It is difficult to diagnose allergic rhinitis (AR) less than 5 years old, especially less than 3 years old. The diagnosis for AR requires the detection of serum antigen-specific IgE and detailed medical interview.
A younger age of onset of AR has recently become a problem in Japan. We examined the prevalence of AR in children undergoing 18-month infant health checks provided by local government. Among 408 infants, 10.7% had antigen-specific IgE (mite, cat or Japanese cedar pollen) , 7.1% had nasal eosinophils, and 2.0% had both.
Since several anti-histamines have been supported by health insurance for pediatric AR recently, it is easy to treat for patients with pediatric AR. The addition of anti-leukotriene or nasal steroid to anti-histamines is effective for the stuffy nose.
Sublingual immunotherapy for the seasonal AR caused by Japanese cedar pollen has been applied for the indication of health insurance. We will have a chance to choose sublingual immunotherapy for AR patients over 12 years.

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The prevalence of allergic diseases in school children was examined in 1992 (n=46,718), 2002 (n=36,228), and 2012 (n=33,902) in 11 western districts of Japan. Three studies were conducted with the same questionnaire in the same districts.
Results:
1) The study in 1992, 2002, and 2012 established prevalence rate of 15.9, 28.1, 20.5% in allergic rhinitis (AR), 17.3, 13.8, 11.7% in atopic dermatitis (AD), 6.7, 9.8, 11.4% in allergic conjunctivitis (AC), 4.6, 6.5, 4.7% in bronchial asthma (BA), 3.6, 5.7, 9.9% in Japanese cedar pollinosis (P), respectively. These rate were higher than those of 10 years ago except AD or BA.
2) The prevalence rate of allergic diseases was 31.3% in 1992, 34.1% in 2002 and 38.6% in 2012. The cumulative rate was 45.5% in 1992, 48.5% in 2002 and 50.6% in 2012.
3) The prevalence rates were not found area's differences in 2002 and 2012.
Higher prevalence rates of AR, AC and P were found in elder children. No age differences were found in AD or BA.
4) There was slight difference among nutrition during infancy, indoor smoking, type of heating or air conditioning in all allergic diseases.
5) Higher prevalence were found in children who had family history of allergic diseases and early history of lower respiratory infectious diseases.
6) The prevalence rate of food allergy (FA) and anaphylaxis (An) in 2012 survey was 3.6%, and 0.8% respectively.

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Objective: To establish the clinical utility of a new allergen-specific IgE assay (sIgE) , 3gAllergy^TM, by comparing with the established assay, ImmunoCAP^®.
Methods: Serum samples from a cohort of 93 infants with recurrent wheezing were tested for sIgE to Dermatophagoides pteronyssinus (Dp) , Japanese cedar pollen (JCP) , egg white (EW) , Milk (M) , and wheat (W) with ImmunoCAP^® and 3gAllergy systems. The samples were serially collected at study entry, 1 year, and 2 years after entry. Correlation analyses were performed for sIgE results by the two methods. Data distribution and detection performance were also analysed.
Results: Good overall correlation was observed between ImmunoCAP^® and 3gAllergy results. The Spearman's correlation coefficients for Dp, JCP, EW, M and W were 0.95, 0.94, 0.93, 0.85, 0.93, respectively. Regression analysis also showed high R square and it was considered that the 2 methods can be interchangeable. The data by 3gAllergy for Dp, JCP, and EW were higher than those by ImmunoCAP^® and wider data distribution with 3gAllergy was observed. The data for M in higher range were higher and those for W were lower than ImmunoCAP^®. Frequency of positive results with 3gAllergy tended to be higher than ImmunoCAP^®.
Conclusions: These data indicate that specific IgE levels to Dp, JCP, EW, M and W measured by the 3gAllergy and ImmunoCAP^® systems are highly correlated and can be interchangeable. Wider distribution and higher sensitivity of 3gAllergy may be useful for clinical monitoring and early diagnosis of sensitization.

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【OBJECTIVE】The aim of this study was to evaluate the practicality and safety of the diet instructions to start eating the quantitative amount of the allergenic foods based on the result of an oral food challenge test.
【METHODS】The age of patients was 11 to 161 months. The purpose of oral food challenge test was to diagnose food allergy and acquisition of tolerance baced on guideline.
The oral food challenges were carried out using boiled egg white, udon noodle or milk given in an increasing dose (1, 2, 5, 10 and 20-30 g). The challenge-negative patients were instructed to begin to eat the final dose at home. The initial dose for the challenge-positive patients was reduced based on the severity of the symptoms provoked in the challenge test. Patients were instructed to take the allergenic foods directly; boiled/fried/scrambled egg, udon noodles/pasta, cow's milk/yogurt. After 1 to 2 months, a dietary record of each patient was evaluated to see the frequency of intake and the appearance of symptoms after consumption.
【RESULTS】Excluding 99 patients who were advised to continue an elimination diet, 142 patients (78 challenge-negative, 64 challenge-positive) were instructed to induce the allergenic foods, and 123 of them were able to follow the instruction. From the challenge-positive patients, 68 episodes (5.8% of the total 1181 intake) of the occurrence of a symptom were reported, which was not statistically more frequent compared to those reported from the challenge-negative patients (54/1179 intakes, 4.6%). Anti-histamines were used in 4 cases, but three of them were challenge-negative patients.
【CONCLUSION】This diet instruction method seemed to be practical and safe enough for the challenge-positive patients, as well as for the challenge-negative patients.

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In order to identify predictors for oral food challenge test (OFC) outcomes in egg allergy, we retrospectively analyzed 408 egg challenge results conducted at a hospital and 2 clinics both by pediatric allergy specialists. Of 322 OFCs conducted at the hospital, 59.9% failed and of 86 cases at clinics, only 3.5% failed. Age, egg white-specific IgE (EW-IgE), the number of eliminated foods and history of anaphylaxis in patients who had OFC at the hospital were significantly higher than those at the clinics. In a subgroup of patients with moderate levels of EW-IgE, class 2 and 3, positive rate at the hospital was still higher than at the clinics. Even after matching the age in the group, the positive rate of OFC at the hospital was again higher than at the clinic. Multiple logistic regression analysis revealed that number of eliminated foods in patients aged 0-1 and comorbid atopic dermatitis and history of anaphylaxis in 2-3 years old were significant predictors for positive OFC. These results suggest that multiple food allergy, history of anaphylaxis and unremitting atopic dermatitis may be risk factors for OFC failure at moderate levels of EW-IgE.

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[in Japanese]

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Although the strategy for the management of bronchial asthma has advanced remarkably in late years, we can't recognize the similar advances in the skill for the diagnosis of bronchial asthma. Besides being serious about how to diagnose asthma properly, we always have to scrutinize features of rhinitis and/or sinusitis, or gastroesophageal reflux, and these subjects are dealt with in chapter 11 in "Japanese pediatric guideline for the treatment and management of asthma 2012". Better management of patients with asthma can be achieved by judicious consideration and proper care for respiratory complications occurring during acute or chronic stage of bronchial asthma.

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