Background: There are still disobedience to the indications of allergic food labeling system in Food Sanitation Act.
Methods: We conducted a survey on 295 food sanitation inspectors and 42 institutions. The survey items are followings: understanding of allergic food labeling system by the inspectors and institutions and how they respond to the system etc.
Results: Thirty nine institutions (92.9%) answered the survey and 8 (20.5%) institutions out of 39 institutions violated allergic food labeling system. Two hundred and five inspectors (69.5%) answered the survey. Around 56.9% of them had the opportunity to have the training related to the food labeling system, and 36.8% of them found the dealt with violation. They understand the purpose of allergic food labeling system and food allergies itself well, however, less than 50% understands them in detail. On the other hand, the intelligibility was low for the food-related business operations to understand the food allergy. For future step 46.2% answered that they should focus more on the training toward food manufacturers and distributors in future.
Conclusions: In food labeling system, food related business operations need more understandings, and inspectors, who should manage them, was also be aware of the system. The enlightenment toward food related business operations is very important and at the same time management side needs to take steps to meet with the problem.

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Objective: The influenza vaccine contains a trace amount of egg white, and it is considered that caution is required in inoculating into persons with egg allergy. Since there is no clear criterion of the advisability of inoculation, judgments vary widely among institutions and inoculating physicians, leading to confusion in patients as well. Therefore, a questionnaire survey was conducted in order to understand the current status of inoculations of influenza vaccine for children with egg allergy.
Methods: A questionnaire survey was conducted with guardians of children who currently have, or have had in the past, egg allergy, and responses were obtained from 112 subjects.
Result: 52.7% of the children had had to forego inoculations with influenza vaccine in the past with egg allergy as the reason. Whereas in the group of age less than one year there were many cases in which inoculations were foregone by the judgments of guardians, in the group of age older than one year the most numerous response was that inoculation was denied by the inoculating physician for reasons such as that the physician "is not an allergist", regardless of the degree of removal and the degree of induced symptoms.
Conclusion: In order for children with egg allergy to be able to receive inoculations proactively, it is considered that studies on the safety, for providing the evidence, as well as a clear indication of the criterion of inoculation by such bodies as academic societies are necessary in Japan as well.

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A boy of 8-year-old with severe atopic asthma was hospitalized for treatment and attending special-needs school. Asthmatic symptoms were relieved soon after hospitalization. So, poor compliance and chronic exposure to indoor allergens were suspected as the cause of intractable asthma.
In order to investigate the deleterious effect of home environment on lung function and airway inflammation, we were compared with peak expiratory flow (PEF) and exhaled nitric oxide (eNO) values on Friday and Monday, before and after spending weekend at patient home.
eNO values on Monday increased significantly compared to those on previous Friday, and decreased significantly on next Friday compared to eNO on previous Monday. (22.2±5.7 ppb, 31.9±6.5, 19.5±7.3, respectively. p<0.01) There was no significant change in PEF. Trial test for evaluating correlation between ICS reduction and eNO measures revealed that half reduction of ICS for 2 days showed no influence on eNO values. And, we confirmed the high level of indoor house dust mite and mold allergens in bedroom by visiting patient home.
Considering above, the increase in eNO values after spending at patient home for 2 days suggests that exacerbation of airway inflammation might be induced by indoor allergens. Exhaled nitric oxide measurement is useful to evaluate the deleterious effect of home environment on airway inflammation in an intractable asthmatic child.

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Background: Pediatric allergy specialist certified by Japanese Society of Allergology, carried out a training program on allergic diseases for school teachers from 21 elementary and junior high schools in Kanagawa Prefecture, Japan, who were selected by the Prefectural Education Committee. These schools have a few children who suffer from severe food allergies.
Methods: This training session was held in 2009 to promote the support for allergic children. The program consisted of a lecture and discussion for a total of 2 hours. In the lecture, the specialists used a textbook titled "The Guideline for the Care of Allergic Children in School" (edited by the Ministry of Education, Culture, Sports, Science and Technology and published by Japanese Society of School Health). This Guideline has already been distributed to all elementary, junior high and high schools in all of Japan.
Results: We evaluated these sessions by sending a questionnaire to the participants. Among 799 teachers with valid responses 600 (75%) and 181 (23%) respondents rated this training session as "very useful" and "moderately useful," respectively. As a result 98 percent of them considered it as "useful." Of the 788, 666 (85%) and 120 (15%) respondents also answered that they "clearly understood" and "somewhat understood" respectively the necessity of adrenaline self-injection (Epipen^®).
Conclusions: It may not be easy for the specialist to make time for a lot of training programs in schools, but such a program should be offered to all the teachers. A guidebook answers to the teachers' questions may be required in the future to make the training program with more effective.

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In the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL), asthma occurring in infants under two years of age is defined as infantile asthma. The reason why asthma occurring in infants under two years of age is defined as infantile asthma is that airway narrowing can occur easily in 1 year old infants as well as infants under 1 year of age because of the anatomical and physiological characteristics of the respiratory system at this age. In addition, 60% of children with asthma develop asthma by their second birthdays. Therefore, in order to obtain a good prognosis, treatments and managements, including early intervention based on appropriate diagnosis at an early stage of the disease, are important. Towards this end, it is useful, for selecting the most appropriate treatment strategy, to classify infantile asthma into phenotypes such as allergen-induced asthma and virus-induced asthma. If "good" control can be maintained for three months or more by long-term management, step-down can be considered. However, earlier step-down can be considered for children generally diagnosed as having asthma, because the period after onset of asthma is short in infantile asthma and an early diagnosis is not always easy, with the possibility of over diagnosis. Furthermore, questionnaires, such as the Japanese Pediatric Asthma Control Program (JPAC) and a nighttime sleep diary are useful tools for long-term asthma management.

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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 understand various factors associated with intractability of asthma in adolescence and 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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The childhood asthma death reported to the committee until October in 2011 were reviewed on 207 patients from 0 to 34 years of age, who had died from 1989 to 2011.
The number of annual asthma death has decreased since 1998. Sex ratio (male to female) was 127 to 80. The older the asthmatic children became, the more the number of asthma death at school environment was concerned.
The frequency of asthma severity during the past year before asthma death were severe, moderate and mild, 43%, 29% and 28% respectively. The major factors for asthma death were unexpectedly rapid exacerbation and delay in time for visiting the hospital, 94% and 83%, respectively. The medication during the past year indicated increases in the use of inhaled corticosteroids from 24% to 38%. Furthermore, a beta-agonist patch and inhaled long acting beta 2 agonist have recently been used. By contrast, both the use of an inhaled short acting beta 2 agonist and oral corticosteroid were less frequently. Of 207 patients, the frequency of a broken family was about 15%, suggesting delay in time for visiting the hospital.

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