Speaking of the current treatment of food allergy, the only way is the possible hope of outgrowing the food allergy while on allergen avoidance diet and education in case of accidental food ingestion. However, understanding the transcutaneous sensitization and oral immnunotolerance to food antigens, thorough innovation of our whole concept for the pathogenesis of food allergy may be required. Intentional oral intake of foods may be promising measure to prevent or cure food allergy, which is quite different from the most basic principle of the management of allergic diseases which says ''To reduce or avoid the exposure to relevant allergens.''

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The airway tract is an organ prone to injury by external irritants including allergens (which may induce an allergic response), atmospheric contaminants, bacteria and viruses. All of these may damage the airway mucosa. The mechanism of such damage appears to be reaction to oxidative stress on airway mucosa. Therefore, oxidative stress is an important criterion on the onset and exacerbation of asthma. However, the airway mucosa has various anti-oxidative mechanisms capable of maintaining the stability of the intracellular oxidation-reduction (redox) state. It is speculated that the airway tracts of people with asthma are not properly able to maintain a stable redox state. Considering the effect of oxidative stress and the control of the redox state, it is important to add anti-oxidative reagents in the treatment of asthma.

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A questionnaire survey of 80 pediatricians who have participated in Hiroshima Childhood Allergy Research Group was conducted between June and August in 2005 in order to investigate the treatment of childhood asthma in Hiroshima. Seventy five out of 80 pediatricians (94%) were aware of the ''Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2002'', however, the ratio of them who refered JPGL was lower than that in the national survey of Japan. There were 47% of pediatricians who did not recommend inhaled corticosteroids therapy for asthmatic infants and they needed information on side effects of inhaled corticosteroids and concrete ihalation methods to use them. Sustained release theophylline, leukotriene receptor antagonists, and tulobuterol patch were used in any types of severity of asthma, while inhaled corticosteroids and DSCG+β₂ stimulant inhalation were used in moderate and severe asthma as main long-term management. For asthmatic children using nebulizers at their home, inhalation method when they have asthmatic attacks was guided that β₂ stimulant mixed with DSCG or saline was inhaled every 4 hours and they might visit hospital when their attacks continued after two times of inhalation therapy. To enlighten JPGL based on Hiroshima study of treatment for childhood asthma is useful to improve the treatment of chidhood asthma in that area.

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We administered budesonide inhalation suspension (BIS) to 20 asthmatic infants and young children using mesh nebulizer for the purpose of examining the efficacy and safety. Among these patients, 12 patients had received BIS 0.25mg once daily (maximum dosage period: 24 weeks), remaining 8 patients had received BIS 0.5mg once daily (maximum dosage period: 12 weeks). We also administered BIS to 18 asthmatic patients of the same age (all patients had received 0.5mg once daily) using conventional jet nebulizer (maximum dosage period: 36 weeks). We measured the number of asthma exacerbations per 4 weeks and plasma cortisol levels before and after administration of BIS in all groups. As a result, the number of asthma exacerbations per 4 weeks decreased significantly in all groups. In addition, no significant and sustained fall of the plasma cortisol level was seen in all groups over the observation period. In conclusion, BIS inhalation via mesh nebulizer and jet nebulizer seemed to have comparable level of efficacy and safety for infants and young children with bronchial asthma, but further investigation is necessary because there is little number of cases of the mesh nebulizer group.

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Background and purpose: ICS controller treatment should be established before the age of puberty, the effective patients' education to support of self-management accomplished training of improving adherence to daily ICS treatments were evaluated in the cases of 5 pre-puberty asthmatics with daily ICS therapies, when they lost their adherence to those.
Subjects and Methods: 5 pre-puberty asthmatics of moderate-continuous-type in the definition of JPGL 2005, who were outpatients of the department of pediatrics in Osaka Kaisei hospital, were evaluated. The reasons of loss in adherence to their ICS treatments were evaluated by psychological intervention. Respiratory functions (%FEV_1.0 · %V'₅₀) were used to discuss about clinical effects of patients 'education.
Results: Realization of parents' especially mother's support was considered as the most effective factor to improve their adherence. Psychological interventions were effective to discover their reasons for loss of adherence to accomplish self-management training of daily ICS treatments.
Conclusion: Interventions and patients' educations for a good communication between pre-puberty asthmatics and their parents, especially mothers, are important in some pre-puberty asthmatics to improve and keep their adherence to ICS therapies.

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[Purpose]
To judge specific IgE levels allowing elimination diet discontinuance in children with food allergy, and to survey patients' caregivers in order to gauge their anxiety and difficulty experienced with the elimination diet.
[Methods]
We conducted a questionnaire survey among caregivers of food-allergy patients from January to June 2006. Food allergies were initially diagnosed in these patients from April 2004, and allergen elimination had been in progress for more than 6 months.
[Results]
Sixty-two patients, 47 boys and 15 girls, were enrolled in the study. Age at initial diagnosis averaged 16 months, and age at survey time averaged 30 months. Two major concerns among caregivers were the possibility of accidental allergen intake and of nutritional imbalance due to the diets. Ages at which egg, milk and wheat elimination was terminated averaged 18 months, 25 months, and 28 months, respectively. The mean egg-specific IgE value on termination decreased significantly from the value when the elimination diet was initiated (from 18.64.±3.79 to 13.58±3.71).
[Conclusion]
Elimination diets lowered the quality of life for both food-allergy children and their caregivers. Appropriate conditions for termination of the patient's diet should be considered after a child allergic to eggs or milk, or both, turns two years old and after a child allergic to wheat reaches the age of one and a half. Decreases in specific IgE levels should be considered in making decisions about discontinuing elimination. The combined efforts of doctors, dietitians, psychologists, and school staff are also needed to improve the quality of life of food-allergy children and their caregivers.

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It is important that physicians control asthma symptoms based on daily conditions of patients. The Childhood Asthma Control Test (C-ACT) has recently been developed, and its Japanese version has already been available. We compared C-ACT score with the patient's symptoms score converted from the patient's daily reports. The frequency of PEF reduction and that of rescue use of inhaled beta 2 agonists were also compared with C-ACT, for the evaluation of its effectiveness. C-ACT scores has close correlations with symptoms based on patient's daily reports and the need of rescue use of inhaled beta 2 agonists, but not with the frequency of reduced PEF. The Childhood Asthma Control Test of Japanese version is in general effective in clinical settings, but physicians should understand that it did not reflect respiratory functions.

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[Objectives] This investigation was performed to allow planning of future treatment of childhood asthma by clarifying the current situation in Tochigi Prefecture.
[Methods] Data were collected at about the same time of year in 2002 and 2006. A self-recording questionnaire survey was given to childhood asthma patients and their parents to determine their QOL and the background of the patients.
[Results] Responses were obtained from 1,487 and 1,058 subjects in 2002 and 2006, respectively. The incidence of asthma attack and wheezing was significantly lower in 2006 than in 2002 (p<0.05), and the QOL of the patients and their parents was higher in 2006 than in 2002. The use of inhalated corticosteroids (ICS) and leukotriene receptor antagonists (LTRA) increased from 28.0% to 44.7% and from 53.3% to 70.3%, respectively, from 2002 to 2006.
[Conclusion] Long-term management of childhood asthma has been performed using ICS and LTRA, and our results suggest that these medicines have been effective in reducing asthma symptoms and improving QOL. In the future, we propose that further treatment using these medicines is desirable.

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