Background: Generally, children who are allergic to cow's milk can consume lactose. Some people however, suggest that both cow's milk and lactose should be completely eliminated. Methods: We retrospectively analyzed the results of 42 oral food challenges (OFC) on lactose, performed at Sagamihara National Hospital between 2007 and 2013. The total dose was 3g of lactose. When the objective symptoms appeared to be strong, the results of the OFC were considered positive, and when objective symptoms or subjective symptoms appeared to be mild, the results were considered uncertain. In all other situations, the OFC result was considered negative. Results: In total, 19 patients had anaphylaxis to cow's milk. Their median age was 53 months. The OFC result was positive in 2 patients (5%), of whom one had vomited twice and the other had urticaria. The others could freely consume lactose. Conclusions: The lactose OFCs were performed safely without severe symptoms. Therefore it is important to confirm that children with cow's milk allergy can consume lactose.

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Objective: We carried out a prospective study of immediate food allergies at an after-hours urgent-care clinic. Patients and Methods: We compared 49 patients who developed immediate food allergy in fiscal year 2014 and were examined at Sagamihara Chuo Medical Center, an after-hours urgent-care clinic open at weekends and national holidays and at night, with 29 patients who were surveyed at Sagamihara Hospital over almost the same period. Results: The median age at examination was 2.0 years and 4.9 years, respectively, with those examined at the urgent-care clinic being significantly younger (p=0.047). At the urgent-care clinic, the foodstuff that caused the immediate symptoms was chicken egg in 31% of cases, milk in 16%, and peanuts in 14%, whereas at the hospital it was milk in 24% of cases, chicken egg in 21%, and wheat in 21%. This was the first appearance of symptoms in 74% of the patients seen in the urgent-care clinic, significantly higher than the 21% of patients for whom this was the case at the hospital (p<0.001). Anaphylactic reactions were present in 18% of patients who attended the urgent-care clinic, a significantly lower proportion than the 52% of those who attended the hospital (p=0.005). Treatment comprised intravenous infusion or intramuscular injection of antihistamine in 2% and 59% of patients, respectively, and intravenous steroids in 0% and 52%, respectively, with the rates of both being significantly lower at the urgent-care clinic (p<0.001). Intramuscular injection of adrenaline was administered to 6% and 7% of patients, respectively, and there was no difference. Conclusion: The urgent-care clinic saw significantly more patients with mild symptoms compared with the hospital, but as it was also presented with a certain number of severe cases, caution is still required.

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Background and Purpose: The aim of this study was to determine the clinical safety of inactivated influenza vaccine (IIV) with respect to hen's egg allergy (HEA). Methods and Subjects: The subjects were children <3 years of age who received injection of single dose IIV (0.25ml) in the 2013/14 and 2014/15 seasons. Adverse events at 30 min and 1 week after administration were recorded. Subjects who had not ingested hen's egg were used as the no-intake group. HEA subjects were divided into complete and partial elimination groups. Non-HEA subjects were used as the normal group. The primary outcome was adverse events of serious systemic symptoms after IIV. Results: One hundred ninety-one subjects were recruited in our study, including seven subjects with hen's egg anaphylaxis. There were no serious systemic symptoms observed in any group. Local and systemic events were observed in 10-20% of subjects (all were minor adverse events), with no differences among three groups. The median (range) of egg white- and ovomucoid-specific IgE (kU_A/l) in the complete elimination group versus the partial elimination group was 5 (1-63) versus 7 (0.4-60) and 1 (0.2-22) versus 1 (0.1-20), respectively, with no association between adverse events. Conclusions: Our data suggest that injection of IIV in children with HEA is safe.

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Background: There are a limited number of reports on the comparison of the change in the prevalence of child food allergies (FA) and the responsible foods. Purpose: The aim of this study was to evaluate the changes over a 21-year period in the prevalence of FA and the responsible foods. Methods: We compared and examined the questionnaire results in 1993 (n=9,143) and 2014 (n=6,479) from students in all elementary/junior high schools of Gamagori City Aichi prefecture. Results: The questionnaire results indicated that while a similar number of children had FA in both years (4.9%, p=0.48), the percentages of children receiving elimination diets in school had increased (p<0.001). The most responsible food for FA in our city was fruits in 2014. Although most of the cases exhibited mild symptoms, 1.3% indicated anaphylaxis. The responsible fruits in many cases were melon, watermelon and kiwi, and the prevalence was increased as a grade. Approximately 90% of the fruit allergies children had also complicated with a pollen allergy, and 60% of the children exhibited certain symptoms with multiple kinds of fruits. Conclusions: The prevalence of FA in our city did not change during the previous 21 years, however, the number of children receiving elimination diets in school has increased; in particular, the prevalence of fruit allergies has significantly increased.

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The patient was a 14-year-old girl with histories of atopic dermatitis, food allergy to buckwheat, and pollinosis. In her sixth year of primary school, she developed pharyngeal discomfort after she ate nut covered chocolate. This time she ate a cookie containing macadamia nut powder and then developed pharyngeal discomfort, followed by generalized skin flush with itching, dyspnea, headache, abdominal pain, and hypotension. She was emergently transferred to our hospital and treated with intramuscular adrenaline injection as anaphylactic shock, and then recovered. Skin prick tests were positive. Macadamia nut specific IgE (ImmunoCAP^® f345) which was examined later as a research item was 15.1U_A/mL (class 3). While she had a history of pollinosis from early childhood and an episode of pharyngeal discomfort after eating of nuts, this time she raised pharyngeal discomfort followed by systemic symptoms after eating of cookies containing macadamia nut. Therefore her symptoms were considered as anaphylactic shock caused by oral allergy syndrome (OAS) due to macadamia nut. Since OAS due to macadamia nut may lead to anaphylactic shock, rapid and reliable diagnostic methods of macadamia nut allergy possible in the common hospitals are needed to be urgently established.

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Purpose: This study aimed to evaluate the dietary habit in children after the discontinuation of elimination diets due to the previous hen's egg or cow's milk allergies. Methods: A surveillance questionnaire study was performed during May to December 2013, which included children who were previously allergic to hen's egg (n=16), cow's milk (n=1) or both (n=21) and their caregivers, after the discontinuation of their elimination diets. Among the respondents, 21 caregivers participated in a mobile telephone survey to assess the children's food record for 3 days, which included a photographic observation. Results: The burden for the parents was decreased in their daily meals at home, eating out and food shopping. However, they still reported feeling anxiety due to the occurrence of allergic symptoms when their children eat a lot, or when they eat eggs cooked at a low temperature. The mobile telephone-based dietary assessment revealed that more than half of the children ate less than a half an egg or 100ml of milk. The calcium intake in the children who were previously allergic to cow's milk remained inadequate. Conclusion: This study revealed a situation that complete release from food allergy was hard to obtain for most of the allergic children, probably due to their previous lifestyle without the allergenic food and the anxiety of their parents.

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Background: Many infants are sensitized to chicken eggs before the introduction of complementary food. However, the route of sensitization to chicken eggs remains unclear. Objective: To investigate the mechanism of sensitization to chicken eggs in infants. Methods: This birth cohort study included 131 unselected infants who underwent physical examination and the skin prick test every 3 months until 1 year of age. Parents completed a questionnaire at each visit, and maternal consumption of chicken eggs during the previous month was reported at 0, 1, and 6 months after delivery. Results: Of 131 infants, 33 (25%) were sensitized to egg white at 6 months. The sensitization rate increased with an increase in maternal egg consumption, whereas the rate was substantially lower when the mother had consumed a larger amount during late pregnancy or at 1 month. Comparison of infants of mothers with similar egg consumption levels revealed a higher incidence of sensitization or food allergy (FA) in infants who consumed more breast milk. Conclusion: Maternal egg consumption may modulate the sensitization status depending on the timing or amount of eggs consumed. Oral tolerance could be influenced by maternal consumption only until early infancy. Egg-white antigen in breast milk had a stronger association with sensitization or FA development than environmental antigens.

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In pediatric allergy and immunology clinic, we occasionally have an opportunity to see patients with chronic intractable urticaria or recurrent angioedema. It is known that these symptoms are caused by various kinds of diseases, among which hereditary diseases should be kept in mind. In this paper, cryopyrin-associated periodic syndrome, phospholipase Cγ2-associated antibody deficiency and immune dysregulation, and NLRC4-associated periodic syndrome are reviewed as a cause of chronic intractable urticarial rash and hereditary angioedema as a cause of angioedema. Although the prevalence of these diseases is not high, pediatric allergists and immunologists should understand the clinical pictures of these diseases not to miss the diagnosis of them because earlier diagnosis will give patients a better quality of life, sometimes preventive measures for fatal attacks. In addition, it should be remembered that patients with hereditary diseases might not have another family member with a similar clinical phenotype since they could be caused by de novo mutations.

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[in Japanese]

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The childhood asthma death reported to the committee until October in 2013 were reviewed on 215 patients from 0 to 34 years of age, who had died from 1989 to 2013. The number of annual asthma death has decreased since 1998. Sex ratio (male to female) was 134 to 81. The older the asthmatic children became, the number of asthma death at school environment was concerned. The frequency of asthma severity during the past year before asthma death were severe, moderate and mild, 43%, 29% and 28% respectively. The proportion of those who severity of one year prior to death was unknown or blank ones before 1997 was 36.9 percent since 1998 had increased to 46.2 percent. Childhood asthma mortality, particularly since 2004, remained at 1-3 person/year, is considered to be decreased. It is considered that dissemination of guidelines are related largely to this decrease. Asthma death was higher in younger children. It still sufficient diagnosis and treatment is not performed at a low age, understanding of the family and the surrounding persons illness is likely to be inadequate. Sufficient diagnosis and treatment is difficult to be performed at a low age. And understanding of the family of asthma might be inadequate.

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