Japanese Society of Pediatric Allergy and Clinical Immunology covers immune diseases as well as allergic disorders. From this view point, here we discuss both immunodeficiencies and allergic disorders, especially, based on moleculer genetics and structure biology in innate immunity.

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Recent investigations in developed countries have found marked increases hospitalization rates for food anaphylaxis in children. Anaphylaxis is a severe, potentially fatal systemic allergic reaction that is rapid in onset and may cause death. Although it is important to ready access to self-injectable epinephrine and strict avoidance of food allergen, the difficulty in avoidance food allergens and potential for sudden and life threatening reaction can diminish quality of life for patients and families. Effective care for anaphylaxis patients requires a comprehensive managements approach involving families, schools, other related organizations. Heated egg and milk challenges were performed for persistent food allergy children and continued ingestion of then was well tolerated.
Recently, the possibility of obtaining food tolerance through oral desensitization has been attempted for several foods. Allergen specific oral immunotherapy might protect against reaction on accidental ingestion.

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A five-year-old girl had complained of vulvovaginal pruritus and discharge, following symptoms of allergic rhino-conjunctivitis for the past three grass pollen seasons. She was diagnosed as having allergic vulvovaginitis by the seasonal symptoms, the presence of serum grass pollen-specific IgE and an increased number of eosinophils in the vulvovaginal smear. Whereas treatment with hydroxyzine and oxatomide failed to control the pruritus, co-administration of pranlukast and epinastine hydrochloride ameliorated her symptoms, suggesting the involvement of cystinyl leukotriene in the pathophysiology of allergic vulvovaginitis and the usefulness of add-on of leukotriene antagonist for the treatment of refractory cases.

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We conducted a survey of management of childhood asthma at clinics and hospitals in Nara prefecture in 2008, using the same questionnaire as that used in our 2004 study. The period of the survey was from June 1^st to July 31^st, 2008, and 405 patients completed the questionnaire (270 males, 135 females). The median ages for enrollment at the clinic, onset of asthma, and first diagnosis of asthma were 6 (range: 1-17), 2 (0-12), and 2 (0-12) years old, respectively. Asthma attacks were least frequent in the summer season. The most common factors associated with worsening of asthma in the children were inhalation of house dust and catching a common cold in 2004 and 2008. However, the percentage of children with asthma worsened by exposure to smoking was significantly lower in 2008 compared with 2004. Fewer patients who enrolled at the clinical in 2008 had been hospitalized, visited an emergency room, or used beta 2-stimulant inhalation therapy compared to patients in 2004. However, fewer patients in the 2008 survey understood the methods for relieving attacks and removing antigens. The frequencies of wheezing, sleep disturbance, and absence from school and events, were all significantly lower in 2008 compared to 2004, which suggests that control of bronchial asthma in childhood has improved. However, 12.6% of the patients in 2008 felt that their control of asthma was poor and that this disrupted their life and their parents' lives. Therefore, further consideration of approaches for improvement of the QOL of patients with childhood asthma and their parents is of importance, including increased patient education.

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Japanese pediatric guidelines for the treatment and management of bronchial asthma (“the JPGL”) apply to childhood asthma from infancy to adolescence. Already, the JPGL have become popular with Japanese physicians because they are concise and useful. JPGL 2008 is the third version of the JPGL. This guideline has partially revised the section of pathology, the evaluation of asthma severity and treatment steps. JPGL 2008 incorporates new information derived from recent studies of asthma pathology. The sections on asthma severity and treatment steps are revised more plainly for choice and administration of drugs in the long-term management of childhood asthma. When the treatment is stepped down or stepped up, the understanding of “superficial severity” is important. On the other hand, when the long-term management and education of patients are advanced, the understanding of “true severity” is important.

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Although the strategy for the management of bronchial asthma has advanced remarkably in late years, it is rather difficult to concede the similar advance in the skill for the diagnosis of bronchial asthma. With untypical symptoms as bronchial asthma, we always have to scrutinize features of rhinitis and/or sinusitis, and probably to raise the awareness about GERD. Along the course of treatment of bronchial asthma, better management of patients can be achieved by judicious consideration and relevant care for complications occurring during acute or chronic stage of bronchial asthma.

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