Bronchial asthma is a heterogeneous disease caused by a combination of genetic and environmental factors. To determine the genetic components of these diseases and discover the genes and cellular pathways underlying them, genetic studies have been conducted. The genome-wide association study (GWAS) is a test of the association between common genetic variants spreading across the genome and disease in an unbiased and hypothesis-free manner. Comprehensive, well-powered, genome-wide surveys using GWAS have revealed susceptibility loci for bronchial asthma. The findings of GWASs of asthma imply the importance of genes that play a role in communication of epithelial damage to the adaptive immune system and activation of airway inflammation and will be helpful to highlight the genes involved in human allergic diseases. A number of GWASs of allergic diseases have revealed that different allergic diseases share overlapping susceptibility loci. Further studies of these overlapping loci might help to clarify the mechanisms underlying allergic march. Although a more complete collection of associated genes and pathways is needed, biologic insights revealed by GWASs improve our understanding of the pathophysiology of human allergic diseases. Further cross-disciplinary studies combining genetics, immunology, epidemiology, and clinical allergology are necessary to the development of better treatment and preventive strategies.

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The goal of the study was to examine the relationship between Japanese Pediatric Asthma Control Program (JPAC) scores and evaluation of childhood bronchial asthma control by the Japanese Pediatric Guidelines for Treatment and Management of Asthma (JPGL) 2012. Of 95 patients or parents giving informed consent, 87 completed the JPAC from 1st May to 30th June 2012 (age 0-15 years old; median 5 years old). Doctors independently evaluated the status of bronchial asthma based on the JPGL 2012. The JPAC score was 15 points in 25% of patients, 12-14 points in 52%, and ≤11 points in 23%. Medications were used by 98% of patients: 47% used inhaled corticosteroids and 87% used a leukotriene receptor antagonist. Symptoms of cough and wheeze in the past month were 'intermittent' in 53%,'mild persistent' in 39%, and 'moderate persistent' in 8%. Considering controller use, 26% of the patients had intermittent asthma, 35% had mild persistent asthma, 24% had moderate persistent asthma, 13% had severe persistent asthma, and for 2% this information was unknown. A comparison of the JPAC results with those from the JPGL 2012 showed that children with partly controlled or uncontrolled asthma based on the JPGL had lower JPAC scores than those with controlled asthma (P<0.001 by Steel-Dwass test). However, 10 patients with JPAC scores of 12-14 were reported to be 'poorly controlled' using the JPGL, and 8 patients with JPAC scores of ≤11 were 'partly controlled' based on the JPGL. This suggests that there is some discrepancy between JPAC scores and evaluation of the status of bronchial asthma based on the JPGL 2012. However, if cases with a JPAC score ≤10 were estimated to be uncontrolled, this result would have total, positive and negative rates of concordance of >80% with evaluations based on the JPGL2012. This finding suggests that a JPAC score ≤10 gives a more reliable indication of uncontrolled bronchial asthma. Overall, the results suggest that care should be taken when evaluating the status of bronchial asthma control using the JPAC score.

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There is strong evidence that atopic dermatitis (AD) has a significant impact on quality of life (QOL) of children and QOL may be a reasonable outcome measure. Relentless itching in AD impairs QOL and antihistamines may alleviate the symptom by antagonizing histamine as a pruritogen. We investigated possible efficacy of a new non-sedating anitihistamine, levocetirizine, on QOL of school children with AD. Twenty three children at 7 to 14 years of age who had been uncontrolled with guideline-based standard treatment with topical glucocorticoids, topical calcineurin inhibitors, and moisturizing agents were enrolled in the study. Levocetirizine at 2.5 mg was administered twice daily for 4 weeks and the Children's Dermatology Life Quality Index (CDLQI) was evaluated before, at 2 and 4 weeks after treatment. The patients recorded their perception of itching during day and night in "itching diary" and severity of AD was evaluated with SCORAD index. Levocetirizine treatment resulted in significant improvement in total score of CDQLI as well as SCORAD score and diary-recorded itching score. In CDQLI, domains of itching, sleep quality, negative emotions and treatment burden were significantly improved by the treatment. There was a significant correlation between CDQLI and SCORAD scores (Spearman' correlation coefficient of 0.43) indicating the QOL measure well represents severity of AD. These results suggest that levocetirizine may be useful as a second line treatment for children with AD and that CDQLI may be a good outcome measure in clinical studies of AD.

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Objective: Educating the school staff on anaphylaxis and its management is indispensable for safety during school. We analyzed the usefulness of a lecture on food allergy followed by a practice session on an adrenaline autoinjector, EpiPen^®.
Method: We recruited the school staff from elementary and junior high schools in Fukui-city, Japan. After a questionnaire survey to assess the knowledge of anaphylaxis and its management, a lecture on food allergy and a practice session on an EpiPen^® were conducted. The change in staff attitude toward management of children presenting with anaphylaxis was analyzed by comparing the answers to the questionnaires before and after the lecture and practice session.
Results: Although 97% of the staff knew about the EpiPen^®, only 29% understood its proper usage. Their major concerns were the optimal timing for EpiPen^® use (82%) and guardians' complaints about having used an EpiPen^® (68%). After the practice session, the percentage of staff who answered that a teacher or school nurse who encountered a child presenting with anaphylaxis should use the EpiPen^® increased from 50% to 75%. Some participants answered that the practice reduced their hesitation to use the EpiPen^®.
Conclusion: A lecture on food allergy combined with a practice session on an EpiPen^® was effective for the school staff in understanding anaphylaxis and for reducing their hesitation to use the EpiPen^®.

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Objective: The differential diagnosis of continuous adventitious sounds is important. However, it is not easy to distinguish asthma from vocal cord dysfunction (VCD) as VCD can coexist with asthma or masquerade as asthma. The misdiagnosis of VCD as asthma leads to the inappropriate use of systemic steroids, which can result in adverse effects. Breath sound analysis is a non-invasive method of evaluating airway status. In the present study, we used breath sound analysis to differentiate between VCD and asthma in children.
Methods: We performed breath sound analysis before and after the inhalation of a bronchodilator in patients with asthma or VCD.
Results: Continuous adventitious sounds were detected in both the VCD and asthma patients. The sounds detected in the VCD patient displayed a lower frequency range than those detected in the asthma patient. In addition, VCD produced more distinct peaks during the inspiratory phase than the expiratory phase, whereas asthma produced more distinct peaks during the expiratory phase than the inspiratory phase. The peaks produced by asthma improved after bronchodilator inhalation; however, those produced by VCD did not.
Conclusion: We found that VCD and asthma cause different continuous adventitious sounds to be produced. Breath sound analysis of continuous adventitious sounds might be useful for differentiating between VCD and asthma.

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There are only a few reports on allergen-free lunch box menus provided by hospitals. It is important to provide meals without causative foods for hospitalized children with food allergies. We prepared routine allergen-free menus for food-allergic children, and compared the number of adverse events that occurred before (April to October 2010) and after the implementation of the routine allergen-free menu (November 2010 to February 2011). The routine lunch box menu was implemented for 1 week, from which 10 food items (hen's egg, cow's milk, wheat, peanut, soybean, shrimp, crab, yam, and sesame) were eliminated beforehand. The average age of the patients was 4.6±3.3 years and the number of eliminated foods was 2.4±2.2 items.
After preparing routine allergen-free menus, the number of allergy-related adverse events reduced significantly from 8 cases from 366 meals to 1 case from 350 meals (p=0.038). We believe that routine allergen-free menus might reduce the number of adverse events that occur from consuming the meals provided in the children's lunch boxes, and may also decrease the risk of accidents that occur during meal time.

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In chapter 10 of Japanese Pediatric Guideline for Food Allergy 2012 4 diseases were described independently from common food allergy because of unique clinical features, clinical and laboratory tests, and provocation tests.
Gastrointestinal allergy in neonate and infant is a cell-mediated allergic disease and shows mainly gastrointestinal manifestations. Major causative food is cow's milk formula. Since there are large varieties in this disease, re-classification of the disease should be done in near future.
Food-dependent exercise-induced anaphylaxis (FEIAn/FDEIA) is classified into IgE mediated immediate type allergy. Major allergens are wheat and crustaceans. Provocation test is desirable for the accurate diagnosis of the disease except for the severest case. Recently, we experienced FEIAn cases after and/or during the course of oral immunotherapy for patients with severe food allergy. And the epidemiological study in adult and improvements of accurate diagnosis are necessary.
Oral allergy syndrome (OAS) is triggered by cross-reactions between pollens and fruits and vegetables. It is classified into IgE mediated immediate type allergy. And pollinosis usually precedes the onset of OAS. Analysis of allergens of OAS goes forward in this field. OAS represents usually mild oral and pharyngeal symptoms, but seldom shows severe generalized symptoms. In addition, latex-fruit syndrome (LFS) is also immediate type allergy and is caused by the cross reaction between hevein of latex and class I chitinase of fruits and vegetables. It sometimes shows severe generalized manifestations like anaphylactic shock.
Studies of these diseases are now in progress. Therefore, it might change even the disease entity in future. We would expect that the progress in the study of the disease could contribute to an improvement of the treatment.

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Objective
The purpose of this study is to document clinical utility of measurement of specific IgE antibody to Ara h 2 (Ara h 2-IgE) for diagnosis of peanut allergy in Japanese children.
Methods
One hundred and fifty two children were included having a suspicion of peanut allergy (peanut allergy: PA n=68, non-peanut allergy: NPA n=84). Specific IgE antibodies to five allergen components from peanut in the sera from those subjects were measured by ImmunoCAP^®.
Results
Ara h 2-IgE was the best for diagnosis of peanut allergy. The specific IgE titer of 95% PPV was 4.71 U_A/ml. Sensitivity at that IgE titer was 57.4%. For specific IgE antibody to crude peanut extract (f13-IgE), sensitivity at 50.8 U_A/ml (95% PPV) was 20.6% and that at 14.0 U_A/mL, which was the decision point for 95% PPV reported by Sampson, was 36.8%, respectively. NPV of Ara h 2-IgE at the existing cut off (0.35 U_A/ml) was 89.3% regardless of specific IgE titer of f13.
Conclusion
The measurement of Ara h 2-IgE combined with f13-IgE is accurate for diagnosis of peanut allergy and is useful in order to decrease the number of peanut challenges at the clinic.

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