatric medicine is not only treat the disease but also support the patient's development and growth by the treatment of disease.

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Association of pollinosis with sensitivity to fruits and vegetables has been reported. A Japanese cedar pollinosis is the most popular disease in Japan, however there are quite few papers about cross-reactivity between Japanese cedar pollen and fruits or vegetables.
Using the serum from a 14-years old girl, who has Japanese cedar pollinosis and oral allergy syndrome after eating tomato since 12 years old, we have studied the cross reactive allergens from Japanese cedar pollen and tomato extracts.
The study was performed by SDS-PAGE immunoblot and inhibition immunoblot. In immunoblotting, the patient's IgE antibody reacted to both major allergens of Japanese cedar pollen, Cry j1 and Cry j2, and several tomato protein bands including non-specific bands. Inhibition immunoblot study has shown that the IgE binding to Cry j1, not Cry j2, can be inhibited by tomato fruit extract. However, only binding to 14kDa protein in the tomato fruit extracts can be inhibited by Japanese cedar pollen extract. Therefore, the observed cross-reactivity of Japanese cedar pollens and tomato fruit may be due to 14kDa proteins.

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A 2-year-old girl with asthma, who had developmental delay originated in 18q- syndrome, showed involuntary movement in spite of low serum concentration of the drug when she ingested 10mg/kg/day slow-release theophylline.
She also had signs of intoxication for oral β-adrenergic agonists, including restlessness and insomnia. Although she behaved violently whenever nebuliser inhalation was performed, daily inhalation therapy with disodium cromoglycate (DSCG) using ultrasonic nebuliser must be introduced instead of oral medications because she had continuous moderate asthmatic attack. After the treatment with DSCG was started, her asthma score has remarkably improved and she has been able to participate in training for mental and physical development. Her plasma concentrations of DSCG measured by high performance liquid chromatography at 5 and 30min after inhalation of DSCG were equal to mean levels of DSCG in asthmatic children with normal development who were improved by treatment with DSCG inhalation, suggesting that inhalation therapy was effective. It was also effective for her to increase dosage of DSCG when she had frequent asthmatic attacks again during therapy with common dose of DSCG was performed.

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The bronchial hyperreactivity threshold, the ventilatory function, and the exercise tolerance test were evaluated at the times of hospital admission and discharge, recruiting 214 pediatric patients with bronchial asthma who were hospitalized in a facility. These patients were divided into 2 groups according to the hyperreactivity threshold (<1250μg/ml and ≥1250μg/ml) measured at the hospital admission, and factors affecting bronchial hyperreactivity, ventilatory function, and exercise tolerance test were also studied. The results are as follows: 1) all of the cases showed marked improvement in all of the tests at the time of hospital discharge, compared with those at the time of admission; 2) in patients who showed a lower hypersensitivity threshold (<1250μg/ml) at the hospital admission, the duration from the time when perennial asthma was confirmed to the hospital admission was longer, and βMDI was used at a higher frequency; 3) the rest of the patients (hyperreactivity threshold ≥1250μg/ml) showed better ventilatory function and exercise tolerance test results at both times of hospital admission and discharge, compared with the lower threshold group. Thus, it appears that inpatient therapy should be considered for the cases where asthma attacks are poorly controlled with various drugs and where adequate environmental arrangement inside/outside of the house and training are not possible.

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Because of anxiety against exercise induced asthma (EIA), the loss of ability in exercise or confidence in thier ability in sports become a problem among asthmatic patients. Serial maximum % fall after exercise in FEV_1.0, acethylcholine threshold and exercise competence test (50m running, pretracted running) were studied for 1 year in 183 patients with EIA. And comparison of medications between on admission and on discharge were studied. Results were as follows: 1. Maximum % fall after exercise in FEV_1.0, acethylcholine threshold showed improvement gradually during admission. 2. Ability of exercise performance was also improved. 3. Dose of medications were markedly decreased. It seem that daily training for asthmatic patiens is good for not only getting ability of exercise but also decreasing dose of drugs, improvement of bronchial hypersensitivity.

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Raw and heat-coagulated hen's egg white proteins were evaluated for their peptic and pancreatic digestibility by the methods of SDS-PAGE and immunoblot analysis using antibodies against ovalbumin (OA) and ovomucoid (OM). Digestibility of OA was resistant to both peptic and pancreatic digestions in raw egg white, but this resistance was almost lost in heat-coagulated egg white. OM and ovotransferrin (OT) were easily digestive proteins against pepsin in both raw and heat-coagulated egg white and against pancreatin in heat-coagulated egg white, but these proteins were resistant to pancreatic digestion in raw egg white. These results indicate that peptic and pancreatic digestibility in hen's egg white proteins differ between raw and heat-coagulated egg white, and suggest that digestive ability in the stomach may be key for sufficient digestion of OM and OT when raw egg white is taken, because of both proteins being easily digestive to pepsin but being resistant to pancreatin.

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We assessed the clinical significance of specific IgE antibodies for ovomucoid (OM), ovalbumin, ovotransferrin, lysozyme and OM third domain with (D3 CHO) or without carbohydrate chain (D3) in hen's egg hypersensitivity. Thirty-two subjects with high IgE antibody titers for egg white were divided into two groups of positive (n=19) and negative (n=13) immediate hypersensitive reactions to double-blinded placebo-controlled food challenges with freeze-dried egg white antigens. The positive challenge group showed a tendency (p<0.1) toward higher specific IgE antibody for OM than the negative challenge group. The sensitivity, specificity and accuracy for a diagnostic power of specific IgE antibody titers to OM were 89.5%, 30.7% and 65.6%, respectively. These results were better than those of the other egg white components.
Specific IgE antibodies for OM domain 3 with or without CHO was statistically higher in positive IHR group than in negative IHR group. The, sensitivity, specificity and accuracy were 89.5%, 92.3% and 90.6%, respectively, for D3 CHO and 94.7%, 69.2%, and 84.4%, respectively, for D3. These results indicate that specific IgE antibodies for D3 with or without CHO give more useful diagnostic tools in hen's egg hypersensitivity compared with OM and other egg white components.

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We examined the factors related to disappearance of the circadian rhythm of parasympathetic nervous function in asthmatic children. The subjects were 145 children with asthma. All the patients underwent 24-h electrocardiography. We measured the %RR50 for 1h and analyzed the rhythm using the single cosine fitting method. We used the values of the MESOR (the midline-estimating statistic of rhythm), amplitude and acrophase. Circadian rhythm disappeared in 34 (disappearance group) of the patients, and was retained in 111 patients (retained group). Several factors, including age, status, time of asthma attack, severity of asthma, therapy and NNA were compared between the disappearance group and the retained group. The NNA value was lower in the disappearance group than in the retained group (t=2.07, p=0.04). There was no significant difference in other factors between the groups. In some asthmatic children, the circadian rhythm of %RR₅₀ disappeared, and parasympathetic nervous function was poor during remission. It is suggested that increase in heart rate is related to some disorder of biologic rhythm of asthmatic children.

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Appraisal of therapeutic cost-benefit must become an essential part of the national allocation of limited resources. To recognize cost-effectiveness in management of childhood atopic dermatitis (AD), cost of outpatient care were assessed at 3 private offices, 4 general hospitals, and 2 university hospitals. Two-hundred and forty two AD patients aged 0 to 20 years were enrolled. Mean of total cost over one-month was ¥11, 000; ¥3, 000 was on physician's fee, ¥5, 000 on prescribed medications, ¥1, 600 on prescription, and ¥1, 400 on laboratory tests. Anti-allergic agents comprised 56% of the cost of medications, while oral DSCG comprised 21%, ointments 21%, antihistaminics 3%. Categorization of AD into subgroups of different severity showed that the amount of anti-allergic agents and oral DSCG prescribed to moderate and severe patients was higher than that of mild patients, which resulted in higher medication cost of moderate and severe groups.

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