Treatment goal and management of infantile bronchial asthma described in JPGL 2005 were weighed against the relevant parts in GINA 2006 and NAEPP EPR3. JPGL 2005 recommends starting anti-inflammatory therapy from the earlier stage than these international guidelines, however, the reality of the treatment in Japan has not followed it. Although the secondary prevention effect by an administration of the inhaled steroid reported a negative result in 2006, an ideal early intervention was proposed by reviewing these study protocols and results in details. The ideal early intervention by anti-inflammatory treatment, which the mainstream is an inhaled corticosteroid, seems to increase the possibilities of modifying a natural history of asthma, and further investigation is necessary to examine the hypothesis in the future. Also this report reviewed genetic and environmental factors related to the onset of disease and the long-term prognosis, and actions to be taken near future for an infantile asthma treatment were summarized at last.

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Atopic dermatitis due to food allergy is the most common manifestation of food allergy in babies and infants and builds up an independent disease entity among atopic dermatitis from the point of view of pathogenesis and clinical course.
Minimal elimination diet based on adequate diagnosis of offending allergen in addition to appropriate skin care is the most effective and rational management of atopic dermatitis due to food allergy.
Another important facet of this disease entity is that suffering babies have high atopic diathesis and that atopic dermatitis due to food allergy is the first manifestation of allergic disease in their life in most of them. Environmental arrangement as well as dietary manipulation is very important as early intervention of babies with atopic dermatitis due to food allergy in order to prevent them from the development of allergic march.

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Objective: To evaluate the effects of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer-processed fabric, which is characterized by its biocompatibility, and Pebax^® fabric, which is characterized by its water absorption and diffusion, and vapor permeability in children with atopic dermatitis (AD).
Methods: Fifty-three children with AD were recruited to a randomized, controlled trial: 19 wore MPC underwear, 17 wore Pebax^® underwear, and the other 17 (control group) wore cotton underwear; they were instructed to wear this underwear for 4 weeks. The severity of AD was evaluated using the scoring atopic dermatitis (SCORAD) index. In addition, stratum corneum hydration, transepidermal water loss, growth hormone, cortisol, and s-IgA were assessed.
Results: A significant decrease in AD severity was observed in the children in the Pebax^® (p=0.008) and control (p=0.003) groups, while the decrease in the MPC group was not significant. Growth hormone was increased significantly in the MPC group, compared with the controls (p=0.009), while stratum corneum hydration was increased in the Pebax^® group (p=0.020).
Conclusion: MPC fiber, the new synthetic fiber Pebax^®, and cotton appear to be safe for prolonged use. Furthermore, underwear fabrics appear to have different effects on physiological function in children with AD.

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We made the questionnaire survey for the pediatricians, who belonged to the Osaka Childhood Asthma Treatment Research Group, in November 2002 with 202 respondents, and in November 2004 with 164 respondents. Younger physicians more frequently used the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2002 than older physicians. Hospital physicians used it more frequently than private physicians. The physicians, who followed the guideline, usually used inhaled steroids, asthma diaries and peak flow measurements. For the long-term control of bronchial asthma, the frequency of using leukotriene receptor antagonist and inhaled steroids increased in 2004 compared with 2002.

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The clinical features of immediate-type-food allergy are not obvious from emergency visits. We investigated the cases of 55 pediatric patients with food-related allergic reactions who visited our pediatric emergency department from April 2005 to March 2007. Data were collected on the following: patient age, the ratio between pediatric emergency visits and transference by ambulance, symptoms, severity, causative foods, time of patient arrival at the hospital, duration of the symptoms, and the treatment. Age, symptoms, and causative foods were similar to those reported by the Japanese Ministry of Health, Labour and Welfare in 2002. These 55 patients corresponded to 0.44% of all pediatric emergency visits. Furthermore, 20.4% of these patients were transferred by ambulance, a figure that represents 0.76% of all patients transferred by ambulance. Most of the patients visited the emergency department after 18:00; this presumably reflects the onset of symptoms after eating supper. More than half of the patients visited the hospital within 90 minutes of the onset. Relatively so much severe case, 9.1% of those needed epinephrine administration, suggesting an unexpectedly high numbers of severe cases.
It is recognized that pediatric emergency aid is important in the medical care of pediatric food allergy. The pivotal role of emergency treatment in the medical treatment of childhood food allergy, and the cooperation between primary physicians and allergologists should be re-emphasized in light of the current reorganization of the pediatric emergency system in Japan.

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The objective of this paper is to compare asthma control between patients who attend special medical facilities and those who attend general medical facilities. A questionnaire survey was conducted among parents of patients with childhood asthma in November, 2004. Data were analyzed from 1,846 answers (392 for patients in special medical facilities and 1,454 for those in general medical facilities). The percentage of patients who had visited an emergency room or had been hospitalized was lower among those who attended special facilities compared to general facilities. The percentages of patients who regularly attended medical facilities regardless of symptoms, who used a peak flow meter, and who kept a diary were higher in special facilities than general facilities. There was no difference in the frequency of use of controller medication between the two groups, but the understanding of how to use the medicine, knowledge of the effects of the medicine, and compliance were all better in patients who attended special facilities. These patients showed better control of asthma symptoms, with fewer burdens of asthma on daily physical and mental activities, leading to a better QOL in the patients who attended special facilities. Our results suggest that improvement of medical care may be achieved by referring to specific guidelines in cases in which general pediatricians treat asthmatic children.

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Background: Recently, wrong belief on topical steroids for atopic dermatitis (AD) has been disseminated in Japan and been producing a number of patients with ''steroid-phobia'', which further exacerbates the disease. In order to reveal possible adverse influence of ''steroid-phobia'' on clinical course of AD, we performed questionnaire to patients with severe AD who had been hospitalized for intensive treatment for AD and analyzed relationship between clinical course and patient perception of AD treatment.
Methods: Eighty four patients with severe disseminated AD who were hospitalized and followed for 1 year after hospitalization were evaluated. Severity of disease was evaluated at admission, discharge, 1, 3, 6, and 12 months after hospitalization. Factors relating to exacerbation were also reviewed from the charts. Questionnaire asking perception and performance of treatment of AD, especially topical steroids, was filled out by patients or mothers who took care of the children.
Results: All patients improved to mild by hospitalization. Fifty to sixty percent of patients, however, temporarily experienced exacerbation by 6 months after discharge although many of them improved again by 12 months. Outcome at 12 month after hospitalization was significantly better in patients less than 2 years of age. Questionnaire revealed that about 80% of the patients or mothers had exaggerated concerns about adverse effects of topical steroids and that they were influenced by wrong information from internet or TV despite that comprehensive education had been provided during hospitalization. Patients who had concerns about steroid treatment tended not to be compliant to therapy and to have worse clinical outcome.
Conclusion: ''Steroid-phobia'' in Japan is still incorrigible even among patients who received comprehensive education by hospitalization. It is very important to advocate correct information about treatment of AD.

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[in Japanese]

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[in Japanese]

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