It came true at the beginning of 2001 that we can see all human genome sequences just by connecting to the Internet. It was the year that we used to dream, in the last century, the departure of starship “Discovery” bound for the Jupiter. Now, we have a powerful tool for learning how genomic DNA sequence varies among individuals, and what the role of such a single nucleotide polymorphism (SNP) is in the pathogenesis of diseases and responses to drugs. Comprehension of the genome will also accelerate the understanding of the transcriptome, the whole transcripts present in a cell, and the proteome, which controls the whole regulatory elements in a cell. In the near future, we can sub-classify the multifactorial diseases such as asthma into a set of diseases based upon the dysfunction of various molecules.

View full abstract

We retrospectively studied 93 children with 103 episodes of food allergy, who visited in our emergency room between 1995 and 1999. The age and sex of patients and the causative agents, the onset of reactions, signs and symptoms, and the seasonal factors of episodes were determined based on patient's records.
The incidence of food allergy increased gradually over the period and was lower in winter. Patients ranged in age from 0 through 18 years (mean age 3.7 years). Among the 103 food allergy cases, about 80% of patients were infants. The onset of about 50% of reactions occurred within 30 to 60 minutes and about 10% occurred after 60 minutes. In regard to symptoms, 95.1% of the cases had urticarial rashes, 35.9% had wheezing and/or cough and 1.9% had cardiovascular symptoms. Egg was the most common allergen in our subjects including anaphylaxis. Other food allergens of high frequency were wheat, salmon roe and buckwheat. An epinephrine was used in only 6 cases. Early treatment with epinephrine can be effective in delaying the progression of anaphylactic reaction.

View full abstract

We investigated questionnaires on a school lunch to food allergy children in order to find the problem of it. The questionnaires were returned by 76 patients, 48 males and 28 females. Thirty-one of them were preschool or elementary school children, and 45 were not at any schools. The rate of food-induced anaphylaxis was 1.3% in surveyed children. More than 90% children at preschool or elementary school ingested elimination diets avoiding food allergens. Of the 31 children attending school, eight (25.8%) did not consult with teachers that they should deal with the trouble of ingesting food allergens by accident. Our investigations suggest that doctors who care food allergy children should communicate with guardians and teachers carefully. Further, administrative management and economic aid are needed.

View full abstract

We investigated questionnaires on a school lunch to 107 day nurseries or kindergartens around our hospital in order to find problems of it for children with food allergy. The rate of children with food allergy was 2.26%. Out of 82 preschools, 73 (89.0%) removed foods with food allergens from lunch or provided elimination diets avoiding food allergens. The higher the rate of children with food allergy was, the more patients were provided elimination diets avoiding food allergens. Thirty-five (42.2%) of 83 preschools experienced that patients ingested food allergens by accident.
From our investigation, it is recognized that pediatricians should take care of patients communicating with parents and the staff of preschools.

View full abstract

Using a questionnaire, we investigated the prevalence and risk factors of allergic diseases in infants living in Osaka City. Out of 905 subjects, the prevalence of atopic dermatitis was 16% in infants up to 1.5 years of age, then increased to 19% up to 3 years of age. The prevalence of bronchial asthma also increased from 6% at 1.5 years of age to 14% at 3 years of age. The family history of allergic diseases, level of eosinophils, and RAST score for egg whites were all significantly correlated with the development of atopic dermatitis. None but atopic dermatitis was the risk factor for the subsequent onset of bronchial asthma.

View full abstract

We report on 2 infants suffering from severe atopic dermatitis with hypoproteinemia. They had overconsumed prune juice, a folk medicine. In both cases, hypoalbuminemia was most likely caused by percutaneous protein loss, inadequate dietary intake of protein and protein malabsorption. Excessive consumption of prune juice was one of adverse factors in the hypoproteinemia. The parents had misunderstood diet therapy, refused medication, and placed undo faith in folk medicines. We conclude that information regarding the risks of folk medicines and supplement foods is important for severe atopic dermatitis.

View full abstract

I examined the appropriateness of the reference value of serum IgE levels, I proposed before, using large data obtained in my ordinary clinical practice. The IgE levels in the “High IgE Zone” were considered to indicate RAST positivity to some antigen. And the IgE levels in the “High IgE Zone” before 1 year, sugested the future sensitization to some antigens. And thus, this reference value was considered to be appropriate.

View full abstract

Diagnostic procedures of offending food in food allergy include clinical history, skin testing, in vitro specific IgE tests, and elimination and provocation tests. Oral provocation test is the most relevant method for determination of causative food. Especially, double-blind placebo-controlled food challenge currently remains the _??_old standard·for the diagnosis of food allergy. This method is, however, occasionally followed by severe adverse reactions such as anaphylaxis. Skin testing such as prick or scratch tests is relatively safely done as compared to oral challenge test. However, this method is affected by medication such as anti-histamines and anti-allergic drugs as well as oral challenge test. In vitro specific IgE tests are safely performed without effects by medications, but occasionally show false positive or false negative results as well as skin tests. These tests indicate the presence of allergen-specific IgE, but they do not establish the diagnosis of clinical food allergy.
A recent study by Sampson et al demonstrated 95% positive predictive value of specific IgE to egg, milk, peanut and fish using CAP system (Pharmacia & Upjohn), in which upper limits of range of measurement is extended. A patient with a serum food allergen-specific IgE titers in excess of the 95% predictive value may be considered reactive, and an oral food challenge would not be warranted. We also determined the 95% positive predictive value of specific IgE titers to egg white and ovomucoid in egg allergy. The 95% positive predictive values are 10.5Ua/ml of egg white and 6.22Ua/ml of ovomucoid for freeze-dried egg white with allergenicity close to raw egg. For diagnosis of heated egg, 62.1Ua/ml of egg-white-specific IgE titers and 19.6Ua/ml of ovomucoid-specific IgE titers were 95% positive predictive values. The measurement of IgE to ovomucoid, of which IgE-binding activity is relatively stable to heat treatment, was superior to egg white in diagnosis of clinical hypersensitivity to heat-treated egg white.
Next, we measured IgE-binding activity to pepsin-treated ovomucoid by RAST inhibition in order to distinguish challenge-negative and -positive subjects with high egg-white-specific IgE titers. The IgE from challenge-negative subjects showed lower activity to bind to pepsin-resistant IgE epitope(s). Furthermore, the egg-allergic children from which IgE antibodies bind weakly to pepsin-stable epitope(s) on ovomucoid is likely to outgrow as compared to subjects with IgE reactive to pepsin-stable epitopes on ovomucoid. The reason is why the children with IgE recognizing pepsin-resistant epitope(s) retain hypersensitive reactions to egg white ingestion in spite of development of pepsin secretion with age.
Domain 3 of ovomucoid contains pepsin-stable IgE-epitope(s). Measurement of specific IgE to domain 3 was useful not only to diagnosis the clinical hypersensitivity after egg ingestion but also to predict the outcome of egg allergy in subjects with high IgE titers for egg white.
Development of hypoallergenic foods is promising area in treatment of food allergy. Because these products contribute to improvement of QOL of food-allergic patients and their family. Several hypoallergenic products of cow milk and rice have been already available. We have developed heated and ovomucoid-depleted egg white and proved it hypoallergenic by double-blind and placebo-controlled food challenge. Approximately 97% of the subjects hypersensitive to heated egg white showed negative reactions to this sample.
Many investigators are working on novel form of immunotherapy for food allergy. In future, food products inducing tolerance will be developed. We extensively digested ovomucoid with pepsin to an extent of elimination of IgE-binding capacity and assessed its cytokine-producing activity from peripheral blood mononuclear cells from eggallergic subjects. IFN-γ production by the ovomucoid fragments was unchanged and IL-4 production

View full abstract