Cysteinyl leukotrienes(cysLTs) are potent lipid substances which are enzymatically synthesized from cell membrane phospholipid. It has been elucidated that cysLTs play significant roles in the development of chronic inflammatory changes and airway remodeling in bronchial asthma through cysLT1 receptors which are present on the cell surface of various cell types including airway smooth muscle cells, eosinophils, mast cells, fibroblasts and vascular endothelial cells. In this review new proceedings regarding cysLTs and cysLT1R are summarized.

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Background: Schoolchildren who have not acquired tolerance against food allergy require food elimination even in school lunch.
Objectives: We intend to understand the present conditions and issues of measures against food allergy in school lunch.
Methods: We distributed questionnaire to 555 dieticians who had attended to the conference held by Japanese school dietician association. The reply of the questionnaire was 100%.
Results: Dieticians who had taken care of food allergy children were 76.0% (422/555). School meal providing facilities with special menu for food allergy children were only 68.7%. The most common food allergen was milk products followed by hen's egg, shell, selfish, fish, and peanuts. Dieticians who had faced food allergic reaction of schoolchildren after ingestion of school lunch were 27.2% (151/555). Among these cases, medical cares were necessary in 46.4% (71/151) of the cases.
Conclusions: Countermeasures against problems of food allergy in school lunch seem to be unsatisfactory judging from our survey. With increasing number of schoolchildren with food allergy, it is necessary to provide special menu for these children in each school lunch providing facility.

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To compare the efficacy of the on-demand use with that of the regular use of β stimulants in Disodium Cromoglycate (DSCG) inhalation therapy, we randomly divided 30 patients into two groups (on-demand use group and regular use group), and compared the clinical courses prospectively for 56 weeks between these groups. Excluding 8 patients, including 2 in the on-demand use group and 2 in the regular use group into whom regular use of inhaled steroid was introduced, 13 patients in the on-demand use group and 9 in the regular use group were finally examined.
The frequency of on-demand inhalation of β stimulants was significantly higher in the on-demand use group (mean; 190 times) than in the regular use group (mean; 40 times), but the mean total amount of inhaled β stimulants was significantly less in the on-demand use group (mean; 29.9ml) than in the regular use group (mean; 87.8ml). The days when the patients had cough were on the average 92.1 days in the on-demand use group and 49.6 days in the regular use group, and the difference was statistically significant, but there was no difference in the asthmatic attacks between both groups. The ratio of patients who showed decreased levels of Dp-IgE was 5/12 in the on-demand use group and 1/8 in the regular use group. The bronchial hyperresponsiveness to acetylcholine was measured in 3 patients in the on-demand use group and in 1 in the regular use group, but there was no difference between them.
There was no difference in the asthmatic attacks between both groups, and the total amount of inhaled a stimulants was less, but the days when the patients had cough were more in the on-demand use group than in the regular use group. In this study, we could not show the efficacy of the on-demand use of β stimulants in DSCG inhalation therapy. Further studies with more subjects are necessary to assess the effectiveness of the on-demand use of β stimulants.

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The interrupter technique may be used to monitor airway resistance in preschool children, because it is noninvasive and requires minimal patient co-operation. We investigated the utility of the interrupter technique (Rint) in pediatric patients with asthma. Three hundred and nineteen asthmatic children aged 2-17yrs with no asthma attack performed Rint measurements. And two hundred and eighty four patients performed spirometry at the same time. The airway resistance that we measured by Rint was negatively correlated with age, height, weight, and the surface area of the body, but was not correlated with morbid period. Spirometoric parameters were negatively correlated with the airway resistance.
We think the airway resistance that we measured by Rint is very close to the normal value of that in healthy children. And the interrupter technique may be useful for the lung function test in asthmatic children, similar spirometry.

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In Japan, the strategy for the proper use of anticholinergic drugs in the management of childhood asthma is not established. Thus, we wanted to know how anticholinergic agents were used in the clinical practice. For the purpose, we prepared a questionnaire in which clinical effectiveness and the role of anticholinergic agents in the management of asthma were asked, and sent it to pediatricians who specialized allergy and clinical immunology. Among 297 pediatricians who answered the questionnaire, 196 pediatricians (66%) had the experience to prescribe anticholinergic drugs to their patients. Approximately 15% of them answered that they felt the drugs to be “frequently” effective, 47% did “sometimes” and 29% did “rarely”, and 10% did “not effective”. The majority of them answered that the agents were more effective for the students of primary and/or junior high school than infants or preschool children. Cold air inhalation, changes in the weather and exercise were found to be major factors of asthmatic attacks which could be prevented by anticholinergic drugs. It was found that these agents were more effective for the control of respiratory symptoms such as cough and asthmatic attacks than phlegm. Among 196 pediatricians, 25% and 26% of them answered that anticholinergic agents might be useful for asthmatic attacks as controller and reliever respectively, whereas 20% and 27% of them denied the usefulness, respectively. The rest of pediatricians answered that they could not determine the effectiveness. In Japan, we cannot use the anticholinergic drug by nebulizer because such product of this agent is not available now. Thus, it is possible that inability to use this drug by nebulizer may influence the answer that anticholinergic drugs are less effective for asthma in infants or younger children.

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Among children who received infants' health checks in our hospital from 1991 to 1995, the rate of development of bronchial asthma until the time they entered schools was investigated by the questionnaire to the parents. According to the skin conditions in the health checks, 150 children examined were categorized into the following three groups: group A (9%); children diagnosed as atopic dermatitis, group B (22%); children not diagnosed as atopic dermatitis but having light skin symptoms, group C (69%); children without skin symptoms. 71% of group A, 33% of group B and 21% of group C developed asthmatic until entering schools. The asthmatic prevalence rate was 29% of the whole, and was significantly higher among children that had more obvious skin symptoms. The family history of allergic diseases was seen in 56% of the whole. The asthmatic rate was 15% among children without family history but was 41% with family history. It was significantly high among children with family history, and especially reached 64% in group B with family history.
It seems that the risk of the future development of asthmatic becomes high not only among infants who were diagnosed as atopic dermatitis but also among ones who had both light skin symptoms and family history of allergic diseases.

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[in Japanese]

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