[in Japanese]

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In the preventive drug therapy of childhood asthma, inhaled corticosteroid (ICS) is thought to be the most effective drug, as of adult asthma. But whether ICS can lead childhood asthma to remission or cure is not clear by now. In this article, I tried to clear this question by our experience and other articles. First, based on our experience, we found two results. Namely, once a child had to use ICS, it could hardly be stopped after two years. And the older children are, the less effect of ICS to respiratory function is. Second, there are many reports that may show the limitation of the effect of ICS. Even if a patient is leaded to remission during two years by ICS, this effect diminishes after ICS is stopped. And if the early intervention was done, there existed a few, but clearly, patients who were experienced severe asthma related event. By other study, the rates of patients whose respiratory function after bronchodilator inhalation became worse were the same between ICS users and others. Finally, it is important that childhood asthma have heterogeneity, and when we consider the ICS effect, this characteristic must be also considered.
In conclusion there is no obvious evidence to support the efficacy of ICS on the remission or cure of childhood asthma at the present point.

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[in Japanese]

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This article describes a retrospective study assessing the effect of early intervention with inhaled sodium cromoglycate in childhood asthma. The study was performed using the records of 54 severe asthmatic children treated with inhaled sodium cromoglycate for 5years and when asthma was first diagnosed during 0.0 and 11.0 years old. They were divided into the Early Intervention Group (sodium cromoglycate inhalation started within 2 years of the onset of asthma; n=41, male: 37, female: 4, the mean age of the onset of asthma was 1.8±1.4 years) and the Control Group (sodium cromoglycate treatment started more than 2 years after the onset of asthma; n=13, male: 7, female: 6, the mean age of the onset of asthma was 2.2±1.2 years). Early intervention with sodium cromoglycate shows greater improvements over time in clinical scores, treatment scores, asthma scores, severity scores, proportions of patients that required additional treatment with inhaled corticosteroids and number of emergency department visits. Our results suggested the early use of inhaled sodium cromoglycate by a nebulizer might be a treatment with an activity of good long term prognosis of childhood asthma.

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The percentages of children with asthmatic attack in all children who visited the ER at Otake National Hospital were studied from 1992 to 2003.
Thirteen thousand seven hundred and eighty-four children visited the ER, and 2, 019 of them showed asthmatic symptoms. Whereas the percentages of asthma in all children remained constant (16.8-19.6%) until 1997, they gradually decreased after 1998 and 7.9% of the ER visitors showed asthmatic attacks from 2002 to 2003.
In 1993, 1998 and 2003, the percentages of asthmatic children were also studied in each month, and in almost all months, the percentages of asthmatic children who visited the ER decreased in 2003.
The percentages of asthmatic children with attacks in all children who have been taking controller medicine at our hospital were also studied, and they decreased gradually from 1998.
In conclusion, our results suggest that changes in treatment for asthmatic children may decrease the asthmatic attacks at night.

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Yam (Dioscorea opposita THUNB.) is known to induce allergy-like symptoms due to the presence of choline in yam. But yam allergy is not well characterized, because an allergen extract for skin test and a system for detection of anti-yam IgE antibody were not commercially available. The aim of this paper is to report the 7 cases of yam allergy with positive IgE antibody detected by UniCAP specific IgE. Allergic symptoms after ingestion of yam included systemic erythema and urticaria, or angioedema on the face, as well as respiratory symptoms (n=2, cough and wheeze) and gastrointestinal symptoms (n=1, vomit and diarrhea). Patients were also reacted to heat processed foods such as cookies containing yam. Seven patients without IgE antibody to yam only had mild and transient rash around the mouth, considered to be due to the presence of pseudo-allergen in yam. In conclusion, detection of IgE antibody by UniCAP specific IgE was useful for the diagnosis of yam allergy.

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Objective:
Studies have been conducted about the allergens that led to hospitalization, but field surveys have not been conducted thoroughly focusing on the patients' behaviour. Therefore, in order to illustrate the buyers' behaviour in food allergies patients' families.
Method:
With the collaboration of nationwide patients associations for food allergies, a questionnaire survey, involving 1, 510 member families for the prevention of food allergies was carried out by mail. The survey inquired about the type of offending foods that are responsible for food allergies, the place of onset, the treatment methodologies and the degree of understanding of allergy indicators, etc. The questionnaire gathered the responses of 878 families, 1383 patients (including 402 patients with a history of anaphylactic shock).
Results summary:
The food suppliers of the families of patients affected by food allergies were mostly co-ops, supermarkets and natural-food stores. When buying food, about 99% of families checked the labelling, and “may contain” list of allergens in the product. If these families found an allergen in the ingredients, they rejected the product. Those families choose food based on this information, but they thought that the chances of access to information about food allergies were very few. Therefore, in the future, it will be necessary to provide information regarding food allergies at the locations where sales of these alimentary products are carried out, on the inter-net.

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Objective:
Studies have been conducted about the allergens that lead to hospitalization, but field surveys have not been conducted thoroughly focusing on the patients' eating and buying behaviour. Therefore, in order to illustrate patterns in allergy cases, the places where foods allergies occur as well as their response are studied.
Method:
With the collaboration of member from the nationwide association for food allergies, a mail questionnaire survey was sent to 1, 510 families. The survey inquired about the type of offending foods that are responsible for food allergies, the place of onset, the treatment methodologies and the degree of understanding of allergy indicators, etc. The questionnaire gathered the responses from 878 families, represented 1, 383 patients (402 of those being patients with a history of anaphylactic shock) were received.
Results summary:
As for the pattern of foods responsible for anaphylaxis, patients mostly indicated “packaged and processed foods”, followed by “foods sold in shops” and “meals at restaurants”. In terms of relationships between the place of onset and the pattern of foods responsible, most of the foods indicated were “packaged and processed foods” and “foods sold in shops”, which eaten at home. These were followed, in order, by “meals” at restaurants and “foods sold in shops” at fast-foods restaurants, than the “school lunch”. For the time required until improvement of symptom, buckwheat and peanuts take longer than other ingredients.

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We investigated 117 children who had experienced anaphylactic reaction against foods. Ninety six children experienced severe anaphylactic shock. Thirty three% of children experienced one episode of anaphylaxis, while 67% had two more episodes.
The reactions were due to milk (35.9%), egg (23.9%), wheat (21.4%), peanuts (7.7%) and others. A younger age and eczema were more frequent among the children. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal one.
In 41% and 25% of the children, anaphylaxis rapidly progressed within 9 minutes and 10-19 minutes respectively. It is desirable to provide a self injectable epinephrine to children who experienced severe food induced anaphylactic reaction and their parents.

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