Recently, the anti-inflammatory treatment with inhaled corticosteroid (ICS) has become a standard therapy for asthma and asthma-related hospitalizations have gradually been decreased in pediatric practice. However, when hospitalizations are compared among age groups, younger children (0 to 4 year-old) group did not show the decreased trend, furthermore, proportion of this age group in hospitalizations tended to increase. In western countries, inverse association between ICS use and hospitalization was reported. Our present study surveyed regional situation of asthma-related hospitalizations before and after the introduction of nebulized budesonide inhalation suspension which is suitable formulation for younger asthmatic children. The result demonstrated that the number of hospitalizations was clearly reduced after the introduction. Compared to western countries, ICS treatment has not yet been widespread for younger children. It is important to decrease asthma-related hospitalizations along with the increased use of ICS for this younger patient group.

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A ten-month-old girl with food allergy presented with mild developmental delay, elevated serum creatine kinase levels and hypocarnitinemia. Her mother had adhered to a vegiatrian diet during pregnant and lactating periods because of the elder sister's egg allergy. She had been treated with a strict elimination diet. Her abnormal serum carnitine and creatine kinase levels were promptly normalized by treatement with L-carnitine and nutrition counselling. Strict elimination diets and inappropriate altenative foods may cause carinitine deficiency and myopathy.

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A multi-center, randomized, parallel-group, comparative study was conducted to evaluate the efficacy and safety of ciclesonide (administered via a metered-dose inhaler, referred to as BTR-15) vs. Hydrofluoroalkane-beclometasone dipropionate (HFA-BDP) as the reference in children with asthma. A total of 167 children (aged 5-15 years) with asthma were randomized to receive BTR-15 50μg, 100μg or 200μg once daily, or HFA-BDP 50μg twice daily (100μg/day), both for 8 weeks.
A total of 217 patients were enrolled and the data of 167 (69 girls and 98 boys) were analyzed. The median age was 8 years (5-15 years); when rated according to the severity criteria of the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2005, 116 had mild persistent, 50 had moderate persistent and 1 had severe persistent asthma.
BTR-15 treatment showed efficacy in all of the dosing groups and no safety problems were found. In the exploratory analysis for the patients stratified by the severity of asthma symptoms, the efficacy and safety of BTR-15 treatment was confirmed in all of the dosing groups in patients with mild and moderate persistent types. The PEF levels and asthmatic symptoms were improved in one patient with severe persistent type who was allocated to the BTR-15 200μg group. There were no adverse events that occurred in this patient.
Based on the above results, BTR-15 is considered to be a clinically useful agent for the treatment of pediatric asthma.

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A multi-center, open-label study was conducted to evaluate the efficacy and safety of ciclesonide (administered via a metered-dose inhaler, referred to as BTR-15) 50μg, 100μg or 200μg administered once daily for 28 weeks in 69 children with asthma (5-15 years of age) . The data of all of the 69 patients were included for both the efficacy and safety analyses.
No specific adverse events associated with long-term administration of ciclesonide occurred. No safety concerns arose over the long-term 28-week administration period for the BTR-15 dose range examined in this study, that is, 50μg to 200μg daily. Adequate improvement of the PEF levels was observed in the patients administered BTR-15 50μg, 100μg or 200μg once daily, based on the asthmatic symptoms. The efficacy of BTR-15 was maintained throughout the 28-week administration period.

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Purpose: The diagnosis of food allergy has been gradually standardized with the spread of manuals and guidelines. However, there are still some occasions, where instructions of inappropriate food elimination worsen "quality of life" (QOL) of patients and guardians. We clarified the burden caused by the inappropriate instructions to patients and guardians to eliminate various foods.
Methods: We examined 30 patients who had eliminated a lot of foods including more than five items from the list of the main foods (eggs, milk, wheat, rice, soy beans, meat, fish etc) prior to the visit to our department, and whose elimination has been improved drastically after the consultation in our department.
Results: The number of eliminated foods has been declined tremendously from 12.0±2.8 (mean±SD) items to 5.0±2.3 items before and after the consultation.
The rate of elimination release was 100% for rice and beef, more than 80% for chicken and pork, more than 50% for soybeans and fish.
Based on the questionnaires, physical and mental burden imposed on the patients were removed from almost all the cases, and it turned out that not only "the number of eliminated foods", but also "severe elimination diet for breast-feeding mothers" and "strict rotation diet" were the main causes of the burden to the patients and guardians.
Discussion: By the food elimination based on appropriate diagnoses, various burdens of patients and guardians have been remarkably removed.
It is our hope that food allergy patients would maintain QOL with the standard diagnosis and the nutritious guidance based on minimal food elimination, even though they have to eliminate causative foods to avoid adverse reactions.

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The patient who had had bronchial asthma since the age of 8 was being followed up at her local pediatric clinic. When she was in the sixth grade of elementary school, she suffered from bronchial asthma attacks every month or so, and suffered from generalized fatigue for 2 or 3 days before the attacks. Since first menstruation in the first year of junior high school, her asthma attacks lasted from a few days before the onset of menstruation until 3 days after menstrual onset, and she also experienced menstruation-associated symptoms such as anxiety, irritation, easy fatigability, lassitude, edema of the extremities, and difficulty in sleeping. Because these symptoms began to interfere with her school life, she was diagnosed as having premenstrual syndrome. After obtaining informed consent from the patient herself and her family, we started the patient on off-label use of selective serotonin reuptake inhibitors (SSRI) at the time of symptom occurrence, and her symptoms responded satisfactorily to the treatment.

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[in Japanese]

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Japanese pediatric guidelines for the treatment and management of bronchial asthma 2008 (JPGL 2008) discusses about the quality of life for patients in school time, allergic problems for vaccination and problems when given the surgical operations, in the 15^th chapter. Pediatricians should concern about the detail of patients' life in school for their well-being during the management of asthma. Influenza vaccine is thought to be safe for egg-sensitive patients except who have shown anaphylactic shock after the vaccination. Special attention should be paid for controlling the asthma best before the planned surgical operation.

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