Measurement of allergen-specific IgE antibody (sIgE) levels is commonly used for the clinical diagnosis of food allergies, and ImmunoCAP is the standard test used to measure sIgE level. sIgE has shown satisfactory accuracy for the diagnosis of hen's egg and cow's milk allergies. Recently, probability curves have been used for the management of children with these allergies. Although the diagnostic precision of sIgE for soy, wheat, or peanut allergies is insufficient, sIgE against purified component proteins of each food, such as Ara h2, may have better diagnostic value. AlaSTAT 3g Allergy, a relatively new method to measure sIgE levels, has been gaining attention. Although the diagnostic accuracy of AlaSTAT seems to be comparable to that of ImmunoCAP, the upper limit of the measurable range of AlaSTAT is higher than that of ImmunoCAP; therefore, it might be useful for the study and management of patients with extremely high sIgE levels. BAT and HRT use basophils to examine IgE-mediated hypersensitivity reactions against foods. The diagnostic accuracy of these tests seems to be comparable to that of ImmunoCAP. Because the individual property of basophils is reflexed in the results of the BAT and HRT, these tests could be used for the diagnosis of patients who are not accurately diagnosed using sIgE. ALST is useful for the diagnosis of gastrointestinal food allergy in neonates and infants, which is a well-known cell-mediated food allergy. Because ALST is performed by a major clinical examination company, the same test and cut off level can be used for diagnosis throughout the country. DLST is not suitable for the diagnosis of cell-mediated food allergy.

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[Purpose] This study aimed to evaluate the efficacy of a portable manual for the parents of children with food allergies addressing how to correspond to the allergic symptoms according to severity assessment. The manual was also examined to identify parts needing improvement. [Method] We asked 435 parents of children with food allergies to complete a confidential multiple-choice questionnaire in the spring of 2013. In addition, we asked 214 elementary school teachers to complete the same questionnaire in the summer of 2013. [Result] A majority of the parents (93.6%) and teachers (92.5%) found the manual easy to understand. Regarding correspondence to the symptoms, information about the efficacy of medicines, and the use of medicines, 74.3%, 74.3%, and 77.0%, respectively, of the parents reported understanding these sections, while only 57.5%, 58.9%, and 44.9%, respectively, of the teachers understood these sections. These rates were significantly different (p<0.001), with a lower percentage of the teachers reporting understanding these sections than the parents. [Conclusion] Both parents and teachers understood the manual. Most parents were able to understand the complete contents. The teachers did not understand sections of the manual as well as the parents did. Therefore, it is important to adjust the contents of the manual based on the intended use and audience.

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Objective: We have investigated the difference of allergic symptoms between the allergic children who were evacuated to shelter and those who were not evacuated, near the Pacific coast of Iwate, Miyagi, and Fukushima prefectures. The area was affected by Tsunami after the Great East Japan Earthquake. Subjective and method: We asked administrative organs to give questionnaires to parents of allergic children who lived in the area. The parents who agreed with our purpose answered the questionnaires and mailed them to us. We have examined the incidence of asthma attack and exacerbation of atopic dermatitis between the two groups. Results: The asthmatic children in the shelter caused more asthma attack significantly than those who were not in the shelter. On the other side, the atopic dermatitis children in the shelter also caused more exacerbation significantly than those who were not in the shelter. Conclusion: We found that the allergic children, such as asthma and atopic dermatitis who were in the shelter got worse compared with those who were not in the shelter. We hope that those allergic children who were sensitive to environmental deterioration could stay in the shelter more comfortably in the disaster.

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Background: Peanut allergy (PA) is usually diagnosed by a routine analysis, wherein the level of IgE antibody specific to whole peanut antigen (WPA-IgE) is measured. Recently, relatively new laboratory tests, namely, the basophil activation test (BAT) with WPA (WPA-BAT) and IgE antibody specific to a component protein Ara h2 (Ara h2-IgE), have been shown to be more sensitive than WPA-IgE for the diagnosis of PA. Objective: To compare the diagnostic accuracy of BAT with that of IgE antibody by using purified proteins Ara h1 and Ara h2 in Japanese children with PA. Methods: Twenty-four patients with PA (median age: 6 years) and 19 controls without PA (median age: 6 years) were enrolled in this study. PA was diagnosed by an oral food challenge test. BAT was performed with WPA, Ara h1 (Ara h1-BAT) and Ara h2 (Ara h2-BAT). The accuracy in the diagnosis of PA was estimated by receiver operating characteristic (ROC) curves. Results: Areas under ROC curves (AUC) were significantly high for Ara h2-BAT (0.967, p=0.023) and Ara h1-BAT (0.922, p=0.046). Although the AUC for WPA-BAT was also high (0.910), it was not significant (p=0.073). There were no significant differences in AUCs (p=0.561) between Ara h2-BAT and Ara h2-IgE (0.897, p=0.064). Conclusions: This study showed that Ara h2-BAT is as accurate as Ara h2-IgE for the diagnosis of PA in Japanese children.

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We recently encountered 3 cases in which systemic anaphylaxis developed after eating mixed flour contaminated by mites. Since 1993, systemic allergic reactions following ingestion of foods made using mite-contaminated wheat flour have been reported; therefore, we developed a questionnaire regarding mixed flour contaminated by mites. Responses were received from the caregivers of 54 children treated in the allergy division of our department. 38.9% of caregivers had knowledge about allergic reactions following ingestion of mixed flour contaminated by mites, and 64.9% of caregivers did not always store mixed flour in the refrigerator. At-risk populations of allergic patients should be informed about prophylactic measures.

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[in Japanese]

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History taking is the first step in the management of children having allergic diseases. A lot of information is needed for determining the diagnosis of allergic diseases and appropriate treatment for each child. Medical interview sheets are frequently used to gather information from children and their caregivers in clinical and epidemiologic researches. Simple validated questionnaires are useful tools for clinical practice, along with researches. In this paper, we explain about useful questionnaires for pediatric asthma and allergic diseases in clinical practice.

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Food allergy is a condition that may require emergency management at schools and nurseries. For educating the management of food allergy emergencies to school and nursery personnel, the following 5 steps are necessary. "Know the risk" is to know the basics of food allergy and to have accurate information of the child at risk. "Make a plan" is to make a food allergy and anaphylaxis action plan, such as the Tokyo Metropolitan's action plan for food allergy emergency. "Get a kit" is to prepare the necessary items, such as a copy of the action plan, medication and contact information. To "Work as a team" in an emergency, it is important to have the roles clear. Finally to "Maintain your plan", regular training with simulation is required.

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Bronchial asthma is a chronic inflammatory disease of a respiratory tract, and inhalation therapy is important for it. The medication by inhalation is the method that a medicine can be made to act on a respiratory tract directly, and can expect the more effect with the lower dose. To get the good effectiveness, it is important to learn the proper way of inhalation technique. For this reason, we must instruct patients and their caregiver the right method of inhalation technique. Namely, select the right type of medicine dosage form and inhalation implement, explain the proper method of inhalation, and make sure that a patient can do properly. Repeated tailored education is also needed to maintain patient and caregivers adherence. Because this education may take long time for a doctor, the cooperation with nurses and pharmacist is desired.

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Environmental intervention is the key components for pediatric asthma management, together with drug treatment and education. For the effective intervention, careful planning of instruction is needed. Planning procedures based on the theory of instructional design are as follows. 1. Setting up instruction and precondition. 2. Setting how to check impact of the environmental factor. 3. Setting which environmental condition should be checked. 4. Setting the goal of the instruction. 5. Setting contents of guidance. 6. Setting evaluation of the instruction. Hospitalization in asthma exacerbation is the best chance for educational intervention, because care givers have enough time. General environmental problems for pediatric asthma such as environmental tobacco smoking or mites in the bedding should take priority over individual problems. For the valid environmental intervention, it is important to keep evaluating the effect of environmental intervention with patient and caregivers as they are able to realize effectiveness and able to keep self-efficacy.

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Patient education for children is possible from 2 to 3 years old. It is required for developing motivation toward their treatment and independence. Interventions considering the characteristics of childhood and using various skills are preferable. The first step is to prepare the child to be educated. Secondly, guide the child to have the image of their condition, and to understand the relationship of that with their everyday management. After confirming the willingness toward treatment, the third step is to teach the specific methods and skills. It is also important to clarify the roles, that the child himself or herself is at the center of the treatment and the caregivers and medical staffs are supporters. Education should be continuous to improve technique and to enforce the motivation for treatment. Solving the barriers to adherence prevents the child from treatment interruption.

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