The number of pediatric allergic disease (bronchial asthma, atopic dermatitis, food allergy, etc.) are increased these days. There are regional differences in medical treatment for pediatric allergic diseases. I have discussed problems of regional medical treatment for pediatric allergic diseases, and examined the number of specialists for pediatric allergy among prefectures. There are imbalanced distribution of specialists for pediatric allergy among prefectures. I have proposed several things to do for improvement for regional differences in medical treatment for pediatric allergic diseases by Japanese Society of Pediatric Allergy and Clinical Immunology and Japanese Society of Allergology. I hope that these problems will be improved in future.

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We encountered 2 cases of food anaphylaxis, which were non-immediate with regard to the time of onset. One case was a 6-year-old boy who developed anaphylaxis 3 hours and 35 minutes after ingestion of casein in a sausage. Based on positive casein-specific IgE antibody and past history of milk-induced anaphylaxis, the patient was diagnosed as IgE-dependent non-immediate-type anaphylactic response. The other was a 6 month-old boy who developed anaphylaxis 3 hours after ingestion of rice. Based on negative rice-specific IgE antibody, positive oral food challenge test, and positive lymphocyte stimulation test to rice, the patient was diagnosed as non-IgE-dependent non-immediate-type anaphylactoid response. Both cases were serious, and needed emergency treatment. In general, anaphylaxis is IgE-dependent and develops immediately, but non-immediate-type food-induced anaphylactic (anaphylactoid) responses may occur irrespective of the existence of food-specific IgE antibody, depending on the characteristics of the food materials or reactivity of the patients. Although it occurs rarely, non-immediate-type onset should be considered in diagnosing food-induced anaphylaxis or during the performance of oral food challenge test.

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Food-protein induced gastrointestinal allergy is one of the uncommon diseases in newborn and infant. Recently case reports of these diseases are increasing in Japan. Gastrointestinal symptoms such as vomiting, diarrhea, and bloody stool are common in the onset of this disease. We experienced a case with vomiting and eosinophilic bloody stool developing hypertrophic pyloric stenosis. Histopathological examination was demonstrated that many eosinophils infiltrated with minimal degranulation in hypertrophic pyloric muscle. Allergen specific lymphocyte stimulation test with cow's milk products were elevated. These findings indicated that our case was the food protein-induced gastrointestinal allergy with eosinophilic pyloric stenosis.

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A questionnaire survey on the present state of oral food challenge tests(OFC) was conducted for 134 pediatricians in Hiroshima where is one of local areas having few allergic specialists in Japan between April to May in 2009. The ratio of pediatricians performing OFC in respondents was 22.4%, which was lower than that in the national survey of Japan, especially in the pediatricians working in clinic offices. Almost of OFC were performed at outpatient rather than in admission setting. The main reasons why OFC were not performed were lack of inpatients' ward for OFC and risk caused by loading foods as allergen, however, there were few pediatricians who did not recognize the necessity of OFC.
There were 83.5% of pediatricians in respondents, including approximate half number of pediatricians performing OFC presently, who felt it difficult to perform OFC, and most of them explained that risk caused by loading foods as allergen and insufficiencies in stuff and place for tests made it difficult to perform OFC. Cost determined by public health insurance and methodology of tests did not disturb them to perform OFC. To spread OFC, it is necessary to supplement insufficiencies of stuff and place in each institution by cooperating among hospitals and clinics in order to perform OFC safely.

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[Objective] To evaluate the efficacy and safety of a budesonide dry powder inhaler (Turbuhaler^®) (BUD) in Japanese children with bronchial asthma, using fluticasone propionate dry powder inhaler (Diskus^®) (FP) as the reference.
[Method] Patients were included if they were 5 to 15 years old; required treatment with inhaled corticosteroids; their morning mean peak expiratory flow % of predicted normal (%mPEF) was less than 90%; had mild persistent, moderate persistent or severe persistent bronchial asthma, and could use the Turbuhaler^® and Diskus^® appropriately. They were prescribed 100 or 200 μg of BUD twice a day, or 50 or 100 μg of FP twice a day for 6 weeks. The primary endpoint for efficacy was the change in %mPEF at the end of Week 6 from the baseline. (ClinicalTrials.gov identifier: NCT00504062)
[Results] Two hundred and forty-four patients treated with the investigational products (120 in the BUD group) were included in the analysis. The mean change in %mPEF was 8.0% in the BUD group and 7.0% in the FP group, showing a significant improvement in both groups. The estimated intergroup difference in the change in %mPEF was 0.95% (95% confidence interval: -2.77 to 4.67), showing no significant difference. The BUD group showed significant improvement (compared with baseline) in most secondary endpoints at Week 6. Adverse events occurred in 61 patients (51%) in the BUD group and in 60 (48%) in the FP group; the adverse events with high incidence were upper respiratory tract infection, influenza and gastroenteritis. Regarding adverse drug reactions, mild dysphonia occurred in 1 patient in the BUD group. There was no obvious difference in the number of patients showing serious adverse events or the number of patients who discontinued due to adverse events between the groups. No safety concerns were suggested from the changes seen in the other safety items measured.
[Conclusion] Administration of 100 and 200 μg of budesonide dry powder inhaler twice-daily for 6 weeks was effective and well tolerated in Japanese children with bronchial asthma aged 5 to 15 years requiring inhaled corticosteroids.

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The prevalence of EIA is high in the asthmatic children, especially in higher school grade or severe case. Exercise provocative test is important for the diagnosis of EIA. The treatment of EIA is important for the asthmatic children because EIA may have the deleterious effects not only on the development and growth of children but also on the forming their personality.

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Japanese pediatric guidelines for the treatment and management of bronchial asthma, “the JPGLs”, apply to childhood asthma from infancy to adolescence. Already, the JPGLs have become popular with Japanese physicians because they are concise and useful. In the JPGL 2008 edition, revisions have been made to the section on pathology, the evaluation of asthma severity, treatment steps, and the 13th section, lung function, which incorporates new information derived from recent studies of lung function tests. It has been suggested that basic techniques are important, such as flow-volume curve by spirometry, peak flow monitoring and oxygen saturation measurement by pulse oxymeter. Also, assessment of bronchial hyperresponsiveness by inhaled provocation tests, measurement of respiratory resistance by the impulse oscillation method, and measurement of expiratory nitric oxide (NO) are extensively discussed. These lung function tests are necessary not only for the diagnosis of asthma, but also to evaluate the severity. When the treatment is stepped down or stepped up, and when the education of patients is advanced in long-term asthma management, the evaluating of lung function is recommended.

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Women are playing a more active role in society in recent years, but the female doctors have to solve many problems to play an active part in the front lines. It is based on a family and social supports, understanding by co-workers and a lot of enthusiasm for the work. As I am one of the female doctors who have children, I am currently working as research resident at the Sagamihara National Hospital. I have examined role of peripheral blood basophils in the diagnosis of food allergy. As results, it was shown that basophil histamine release test and basophil activation marker of CD203c expression were useful in the diagnosis of tolerance acquisition of food allergy. From 2 years before, I have been analyzing the mechanisms of specific oral immunotherapy for food induced anaphylactic patients. Although I am only one example who has children, I hope this review paper would be a small advice for female doctors.

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