We assessed the diagnostic significance of 20-minute patch tests in immediate hypersensitivity by egg white comparing with prick tests. Forty-six subjects (male:female=25:21, median age±standard deviation=38.6±24.3 months, range; 11 to 124 months) were orally challenged with freeze-dried egg white in a double-blinded manner. We considered reactions of wheal positive in 20-minute patch tests. The reactions of wheal more than 3mm or erythema more than 10mm in a longer diameter were judged positive in prick tests. The agreement rate between 20-minute patch tests and oral challenge tests was 73.9%. In contrast, the rate between prick tests and oral challenge tests was 60.9%. We divided all subjects into two groups under and over three years of age. The results of 20-minute patch tests gave the best agreement rate in group aged three years or younger. Then we concluded that 20-minute patch tests, especially in children up to three of age, have a significant diagnostic value in immediate hypersensitivity by egg white.

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Infection is one of the important causative factors of asthmatic attack. We examined the clinical features of eight children with bronchial asthma who had recurrent lower respiratory tract infection caused by penicillin-resistant Streptococcus pneumoniae. Asthma was severe in all the subjects, according to the criteria of the Japanese Research Group for Pediatric Allergy.
Two of them had IgE antibodies specific to house dust and mites antigens. Immunological examination showed that all children were deficient in IgG₂ subclass antibodies to pneumococcal capsular polysaccharides and one had IgA deficiency. Five children were treated chronically with low- dose erythromycin therapy.
This tratment regimen reduced the frequncy of asthmatic attack in four of them.

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Staphylococcus aureus (S. aureus) is often isolated from infected skin of patients with atopic dermatitis (AD). We examined the specific IgE, IgG, IgG1 and IgG2 serum levels against S. aureus to clarify the sensitization and the roles of the specific IgG antibodies against S. aureus in patients with AD. The antigen was purified from Wood 46 strain, defective of protein A. Fifty nine (29.4%) of 197 patients with AD were positive for specific IgE. The levels of IgG1 and IgG2 againt S. aureus of the positives for IgE were much higher than those of the negatives. Patients with AD are supposed to be easily sensitized by S. aureus. It was suspected that IgG (IgG1 and IgG2) has a supportive role to prevent generalized infections with S. aureus in patients with AD.

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Skin reactions to skin care soaps in children with atopic dermatitis were compared between the left and right extremities in order to select good soaps for atopic dermatitis. The soap routinely used by the patient was used on one extremity and the other soap, named CD, was used on the other extremity. The children and their family members recorded the severity of erythema and itching on each extremity in the atopic diary, and skin dermatitis scores were later calculated in terms of diary. Children and their family members were also interviewed at the hospital and their self-assessments in skin conditions were recorded. In 5 out of 29 cases (17%), the usefulness of the soap used prior to this study was better than that of the CD soap; in 9 cases (31%), the CD soap was superior; 15 cases (52%) reported no difference. Two cases showed different erythema scores, even though no difference in their self-assessments was reported. In one case, CD soap was stopped because of the immediate skin worsening. A comparison of skin reactions in the left and right extremities was useful method in bringing about the good selection of the soap for atopic dermatitis.

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Pemirolast potassium is oral nonbronchodilator antiallergy agent evaluated for the therapy of asthma. Its pharmacokinetics in children with asthma has not been studied in detail. The relation between plasma concentrations of pemirolast potassium and its clinical efficacy in asthmatic children was evaluated.
Fourteen children with asthma received pemirolast potassium, 0.4mg/kg/day, given two divided doses, for at least 2 weeks. Plasma levels of pemirolast potassium were determined and, symptoms and concomitant medications were scored.
Within 5 hours after drug administration, the plasma levels of pemirolast potassium in all patients were above the effective plasma level of drug, 0.266μg/ml, and they had no asthma symptoms. Between 5 and 10 hours after drug administration, the children, whose plasma levels of drug fell below 0.266μg/ml, became symptomatic. In 6 patients who received the same doses of pemirolast potassium for 6 months, wide individual variations were observed in the drug's half life and nadir plasma levels. Total scores of symptom scores and concomitant medication scores were decreased in patients whose nadir plasma concentrations of pemirolast potassium were above 0.16μg/ml and were not decreased in patients with low nadir plasma level of pemirolast potassium during treatment with pemirolast potassium.
To establish the optimal dose, the pharmacokinetics of pemirolast potassium need to be evaluated in asthmatic children. Large doses may be required to achieve nadir plasma levels neaby 0.266μg/ml in children who exhibit low plasma levels of pemirolast potassium.

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The airway inflammation is believed to play an important role in bronchial asthma and beclomethasone dipropionate (BDP) inhalation therapy has been introduced and proved to be effective for treatment of asthmatic children. Although BDP inhalation is generally considered to have less adverse effects than oral corticosteroids, we should watch the adrenal effects of corticosteroids for children carefully. We estimated the adrenal functions of 16 children (11 boys and 5 girls, age: 12.7±2.8 [mean±SD] years old, inhalation period: 648.1±206.0 days, dose: 12.1±5.4μg/kg/day) by serum cortisol levels, urine 17-OHCS levels and rapid-ACTH challenge test before and after BDP inhalation therapy. The results suggest the possibility of adrenal functions suppression after BDP inhalation. We must admit that the safety of BDP inhalation for asthmatic children still remain unestablished. We propose that we should be very cautious when we start BDP inhalation therapy for children and estimate their adrenal functions regularly and continuously.

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We measured plasma concentrations of disodium cromoglycate for various asthmatic treatments in children and adolescents and estimated plasma concentrations and protective effects. Disodium cromoglycate as a 2mg aerosol (n=13), 4mg aerosol (n=5), or 20mg nebuliser solution (n=13) was inhaled by patients when they had no asthmatic attacks. The plasma concentrations of disodium cromoglycate after 5min of inhalation were 3.04±2.72 ng/mL in the 2mg aerosol group, 2.95±0.86ng/mL in the 4mg aerosol group, and 7.72±4.65ng/mL in the nebuliser solution group. Subjects who used the nebuliser exhibited markedly higher plasma concentrations of disodium cromoglycate. There was a significant correlation between the concentration of disodium cromoglycate at 5min and the protective effect determined by a ratio of the difference in the asthma score between baseline and treatment periods to the baseline asthma score. When the plasma concentration of disodium cromoglycate is low, administration of larger aerosol dose or nebulisation might be necessary.

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The case is a three-year-old girl. She was admitted to our hospital for status asthmaticus. Because her respiratory failure was worseninig, continuous l-body isoproterenol inhalation therapy was administered. Fourteen hours later, the T-wave on the electrocardiogram changed, despite bradycardia. Isoproterenol inhalation therapy was discontinued, but her asthma attack worsened again. There was no reliable evidence to substantiate a diagnosis of myocardial toxicity on examination, so isoproterenol inhalation therapy was re-started. Forty-eight hours later, a chest X-ray showed cardiomegaly, and an electrocardiogram showed ST-segment depressions. We made a diagnosis of congestive heart failure due to myocardial toxicity, and discontinued the isoproterenol inhalation therapy. The signs and symptoms of congestive heart failure subsided soon after discontinuation. We call attention to the fact that continuous l-body isoproterenol inhalation therapy may induce myocardial toxicity without tachycardia.

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