This case involves a 12-year-old girl who had had allergic rhinitis from around age 7. At age 10, she experienced itching of the oral cavity and pharynx when she ingested Asian pear, peach, cherry, strawberry, apple, or Japanese plum. At age 11, she was suspected of having oral allergy syndrome (OAS) and was referred to our department. As the OAS was mild and temporary, we administered second-generation antihistamines and put under observation. At age 12, similar symptoms appeared when she ingested heated soy food. She was thus admitted for a more detailed examination. We performed CAP system fluorescent enzyme immunoassay (CAP-FEIA) and the oral food challenge (OFC) test. We detected the birch pollen, peach, apple, and strawberry specific IgE antibody in the CAP-FEIA test, however we did not detect the soy-specific IgE antibody. The OFC test showed positive reaction for unheated tofu (bean-curd) and soymilk. Because of poor objective findings, except mild pharyngeal itching, we could not definitely diagnose the condition. Therefore, we performed component-resolved diagnostics (CRD) to analyze allergen components. Positive results were obtained only with Bet v1 (birch pollen), Pru p1 (peach), and Gly m4 (soy); these are homologous to pathogenesis-related protein 10 (PR 10), which is a member of a family of protective proteins present in plants. We diagnosed the condition as pollen-food allergy syndrome due to cross reactivity between birch pollen and soy. The results of CRD and not the conventional allergy tests aided definitive diagnosis of this case.

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Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. However, whether deterioration of asthma can be predicted using FeNO after stepping down long-term control medications is uncertain. We aimed to evaluate whether FeNO can serve as a marker of the step-down therapy.
We measured the FeNO value, the peak expiratory flow rate (PEFR), and performed the Childhood-Asthma Control Test (C-ACT) at each visit before and after the step-down. Out of 43 asthmatic children (4-11 years old) who underwent step-down therapy after achieving good asthma control for at least three months, 31 maintained a good control level while 12 showed deterioration after several months. The mean FeNO values, PEFRs, and the C-ACT scores were not different between the good control group and the deterioration group. However, in the deterioration group, the FeNO values after the step-down were significantly higher than the previous FeNO values, whereas this was not observed in the good control group (ΔFeNO: 81.4±107 vs. -4.9±33%, p=0.015). These results suggested that if the FeNO value tended to increase more than the previous value, the step-down of medications could cause deterioration in the asthma control.

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Self-efficacy (Bandura, 1986, 1997) is the belief that one carry out a behavior necessary to reach a desired goal, that is, achieve an expected outcome. In Japan, however, childhood asthma's self-efficacy has never been wholly evaluated. The purpose of this study was to develop the persisted Childhood Asthma's Self-Efficacy Scale for long-term management (CASES) and to evaluate its reliability and validity.
An instrument of CASES prepared draft a 22-item. These items were generated based on literature and the developmental stage of children. A specially-designed questionnaire survey was conducted on 133 patients with persisted asthmatic children in hospital.
An explanatory factor analysis on CASES revealed two factors comprised of 6 items. Cronbach's alpha coefficient was more than.75 for the internal consistently and reliability of the CASES. The reliability of the CASES was confirmed by a split-half method correlation coefficient of.73. Construct validity for analysis by structural equation modeling revealed that CASES were significantly related with burden to long-term asthma management and asthmatic symptom control.
Thus, the CASES may be clinically useful to evaluate patients' SE for long-term management of persisted childhood asthma in the constant standards.

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Japanese pediatric guidelines for the treatment and management of bronchial asthma ("the JPGL") were revised in 2012. Already, the JPGL have applied to childhood asthma from infancy to adolescence, and have become popular with Japanese physicians because they are concise and useful. This guideline has partially revised the section of pathology, the evaluation of asthma severity and treatment steps. JPGL 2012 incorporates new information derived from recent studies of asthma pathology. The sections on definition, pathophysiology and diagnosis of childhood asthma are revised according to recent reports. Key words are airway inflammation, bronchial hyperresponsiveness and remodeling. Also, the sections on asthma severity and treatment steps are revised 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 "control level" 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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It is an informational useful to an improvement of not only an answer but a therapy, an instruction to patient, and health care policies to a question simple for an allergist and a health care professionals to get to know the trend of the patient of a bronchial asthma and other allergic diseases. However, old epidemiological data is insufficient. An interpretation of the datum requires that a watch is a requirement and the structural plan which continues further and continues the survey.

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Japanese Pediatric Guideline for Food Allergy 2012 (JPGFA2012) has been published from Japanese Society of Pediatric Allergy and Clinical Immunology in Oct. 2011. The definition of food allergy was revised from "a phenomenon in which adverse reactions (symptoms in skin, mucosal, digestive, respiratory systems, and anaphylactic reactions) are caused in living body through immunological mechanisms after intake of causative food." in JPGFA2005 to "a phenomenon in which adverse reactions are caused in living body through antigen-specific immunological mechanisms on exposure to a causative food" in JPGFA2012.
The point of this change in definition is the entry route of food into living body. The entry of food into the body is limited to ingestion in JPGFA2005, in contrast, is expanded to any pathways such as skin contact, inhalation and injection in JPGFA2012.
This change was motivated by the definition of food allergy in the guideline presented by National Institute Health in USA and the multiple reports of food allergy by the hydrolyzed wheat proteins in the cosmetic soap.
That is, food allergy is a hypersensitive reaction caused by "food" through any entry routes into the body. This is the same category as insect allergy or metal allergy which is termed depending on causative allergen.

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