Background : The patients with wheat allergy have cross-reactivity to barley. Since barley is served as barley rice and the like in daily life, we often need to decide whether they should avoid barley or not. However, factors predicting true barley allergy in patients with wheat allergy are not well-known.

 Methods : Records of patients who undergone oral food challenge (OFC) with barley were retrospectively analyzed. They had been diagnosed as wheat allergy based on positive wheat OFC or recent history of wheat-induced anaphylaxis and had never taken barley. We sought possible associations between barley OFC outcome and symptoms/signs during wheat OFC, wheat and barley-specific IgE (sIgE).

 Results : Twenty-seven patients (3-15 years old, M/F 19/8) undergone barley OFC and 13 (48%) were positive. We analyzed 23 patients with complete records of wheat OFC and sIgE. Ratio of the total score of anaphylaxis scoring Aichi (ASCA) and cumulative protein dose at wheat OFC, abbreviated as TS/Pro, was significantly higher in patients with positive barley OFC than those with negative OFC. Omega 5 gliadin and wheat sIgE were also significantly higher in positive barley OFC group.

 Conclusions : Higher wheat TS/Pro, which indicates severe wheat allergy, higher sIgE to wheat and omega 5 gliadin may be factors to predict positive barley OFC in patients with wheat allergy.

 Background : Interpretation of sequential changes in food-specific IgE (sIgE) levels remains unclear. The relationship between oral food challenge (OFC) outcome at 12 months and sequential changes in sIgE levels during infancy has not been studied.

 Methods : A retrospective observational study was performed. Twelve-month-old infants with infantile atopic dermatitis who had egg white (EW)- and ovomucoid (OM)-sIgE levels measured at 6 and 12 months and had undergone egg OFC a cumulative dose of 6.5 g of heated whole-egg powder equivalent to 1/2 of a boiled whole egg at 12 months were enrolled, and the relationship between changes in sIgE levels and OFC outcome was analyzed.

 Results : Twenty-nine patients were enrolled. EW-sIgE levels significantly decreased from 6 to 12 months in the OFC-negative group, but not in the OFC-positive group. The decrease in logarithmic transformed values was significantly larger in the OFC-negative group. There was no significant association between the changes in OM-sIgE levels and OFC results, although the OM-sIgE levels at 6 months in the OFC-positive group was significantly higher.

 Conclusions : For infants with atopic dermatitis, changes in EW-sIgE levels during infancy may be useful in predicting egg OFC outcome at 12 months of age.

 Hen egg is the most common food allergen in Japan. However, there are few reports on the outcomes of oral food challenges (OFC) to egg yolk. This study aimed to investigate the safety of an OFC using heated egg yolk. We retrospectively compared the outcomes of administering the OFC in 5 installments every 15 minutes (5-installment method) and 2 installments every 60 minutes (2-installment method) in 11 and 62 patients, respectively. The median age is 4.1 and 2.1 years old respectively. Herein, compared with the 5-installment method, the incidence of anaphylactic reactions was significantly lower in the patients who underwent an OFC using the 2-installment method. According to the multivariate analysis, the 2-installment method reduced the risk of anaphylaxis independently of other factors. We suggest that the 2-installment method of administering an OFC is safer than the 5-installment method.

 Objective : The purpose of this study is to provide an index for the egg-related IgE antibody in order to perform test intake at home with the heated hen’s egg yolks safely.

 Subject and method : In this retrospective study, medical records of 106 patients who underwent oral food challenge (OFC) for heated hen’s egg yolk from December, 2010 to October, 2016 were examined. We analyzed hen’s egg yolk, hen’s egg white, and ovomucoid (OVM) specific IgE levels respectively, and the outcome of the OFC.

 Results : Eighty-six patients were OFC negative and 14 patients were positive. We defined the cut-off value of the IgE level which were considered safe to prosecute test intake at home as ‘safety prognostic value (SPV) ’ where the negative predictive value (NPV) was more than 95%. The SPV and NPV of the entire subjects for hen’s egg yolk, hen’s egg white, and OVM were 1.61 U_A/ml ; 94.6%, 5.62 U_A/ml ; 96.7%, 5.06 U_A/ml ; 95.6%, respectively.

 Conclusion : We were able to obtain SPV for children with egg allergy which could be used as an index to perform test intake at home safely.

 Urticaria is a common disease in daily clinical practices. It may accompany angioedema, which appears as local deep edema of the skin and/or mucosa. Angioedema is either mast cell-mediated or bradykinin-mediated. Hereditary angioedema (HAE) is a subtype of angioedema, mediated by bradykinin, and may develop edema of airway and gastrointestinal tract, as well as those in visible body surface and mucosa. Many cases of HAE takes time for diagnosis. A survey performed in Japan in 2014 revealed that the average time from onset to diagnosis of HAE was 13.8 years. Recently, several new medications have been licensed or in process for license for urticaria and HAE, respectively. The former includes antihistamines and anti-IgE antibody, and the latter includes bradykinin-targeting drugs. In addition, organizations of HAE patients have launched and are actively collaborating with physicians. Thus, the environments of urticaria and angioedema are rapidly developing.

 Two kinds of biologics, anti-IgE and anti-IL-5 antibodies, are now used for treatment of both child and adult severe asthma. Anti-IgE antibody omalizumab was introduced into Japan in 2009 for adult asthma, and has been used in more than 4,000 patients so far. This antibody was recently approved also for children with≧6 years old by PMDA (Pharmaceutical and Medical Devices Agency) of Japan. Anti-IL-5 antibody mepolizumab was introduced in 2016 for eosinophilic asthma of≧12 years old subjects. So far internists generally have longer and more abundant experiences of usage of these biologics. I hope that the internists’ experience on biologics use might be helpful for pediatric allergists taking care of children with severe asthma.

 Nutrition and dietary management, as described in Chapter 8 of the 2016 Japanese Pediatric Guidelines for Food Allergy, is key to effective long-term control of food allergies. Clinicians should be aware of the minimal elimination diet, safety assurances, nutrition assessments, and quality of life maintenance, for patients and their families. Parents benefit from explicit instruction on strategies for avoiding accidental ingestion of potential allergens, including information regarding new labeling rules. Nutritional evaluations are recommended for preventing iatrogenic malnutrition. Dietary guidance assists patients and families in their efforts to avoid allergens, and enhances understanding of food challenge test results.

 The Japanese Pediatric Guideline for Food Allergy 2016 (JPGFA 2016) define oral immunotherapy (OIT) as a treatment for patients (1) who do not expect to acquire tolerance to foods in the near future, (2) for whom the threshold dose that induces allergic symptoms was determined by oral food challenge testing prior to OIT, and (3) who underwent OIT under physician supervision. Considering recent clinical trial results and the current situation in Japan, the JPGFA 2016 committee does not recommend OIT as a standard treatment for food allergies. Patient selection for OIT is clearly described ; OIT should be conducted only under the direction of physician specialists who are familiar with food allergies, and only in settings where emergency treatments for potential adverse reactions are available. The decision to undergo OIT should be carefully considered. Physicians must obtain informed consent from the patient, or his or her guardian, after ethics committee approval.

 Elicited symptoms caused by food allergies are evaluated for their severity for each organ, and we are required to treat them based on severity. The Japanese Pediatric Guideline for Food Allergy 2016 uses severity assessment as part of the Japanese anaphylaxis guidelines. Symptoms related to each organ (skin/mucosa, respiratory system, digestive system, nerves, circulatory system) are classified as grade-1 (mild), grade-2 (moderate), and grade-3 (severe). An intramuscular injection of adrenaline is indicated in cases with grade-3 symptoms and should be considered in some cases of grade-2 symptoms. Adrenaline is the first-line treatment option for anaphylaxis. There is no evidence as to the effect of histamine H₁ receptor antagonists and corticosteroids on anaphylaxis. The package inserts included with adrenaline injections in Japan state that their concomitant use with antipsychotic drugs with an alpha-blocking effect are contraindicated. However, if anaphylaxis develops in a patient who is being treated with the antipsychotic drugs mentioned above, the use of adrenaline is considered acceptable at the discretion of the physician.