Acute pancreatitis associated with food allergy is very rare. Here, we report a three-year-old male patient with acute pancreatitis associated with peanut allergy. He had no history of peanut ingestion. Although there was no family history of pancreatic diseases, his elder brother had peanut allergy. He was brought to our hospital owing to pruritus, cough, wheezing, and abdominal pain, which developed about one hour after eating a biscuit with peanuts. We diagnosed him as having anaphylaxis. He was treated by intramuscularly administration of adrenaline after which he rapidly improved. However, his serum total and pancreatic amylase were elevated. A contrast-enhanced CT of the abdomen showed enlargement of the pancreas. Hence, he was diagnosed as having mild acute pancreatitis. Conservative treatment was successful, and his serum levels of pancreatic enzymes normalized within three days. His clinical course and his elevated level of IgE specific to peanut protein (37.1 IU/mL) suggested that his peanut allergy was associated with acute pancreatitis. Although there are only a few pediatric case reports on acute pancreatitis associated with food allergy, we should consider that acute pancreatitis may be involved in patients with food allergy and abdominal pain.

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Background: The management of food allergy in Japan has improved since the Japanese Pediatric Guideline for Food Allergy was published in 2005. However, a recent fatal case of milk allergy has highlighted the need for continued awareness and ongoing improvements in the management of food allergy. Although oral food challenges (OFCs) are essential for the accurate diagnosis of food allergy, the quality and scope of many OFCs are not adequate for patients with or those suspected of suffering from food allergy. Therefore, we aimed to establish an OFC social network to improve food allergy management. Methods: As part of the OFC social network, we developed a user-friendly database using FileMaker database software to manage detailed OFC data. Results: From October 2012 to April 2014, the network has grown to include 12 medical facilities and to provide data from 1,044 OFCs. Conclusion: The continued development of our OFC network with a unified protocol will offer many advantages, including the generation of valuable data from qualified OFCs, the promotion of referral systems, and a platform for participants to share opinions and discuss information about food allergies.

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Background: Although various symptoms are seen in children with hen's egg allergy, there are few reports on the phenotypes of those symptoms. Method: Sixty-five children with hen's egg allergy who showed positive results at oral food challenge tests were enrolled. The symptoms were categorized into 9 groups: 1) skin hives, 2) skin rash, and 3) oral, 4) nasal-ocular, 5) pharyngeal, 6) respiratory, 7) gastrointestinal (GI), 8) neurological, and 9) anaphylactic symptoms. For cluster analysis, Ward's hierarchical clustering method was applied. Results: The patients could be classified into four clusters based on their symptoms: Cluster 1, mainly GI symptoms without hives; Cluster 2, hives with neurological symptoms; Cluster 3, mainly respiratory symptoms; and Cluster 4, anaphylaxis. Cluster 1 could be further subdivided into two groups: Cluster 1-A (GI symptoms alone) and Cluster 1-B (oral symptoms in addition to GI symptoms). Importantly, patients in Cluster 1-A easily acquired tolerance, while those in Cluster 1-B seldom accomplished tolerance. Conclusions: The existence of the clinical phenotype, especially only gastrointestinal symptoms, is noted for patients with hen's egg allergy.

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Background: Neonatal-infantile gastrointestinal allergy is a disorder that causes gastrointestinal symptoms, such as bloody stool and vomiting, after the ingestion of milk formula during early infancy. While a link with the non-immunoglobulin E-mediated allergic reactions has been indicated, the pathogenesis has not been fully elucidated. Case Summary: A male infant weighing 1,740 g was born at 34 weeks 2 days of gestation. A fever and bloody stool developed on the second day of birth after ingesting cow milk-based formula and human breast milk. The symptoms improved quickly within one day by fasting, and no remarkable changes were observed with the ingestion of breast milk only. However, bloody stool reemerged after ingesting of a human milk fortifier at 17th day of birth. The symptoms worsened even after discontinuing the human milk fortifier. After 2 days of fasting, the symptoms disappeared, and an amino acid-based formula resulted in no recurrence of the symptoms. The antigen-specific lymphocyte stimulation test was positive for cow milk antigens and the baby was diagnosed as having neonatal-infantile gastrointestinal allergy. Therefore, the mother tried to avoid dairy products ingestion and the baby gained body weight well without recurrence of the symptoms by ingesting a combination of an amino acid-based formula and breast milk, and discharged on 68th day of birth. Conclusion: Human milk fortifiers, which are often given to preterm infants, contain cow milk antigens and, therefore, may trigger or worsen the symptoms of neonatal-infantile gastrointestinal allergy. This possibility should be taken into consideration when treating neonatal-infantile gastrointestinal disorders.

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Background: There are currently very few birth cohort studies with sensitization data available. Methods: In this study, we followed the infants of our previous birth cohort study; these infants underwent the skin prick test at ages 2 and 3 years. At age 4, we administered a questionnaire and investigated the prevalence of various allergic diseases. Results: One hundred and eighty children were followed from birth until age 4. Of these, 136 had sensitization data at least once after age 1. All children with food allergy (FA) at 4 years had dermatitis during early infancy and were sensitized before 1 year of age. Further, almost all children with atopic dermatitis (AD) without FA were in remission by age 4. Bronchial asthma (BA) at age 4 was associated with daycare attendance, fever, and antibiotics or antipyretic use during infancy, but not with infantile AD or FA, and most children with BA were sensitized to inhalant allergens. Conclusion: Our results suggest that skin sensitization in early infancy may influence the risk of FA at age 4, and infants with AD but without FA may have a good prognosis. Lastly, BA at age 4 was found to be mainly infection-associated and not associated with allergic march, although allergen-induced asthma characteristics were noted.

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Background: The clinical course of childhood atopic dermatitis (AD) is affected by age-related physical and social factors. Childhood AD can be complicated by allergens, bacterial infection, stress, and inadequate treatment with skin care and topical corticosteroids, resulting in deterioration; moreover, some of severe AD cases require hospitalization. Aim: The aim of this study was to analyze the clinical characteristics and complicating factors of childhood AD by age group through the analysis of hospitalized cases. Methods: We retrospectively analyzed 82 cases of severe AD hospitalized in Miyagi Children's Hospital from November, 2003 to November, 2012. Results: Twenty-seven out of the 82 cases (33.0%) were infantile cases, that presented with significantly more electrolyte imbalance and lower protein levels than the older cases. In addition, more of the infantile cases were born in the autumn months, and hospitalized in the winter months, compared with the older cases. In all age groups, the major complicating factors were inadequate skin care, and the prescription and application of topical corticosteroids. Doctors and parents tended to apply corticosteroids less frequently in the infantile cases, and the older cases were often severe because of poor adherence to the prescribed topical therapy. Conclusion: Adequate skin care and application of topical corticosteroids are standard therapies in childhood AD, and these are essential for the prevention of severe childhood AD. Infantile AD should be treated carefully, particularly because they are more severe AD cases in infants than in other age groups.

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Tree nuts are one of the most important causes of food allergy. Many patients develop the allergy during childhood and it is difficult to acquire tolerance. The allergy symptoms are also often very severe. In recent years, the relationship between individual allergens in crude extracts (allergen components) and clinical symptoms have been analyzed. It is also important to understand the correlation of tree nut allergens with clinical symptoms and their cross-reactivity at the component level for future clinical diagnosis and treatment. Here, an overview of the seed storage protein as an important allergen component of tree nuts, their molecular structure and similarities are discussed.

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[in Japanese]

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