The psychosocial factors are important for the diagnosis and treatment of chronic allergic diseases in children. Their development (life task) and the natural history (allergic march) are compared to investigate the relationship between psychosocial factors and chronic difficult (brittle) asthma and atopic dermatitis in children. To estimate psycho-social factors we could use the questionnaire for the parents and doctor who take care of asthmatic children based on the past and family histories, development history, life style, treatment and its effect. We repeated the questionnaire on the same cases two years later and confirm the value of this questionnaire. And two cases are reviewed.

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[in Japanese]

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Vaccination for children with allergic diseases is apt to be postponed or ceased because of the presumed risk of immediate type allergic reaction including anaphylaxis. A new protocol of skin test for predicting allergic reaction by vaccine itself and the following step-wise vaccination method was developed and verified. Intra-dermal skin test using 1:10 and 1:100 diluted measles vaccine indicated that the former was superior than the latter since positive reaction against 1:10 diluted vaccine was found in 28.6% among 49 patients with severe allergic diseases including bronchial asthma, atopic dermatitis, food allergy and allergy for two or more allergens with high levels of IgE comparative to 10.2% against 1:100 diluted vaccine. Negative patients for 1:10 skin test were safe for the following full-dose vaccine shots. Three patients showed very strong local reaction against measles vaccine, and they avoided to be given the following full-dose shot. Positive reaction was found in 11 patients for skin test of 1:10 diluted vaccine, and they were given step-wise vaccination. Three had adverse reaction, and 2 of them had been negative for 1:100 skin test. In case of influenza vaccine, skin test was again more sensitive against 1:10 than 1:100 diluted vaccine, because 3 out of 14 patients with positive reaction showed immediate adverse reaction against the following step-wise vaccination, and 1 of them was negative for 1:100 skin test. Moreover, the comparison between skin prick test (undiluted vaccine) and intra-dermal skin test (1:10 diluted vaccine) indicated that the latter was more useful in both cases of measles (54 patients) and influenza vaccine (69 patients). Taken together, skin test by 1:10 diluted vaccine was the most suitable method for predicting immediate type reaction by measles and influenza vaccination. Negative patients for 1:10 skin test will be safely given the following shots, and even positive ones will complete the vaccine by step-wise method.

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In Japan, it has been known that the continuous isoproterenol inhalation therapy is effective for children with severe asthma attack. There are two types of prescribed isoproterenol; single enantiomer (l-isoproterenol) and a racemic drug (dl-isoproterenol). We sought to compare effectiveness of l-isoproterenol with equivalent amount of l-isoproterenol administered as a racemic drug. One hundred and six children with severe asthma attack were randomly assigned to the inhalation with l-(n=65) or dl-isoproterenol (n=41). There was no difference in their backgrounds between two groups. To evaluate the effectiveness of these drugs, we assessed Wood's clinical score, oxygen saturation, heart rate, and respiratory rate. Improvement of Wood's clinical score and tachycardia by l-isoproterenol was more prominent compared with dl-isoproterenol during the first 6-hour of inhalation. Although all the patients treated with l-isoproterenol improved, three out of 41 children did not respond well to dl-isoproterenol. These results suggest that l-isoproterenol appears to provide a better therapeutic effect than dl-isoproterenol.

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