We examined 2, 901 children aged 6-7 years (the primary school children) and 2, 831 children aged 13-14 years (the junior high-school children) in Japan by random sampling method. These children and/or their families reported to have symptoms of three atopic disorders, including asthma, allergic rhinoconjunctivitis, and atopic eczema by ISAAC questionnaires. Furthermore a video asthma questionnaire was performed in the junior high-school children.
Results:
1. In the primary school children, 17.3% had asthma symptoms, 25.6% had symptoms of allergic rhinoconjunctivitis, and 21.3% had symptoms of atopic eczema. In the junior high-school children, these prevalence were 13.4%, 41.0%, and 13.5%, respectively.
2. The investigation using the video questionnaires showed that 10.2% of the junior high-school children experienced wheezing once or more per month and 16.4% had wheezing after exercise.
3. In Japan, the prevalence rates of these three disorders were higher than in worldwide, and especially the highest in Asia.
4. The wheezy children with more severe symptoms had the higher values of total and house dust mite specific IgE. Further studies are needed to investigate the causes of increasing allergic diseases.

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We reported a case of severe atopic dermatitis with hypoalbuminemia and failure to thrive. A 8-months-old boy was admitted because of severe dermatitis. At 3 months of age he developed dermatitis and conventional treatment has been declined by the family. On admission he had two days history of diarrhea and his body weight was 6000g (-3.25SD). Serum albumin levels were 2.4g/dl. He was given intravenous albumin and intensive skin care with disinfectant and ointment was started. As a disinfectant, 10% povidone-iodine solution was used. His albumin reached to normal levels and he continued to gain weight normally after skin treatment.

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To clarify total serum immunoglobulin E (IgE) levels in relation to age in children with allergic symptoms younger than 3 years old and serum IgE levels that requires the measurement of specific IgE antibodies, we investigated 335 children with allergy ranging from 4 months to 2 years of age (196 boys, 139 girls). The children were divided into 3 groups; 1) the group with bronchial asthma alone, 2) the group with atopic dermatitis alone, 3) the combination group with the two diseases. Total serum IgE levels and specific IgE antibodies were measured in these children. And the same measurement were done in 55 healthy controls (21 boys, 34 girls). In addition, 20 children with atopic dermatitis alone were followed more than one year, and the same measurement were done after it.
(1) In children less than 1 year old, there was no significant difference in the serum IgE levels between the patients and controls. But in children of 1 year and 2 years old, there was significant difference in the serum IgE levels between children with allergy and controls. At ages of 0-2 years, there were no significant differences in the serum IgE levels between the group with atopic dermatitis alone and the group with bronchial asthma alone. But there were significant difference between the single allergic groups and the group with combined allergic diseases.
(2) Of children with allergy who showed serum IgE levels over the serum IgE levels of mean-1SD in the control group at each age (month) (4 to 7 months: 3IU/mL, 8 to 11 months: 8IU/mL, 1 year: 7IU/mL, 2 years: 12IU/mL), 232 children (69.2%) were RAST positive to more than one antigen. And 4 children (1.2%) showed a value below the above value.
From these facts, it is considered difficult to predict the presence of allergic diseases or diagnose the disease in young children with total serum IgE levels alone. In children with serum IgE levels exceeding the mean-1SD of the control group, specific IgE antibodies should be investigated.

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Patient is a 13-year-old boy. He repeatedly experienced urticaria and dyspnea at exercise after meal since 11-year old.
Because he often experienced the symptom and the causative food is not confirmed, he was introduced to our hospital. We took detailed history and performed prick test, specific IgE, and HRT. We speculated that wheat flour was the allergen of food-dependent exercise-induced anaphylaxis and we performed challenge tests in the various situations. We confirmed that exercise following ingestion of 20g, but not 10g, of wheat flour induced symptom by challenge tests. We guide in his daily life on the basis of these results, and he does not experience the symptom by keeping the minimum restriction in his daily life.
The initial treatment of food-allergy is to avoid causative food, however, excessive elimination lowers patients quality of life, and insufficiency may expose patients to the danger of anaphylaxis. To avoid serious outcomes and respect quality of life, we believe it is important that life guidance is appropriate and concrete for each patient.

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There is no simple and common method for evaluating the respiratory status of children with acute asthma. Therefore, we developed a new clinical scoring system to estimate dyspnea. The respiration rate scored 2 points for ≥60/min, 1 point for 59-30/min, and 0 points for <30/min; the expiratory/inspiratory ratio scored 2 points for ≥2, 1 point for 2-1.5, 0 points for <1.5; and retraction scored 2 points for “very severe”, 1 point for “severe”, and 0 points for “little or none”. The total score was called the dyspnea score, and was compared with SpO2 and the severity of asthma based on the influence on daily activities. A dyspnea score of 0-1 points corresponded to a mild attack, 2-3 points to a moderate attack, and 4-6 points to a severe attack. The dyspnea score was inversely correlated with SpO2 (r=-0.5, p=0.02). By calculating the dyspnea score while asthmatic children were in hospital, it became easier to evaluate the respiratory status and to communicate with co-medical staff. Introduction of a dyspnea score like this may be useful when we compare the severity of asthma between patients at different hospitals.

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The causes of asthma death were analyzed on 170 patients, aged from 0 to 28 years old, from 1988 to 2001. Subjects studied were divided in two groups by the year when they died between 1988-1997 and between 1998-2001, to observe recent change of causes of asthma death.
Annual number of registered asthma death decreased since 1998. Sex ratio male to female was 95 to 58 in former group and 7 to 6 in later group. The grade of asthma severity prior to their asthma death were; mild (26.4%), moderately severe (30.2%) and severe (43.4%) in former group and mild (12.5%), moderately severe (62.5%) and severe (25.0%) in later group.
The main contributory factors to asthma death were; unexpected sudden exacerbation 92% in former group and 100% in later group and delayed decision on medical help 88% in former group and 45% in later group. Medications given in the last one month was analyzed. Steroid inhalation therapy was given in 20% in former group and 50% in later group, reflecting the recent asthma therapy trend.
Total serum IgE levels, sensitizing allergens and allergens provoked lethal asthma attack in these cases were analyzed.

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