As for food allergens, the Japanese Ministry of Health Labour and Welfare (MHLW) made a decision for mandatory labeling of foods containing allergenic ingredients in 2001. Egg, milk, wheat, buckwheat and peanut, and most recently shrimp and crab require mandatory labeling. The MHLW announced the Japanese official method for the detection of specific allergenic ingredients in a ministry notification. More recently, many cases have been reported that patients who have been percutaneously sensitized by hydrolyzed wheat proteins experienced wheat-dependent exercise-induced anaphylaxis after ingestion of normal wheat products. From now on, we also should pay attention to the sensitization route of food allergens.

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Oral food challenge is the most reliable clinical procedure for diagnosing food allergy. Also, antigen-specific IgE titers varies in the interpretation by classifications of clinical type and allergens. Therefore, we need enough understanding of antigen-specific IgE titers. Probability curve for specific IgE titers are helpful to predict the probability of positive challenge for some allergens. We would like to explain diagnostic procedure in clinical type.
1. Diagnosis of infantile atopic dermatitis associated with food allergy
The first step to diagnosis of infants who came to the hospital by reason of chronic rash, is as follows. We must get detailed medical history. And, it is important that we teach method of careful skin care, how to apply of steroid ointment and environmental maintenance. For patients that improvement of skin symptom was poor, we need search antigen-specific IgE titers utilizing food diary.
2. Diagnosis of immediate type reaction
We must get detailed medical history from patients and search food specific IgE titers for suspected allergen. The points that we must be careful are as follows.
There are patients who do not develop symptom even if antigen-specific IgE titers positive. The definitive diagnosis of causative antigen is not possible only by antigen-specific IgE titers.
3. Sub type
【Food-dependent, exercise-induced anaphylaxis (FDEIA/FEIAn), Oral allergy syndrome (OAS)】for the definitive diagnosis of FDEIA, the challenge tests consist of three steps: food challenge alone, exercise challenge alone, combination of food and exercise challenge. Food prick test is useful for the diagnosis of the OAS.

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Objective: We have investigated the influence of the Tsunami in the Great East Japan earthquake on allergic children who lived near the Pacific coast of Iwate, Miyagi, and Fukushima prefectures, and explored better medical care in such disasters.
Subjective and method: We asked administrative organs to give questionnaires to parents of allergic children who lived in the area. The parents agreed with our purpose answered the questionnaires and mailed them to us.
Results: Children with bronchial asthma in the area seemed to be suffered more frequent asthma attack than those in area not affected by Tsunami. Some children were not able to go to medical services, even in severe asthma attack. For children with food allergy, it was difficult to take allergen-free foods. There were some cases of anaphylaxis by having offending foods in children with food allergy. In children with atopic dermatitis, their eczema was worsened because it was impossible to taking a bath or a shower in their evacuation.
Conclusion: The allergic children in the area affected by the Tsunami in the Great East Japan earthquake seemed to be forced into severe situation. We proposed that the public organization should prepare the storage of medical stuffs (drugs) and allergen-free foods and make systems for allergic children in the area toward such disasters.

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Children (6 to 15 years old) with mild to moderate persistent asthma who inadequately responded to inhaled corticosteroid treatment (beclomethasone or fluticasone, 100 μg/day) were concomitantly administered a patch formulation of tulobuterol (1 or 2 mg/day), a long-acting beta-2 agonist, for 12 weeks, and its usefulness as an add-on therapy (n=17) was compared with that of double-dose inhaled corticosteroid therapy (n=13). The group concomitantly administered the tulobuterol patch showed significant improvement in %PEF on awakening during the subsequent 1 to 12 weeks as compared with the observation period, with a significant difference in %PEF on awakening at week 7 as compared with the group that received increased inhaled corticosteroid. Moreover, although no significant differences were seen between the groups with respect to bedtime %PEF, asthma symptoms, or quality of life, improvement as compared with the observation period was seen for these measures. Safety with add-on administration of the tulobuterol patch was high. The only adverse events that occurred were itching and skin rash in 2 patients. Although the tulobuterol patch is recommended as an add-on therapy for persistent childhood asthma of moderate or greater severity in the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2012, the present results suggest that add-on treatment with the patch may also be an option for children with mild persistent asthma.

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