Pitfalls in the management of food allergy was discussed with reference to Japanese Pediatric Guideline for Food Allergy 2012 from the view point of diagnosis of causative allergen in early infancy, assurance of safety and improvement of QOL. Importance of detailed medical history and dietary record, usefulness of skin scratch test in babies, the level of antigen component specific IgE antibody as the reflection of the amount of the component protein in the food, probability curve as nothing more than a probability, usefulness of basophil histamine release test in the determination of indication of oral food challenge teat were discussed.

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[Objective] This study was aimed to evaluate the validity of a group free running test as the exercise challenge for exercise-induced asthma (EIA) in asthmatic children.
[Methods] A 6-min free-run test, accompanied by a pacemaker, was performed in 50 school children attending a summer asthma camp in 2008. Peak expiratory flow rate (PEF) was obtained before running, immediately after running, and at 5 and 15 min after running. Heart rate was recorded during the exercise using portable heart rate monitors.
[Results] There were no children who failed to complete the test. In 9 children (18%), PEF was decreased more than 15% before exercise. In 47 (94%) cases, the heart rate rose above 170 beats/minute during the exercise, and it continued for about 5 minutes (mean duration, 296.1±53.1 sec).
[Conclusion] Because of enough intensity for exercise challenge, a group free running test, accompanied by a pacemaker, is adequate to detect the presence of EIA in asthmatic children.

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Objective: We wanted to compare the degree of QOL at different times in not only asthmatic children but also their guardians during periods from 2001 to 2008. Methods: A questionnaire survey on asthma symptoms and QOL was conducted for children with asthma and their gurdians in Gunma Prefecture. Primary physicians were asked for information on the therapeutic approach for each patient. These surveys were conducted in 2001, 2005 and 2008. Results: The frequency of prescription of anti-inflammatory medications such as inhaled steroids and antileukotrienes increased and asthma attacks (evaluated based on hospitalization, number of emergency visits, and asthma symptoms) were ameliorated over time. However, the QOL of the children and their parents was not significantly improved, although there was a trend for improvement. Discussion: Control of asthma symptoms in pediatric patients in Gunma Prefecture has improved over time. However, our results suggest that further efforts to improve the QOL of the patients and their family are required.

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Background: Little is known about differences in the characteristics of and problems associated with school lunch provision for food allergy among day nurseries, kindergartens, elementary schools, and junior high schools.
Objectives and Methods: For the purpose of establishing institution-specific, flexible strategies for school lunch provision for food allergy, we investigated the actual conditions of such provision among day nurseries, kindergartens, elementary schools, and junior high schools in Tochigi Prefecture and performed a comparative analysis.
Results: We found that (i) there were no significant between-institution differences in the retention rate for food allergic children receiving school lunch provision; (ii) compared to other institutions, day nurseries were more likely to require an instruction from a physician to commence the school lunch provision, many of which supplied elimination and alternative diets; and (iii) all institutions were faced with difficulties associated with school lunch provision for food allergy, with elementary schools and junior high schools citing "facility and equipment deficiencies" at a particularly high rate.
Conclusions: The study revealed differences in the characteristics of and problems associated with school lunch provision for food allergy across the institutions. The results suggest the necessity of school lunch provision for food allergy to consider the characteristic of each institution's lunch system.

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Japanese Pediatric Guideline for the Treatment and Management of Asthma was revised majorly in 2002, and restriction of usage of theophylline for younger children was stated from JPGL 2005. In 2008 revision, the point was that JPGL decided not to use the term "anti-allergy drug" any more. Anti-allergic drug contains many spectrum of drugs to treat allergy, such as anti-histamine, leukotirene receptor antagonist, etc. In other international guideline for asthma such as GINA, they have never used the term of "anti-allergic drug". It is a milestone for JPGL to exclude oral anti-allergic drug for the long management of bronchial asthma and to recommend leukotirene receptor antagonist and cromolyn only.

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It is necessary to understand first of all the general characteristics in adolescence from social, economical and psychological point of view in order to treat asthma in adolescence. The bothering problems in adolescence are deteriorations in adherence to treatment and overt narrowing of small airways. Most important to prevent them are to support the patient and the family in establishing their self-management and to re-evaluate and step-up treatment strategies if necessary.

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