It is important to monitor the blood theophylline levels during intraveneous aminophylline infusion in the treatment of acute exacerbation of asthma. Only by monitoring, we can use adequate aminophylline for its bronchodilating effect. We accummulated the data of 995 pharmacokinetic analysis from 451 cases of bronchial asthma during intraveneous aminophylline infusion therapy. From these data, we propose the ideal method and dosage of intraveneous aminophylline infusion for each age and sex.

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During the “Round the Clock” therapy, using sutained-release theophylline preparation, it is important to monitor the blood theophylline lvels, and to analyze pharmacokineticaly and to know individuality in each patients. We accumulated data of 1756 pharmacokinetic analyses in 323 cases. And from these data, we clarified the difference of pharmacokinetic parameters in each age and sex, so we propose, here, the ideal doses of sutained-release theophylline preparatopn.

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[in Japanese]

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We performed an oral provocation test with boiled hen's egg white in patients who had undergone egg elimination therapy. Specific IgE antibodies to EW, OA and OM were measured by the UniCAP system using sera from these patients and the results were compared to those from the oral provocation tests. Twenty patients (P group) had a positive result in the provocation test and 26 (N group) were negative. No difference was found between these two groups in age or duration of egg elimination. Specific IgE antibody titers to EW, OA and OM in group N were 0.3logU_A/ml, 0.3logU_A/ml and -0.3logU_A/ml, respectively. Those in group P were 0.8logU_A/ml, 0.9logU_A/ml and 0.7logU_A/ml, respectively. The prevalences of specific IgE antibodies to these 3allergens in group N were 92.3%, 88.5% and 34.6%, respectively. Those in group P were all 100%. A significant difference in the prevalence of specific IgE antibody to OM was found between the groups. On the other hand, there were no significant differences in those to EW and OA.
These results suggest that specific IgE to OM, measured by UniCAP system is a useful marker for the introduction of heated egg to patients who have undergone hen's egg elimination therapy.

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We described a case of an infant with hypereosinophilia complicated with food-induced atopic dermatitis. Eosinophilia may be present in patients with atopic dermatitis, but hypereosinophilia has been rarely reported. The patient presented with growth retardation, hypoproteinemia and mild liver dysfunction. A complete blood count obtained on first examination showed an elevated absolute eosinophil count of 15, 520per cubic millimeter. The serum IgE level was elevated. The serum levels of specific IgE to egg white, cow's milk and soybean were also elevated. The initiation of therapy with oxatomide and mequitazine was not effective. After oral corticosteroid therapy, the patient's condition improved and hypereosinophilia resolved. The serum levels of interleukin-5, but not IL-4 and eotaxin, were elevated compared with healthy control and correlated with peripheral eosinophil count. However the eosinophil count did not always reflect the clinical conditions and eosinophilic infiltration in the skin lesion did not prominent. The combined results indicate that hypereosinophilia, which unlikely play a central role for clinical manifestation in this patient, caused by the specially elevated serum levels of interleukin-5.

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We measured specific IgE antibodies to ovalbumin (OVA), ovomucoid (OVM) and boiled milk (BM) with CAP-FEIA^® specific IgE in 74 sera from children suspected hen's egg and/or cow's milk allergy. These results were compared to those of hen's egg white (EW) and cow's milk (CM) and the results of clinical histories of allergic symptoms after ingestion of heated hen's egg and CM.
The frequencies of positive specific IgE antibodies to EW, OVA, OVM, CM and BM were 72%, 73%, 58%, 36%, and 22%, respectively. Significant correlation of specific IgE titers among egg related allergens (r=0.77-0.92), and between cow's milk related allergens (r=0.97) were observed. The results of specific IgE antibody titers to OVA were similar to those obtained with EW. The clear clinical histories of allergic symptom after ingestion of heated hen's egg were obtained from 44 children. Eleven of 13 (84.6%) children with negative specific IgE to both OVA and OVM had no symptoms. All the children with positive to OVA and negative to OVM had no symptoms (n=9). Eight of 20 (40%) children with positive to these two had allergic reaction. One of 2 children with border (class 1) to OVA and positive to OVM had allergic reaction. Thus specific IgE to OVM was more specific than specific IgE to OVA and EW. The apparent histories of allergic symptom after ingestion of heated cow's milk were also obtained from 56 children. Only one of 27 (3.7%) children with negative to both CM and BM had allergic reaction. Two of 21 (9.5%) children with positive to these two had allergic reaction. Only one of 9 (11.1%) children with positive to CM and negative to BM had allergic reaction. Therefore specific IgE to BM was more specific than specific IgE to CM.
These results suggest that specific IgE antibody to OVM and BM might be useful marker for diagnosis of hen's egg or cow's milk allergy and monitoring of elimination therapy of these foods. However, reactivity or tolerance to heated hen's egg and cow's milk proteins are not fully explained by these two tests.

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The successful management of asthma requires effective and consistent use of inhaled medications. In Japan, recently pharmacists have been involved in patient education for various diseases including asthma. The aim of this study was to survey how pharmacists educate patients with asthma about inhalation therapy. Questionnaires were completed by 65 pharmacists recruited from 31 hospital pharmacies (HP) and 63 community pharmacies (CP) in Toyama prefecture. Patient education for inhalation therapy was done in 76.9% of the pharmacies, and the several differences were found between HP and CP. Although 68.4% of HP pharmacists discussed about patient education with doctors, only 12.9% of CP pharmacists did. Percentage of pharmacies where patients received demonstration on inhalation technique was higher in HP compared with CP (52.6% vs 16.1%). The pharmacists considered teaching inhalation technique is one of the most important points in patient education in more than 80% of HP while in less than 50% of CP. We conclude that pharmacists are struggling to educate asthmatic patients without any standard programs. There is a need for practical guidelines.

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The survey had been carried out among freshmen enrolled in Osaka Kyoiku University focusing on allergic diseases and their related symptoms. The same students were questionnaired again 4 years later. The incidence of asthmatic attacks in male and female students was increased 2.2 to 2.4 (%) and 1.1 to 1.6 (%), respectively. The prevavalence of wheezing had also increased from 11.0 to 16.8 and 7.7 to 13.9 (%), respectively. The incidence of coughing and smoking habit increased from 6.6 to 8.8, 6.1 to 9.2 (%) and from 7.9 to 40.4, 0.9 to 9.1 (%), respectively. The students developed both atopic dermatitis (AD) and allergic rhinitis (AR) through 4 years university life. It is necessary to educate students on which indoor and outdoor allergen are responsible for the development of allergic diseases.

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Effects of institutional therapy on severe bronchial asthmatic children were investigated at 16 national institutional hospitals in Japan. Subjects were 175 asthmatic children (118 boys, 57 girls) who received institutional therapy over 1 year. Their mean age of hospitalization was 11.2±2.8 years old. We investigated the asthmatic children in terms of 1) the age of the onset, 2) the age of serious condition, 3) time length from onset of serious condition to hospitalization, 4) fit score and 5) medication score. We also examined following data at beginning of hospitalization and 12 months after hospitalization, 1) respiratory function, 2) bronchial hypesensitivity, 3) ability of exercise, 4) serum IgE levels, 5) RAST score.
As the results, institutional therapy is effective for decreasing of fit score and medication score, moreover for improvement of respiratory function, and bronchial hypersensitivity, allergen avoidance and recovering quality of life.

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The causes of asthma death were studied on 164 patients, 101 male and 63 female, aged from 0 to 30 years old, from 1988 to 2000. Twelve cases were excluded because of non-asthma death such as car accident. Subjects studied were divided 2 groups, 1988-1997 and 1998-1999, depending on the period registered to observe the recent changes of causes of asthma death.
Annual number of asthma death decreased in last group comparing with former group. Concerning grade of severity, severe (43.8%), moderately severe (30.5%) and mild (25.7%) are in former group, severe (40.0%), moderately severe (40.0%), mild (20.0%) in last group. Unexpected sudden exacerbation were 92% in former group, and 100% in last group. The delay by patients and/or families in seeking help was 88% in former group and 63% in last group. The delay in seeking help when condition begin to deteriorate was made by patients in 70% in former group and in 67% in last group, and by families in 69% in former group and in 60% in last group. The possible causes of deaths were overtreatment with drugs in 21 cases and 14 of them were beta-stimulants by metered dose inhaler (MDI). Nine of them reported to be fenoterol by MDI and 2 of them tulobuterol by MDI. There are no reported case with overtreatment or overreliance in 1999.

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