Background : The oral food challenge (OFC) can induce the life-threatening anaphylaxis. We should predict a high risk patient for developing severe reactions. Objectives : To identify the risk factors for severe reactions in a low-dose OFC in cow’s milk. Methods : We studied milk allergy patients who underwent a low-dose (less than 5 ml) OFC with cow’s milk from 2011 to 2016. The moderate and severe group was defined as Grade≧2, while the negative and mild group was defined as Grade≦1 according to the classification of the anaphylaxis guideline. We collected the clinical variables (age, cumulative elicit dose, history of bronchial asthma and atopic dermatitis, sensitization for multi allergen, a history of anaphylaxis in cow’s milk and symptoms other than skin, family history of bronchial asthma and period from the onset of anaphylaxis to the OFC) and laboratory data (milk-specific IgE and total IgE) of the patients from their medical records and compared them between two groups. Results : A history of anaphylaxis in cow’s milk, history of bronchial asthma and family history of bronchial asthma were risk factors for inclusion in the moderate and severe group. Conclusion : We should pay attention to the infants with a history of anaphylaxis in cow’s milk, history of bronchial asthma or family history of bronchial asthma before performing a low-dose OFC in cow’s milk.

 Oita Prefecture established an expert committee on allergies consisting of members from the prefectural medical association, prefectural pediatric association, prefectural pharmaceutical association, prefectural dietetic association, faculty of medicine, faculty of food and nutrition, school commissioned physicians, the prefectural board of education, nursing teacher group, and prefectural welfare and health administration as a subsidiary of the Oita Prefecture Regional Health Council chaired by the prefectural governor. A survey on the actual situation of school lunches and training of the management staff in public and private nursery schools, kindergartens, elementary schools, junior high schools, high schools, and special support schools was conducted, from which issues were obtained. General Guidelines for Management of Food Allergy was established for schools, kindergartens, and nursery schools within the prefecture, based on the survey findings such as diagnosis, providing non-allergic food and responding to anaphylaxis. In prefectures having few pediatric allergic specialists and pediatric allergic educators, measures initiated in cooperation with the prefectural welfare and health administration, prefectural medical association, and prefectural board of education will be requiring.

 Aims : The present study aimed to examine the characteristics of pediatric admissions to hospitals in Kochi prefecture for asthma exacerbation, and to determine which viral infections are most commonly responsible for such admissions at Kochi Medical School Hospital.

 Methods : We retrospectively studied children with asthma who were hospitalized during 2005, and from 2010 through 2015. Five major pediatric institutions in Kochi prefecture reported monthly numbers of hospitalized patients, sex, age, detected viruses, ICU admissions, and mechanical ventilations required to treat acute asthma exacerbation.

 Results : The total numbers of hospitalizations for asthma have gradually decreased. The numbers of these events increased to twice as much in September and October 2015 compared to the same months in 2014. At Kochi Medical School Hospital, human rhinovirus was detected mostly from 2012 through 2015.

 Conclusion : Surveillance of infectious diseases and asthma is needed to prevent severe asthma exacerbation.

 Objective : The present study aimed to evaluate the effectiveness of a training program on initial action to anaphylaxis for nursery school employees.

 Methods : We developed and implemented a training program on initial actions against anaphylaxis aimed at compensating for a perceived knowledge deficit and reducing anxiety and lack of confidence among nursery school employees. A questionnaire survey was administered to nursery school employees who participated in the training program at pre-training, post-training, and 6 months post-training. Effectiveness of the program was evaluated using Kirkpatrick’s Four Levels of Training Evaluation Model.

 Results : 155 participants completed the questionnaire. The level of hesitancy among nursery school employees in anaphylactic emergency action decreased significantly at post-training and 6 months post-training compared with pre-training. Understandings of 13 symptoms for which EpiPen^® use is recommended improved significantly, although this was not the case for the symptom “difficulty breathing”. After simulation training, specific areas for improvement in the nursery schools’ emergency action plans were identified. These improvements were actually implemented by 6 months post-training.

 Conclusions : The training program, which included simulation training, improved and maintained the levels of knowledge and technique among nursery school employees and promoted improvements in the emergency action plan.

 The Japanese government advances the policy of allergic diseases based on the Allergy Disease Control Act and the basic guideline, which were formulated in 2014 and 2017, respectively. The basic guideline indicates specific policies from a variety of perspectives. The Ministry of Health, Labour and Welfare promotes those policies in cooperation with other ministries and agencies to create a safe, secure and comfortable society for patients with allergic diseases. Medical services contributing to the equalization of medical care have been established prefecture-wide in Japan. We prepare to build a homepage for providing the precise information of allergy and for explaining the 10-year strategy for allergy research.

 Allergens bind to the allergen-specific IgE in allergic patients and induce allergic inflammation. Recently, there have been many reports about the effects of house dust mite allergen components on airway epithelial cells, keratinocytes and various immune cells.

 Der 1 is a cysteine protease and found in large amounts in faecal pellets. Der 1 may act as a Th2 adjuvant through its proteolytic activities. Der 1 may cause barrier dysfunction and induce IL-33, which is a damage-associated molecular pattern. Der 1 may also stimulate epithelial cells and inflammatory cells, including basophils and eosinophils.

 Der 2 shows structural homology with MD-2, which is an LPS-binding component of the TLR4 signaling complex. Therefore, Der 2 may bind to TLR4 together with LPS and induce innate immune responses.

 Der 3, 6 and 9 are serine proteases, which can enhance the production of a variety of cytokines and chemokines from airway epithelial cells, keratinocytes and dendritic cells via protease-activated receptor-2.

 The possible roles of some other house dust mite allergen components in allergic inflammation are also described briefly.

 The Japanese Pediatric Guideline for the treatment and management of asthma (JPGL) 2017 is the first JPGL according to the methods for making guideline proposed by the Medical Information Network Distribution Service (Minds). In Chapter 1, additional documents on the items and composition to be included in the clinical practice guidelines were posted. Firstly, we clarified the purpose of creating guidelines and showed the processes for revisions and the organizing committee (three-layer structure). Clinical question (CQ) was set from important clinical tasks on “long-term management” and “acute exacerbation” and the recommendations and their commentary were described. In the chapter that describes items other than treatment, consensus statement was adopted. Next, as a basic policy of development of guideline, we aimed for clinical practice guidelines with high transparency considering conflict of interest. In the preparation process, the method of systematic review and the decision method of recommended grade are described. After that, the major revised points from JPGL 2012 are indicated in bulleted form. Finally, future challenges are mentioned after the release of JPGL2017. At the end of the chapter, CQ, recommendations and commentary were posted.

 Japanese pediatric guidelines for the treatment and management of bronchial asthma were revised in 2017. This guideline has partially revised the section of pathology, the evaluation of asthma severity and treatment steps. The sections on definition, pathophysiology and diagnosis of childhood asthma are revised according to recent reports. Key words are airway inflammation, bronchial hyperresponsiveness and remodeling. Also, the sections on asthma severity and treatment steps are revised for choice and administration of drugs in the long-term management of childhood asthma. When the treatment is stepped down or stepped up, the understanding of “control level” is important. On the other hand, when the long-term management and education of patients are advanced, the understanding of “true severity” is important. It is recommended to carry out objective evaluations suitable for the disease condition in individual patients in a timely manner and to promote long-term treatment and guidance based on this result.

 In Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2017, the data on the prevalence, progress and comorbidities of asthma were updated from JPGL 2012 with additional data on the mortality, admission and control of asthma.

 Recent large epidemiologic studies have shown that the prevalence of asthma is not increasing in Japan, which is similar to what is found in other countries with high prevalence. Since JPGL 2000 has been published, the mortality and admission of childhood asthma is dramatically decreasing. However, results from epidemiological studies present issues concerning the treatment for younger children with wheezing symptoms.

 Asthma is caused by individual factors and environmental factors. Revealing the risk factors involved in the occurrence and exasperation of asthma in individual patients and taking action against these factors is central to the prevention of the disease.

 Individual factors and environmental factors associated with the occurrence of asthma vary depending on individual patients. Individual factors involved in the occurrence of asthma include gender, allergic diathesis, airway hyperresponsiveness, low body weight and obesity at birth, and genetic factors, while environmental factors include allergen exposure, virus/bacterial infection in the respiratory apparatus, and indoor air/air pollutants. One recommended prevention for the occurrence of asthma is to avoid tobacco smoke during pregnancy and after delivery. In addition, palivizumab has been reported to prevent recurrent wheezing in premature infants.

 Rectifying the environmental factors related to the exacerbation of asthma, along with medication therapy and patient education, are the main pillars for the treatment and management of asthma. It is recommended to avoid exposure to inhaled allergens and nonspecific factors (tobacco smoke, indoor air/air pollutants), including indoor dust and mites.

 The number of asthma death that had been reported to the Japanese childhood asthma death committee from 1989 to October 2017 was 252, including 6 cases that had been newly registered since the last report in 2014. Two hundred and nineteen cases after excluding inappropriate cases were analyzed in this report. Male/female ratio was 136/83 (1.6/1). Peak of death was observed at the age of 0-3 years and 12-16 years. Regarding the distribution by prefecture, Tokyo was the highest (24 cases), followed by Aichi (16 cases), Fukuoka (15 cases). Regarding phenotype and seasonality, atopic (47%) and perennial (38%) type were the highest, respectively. Proportion of severity during the year before death was as follows ; 26% severe, 18% moderate, 18% mild, 38% unknown or unwritten. The rate of unknown or unwritten cases was higher (53%) since 2000, compared to that until 1999 (34%). Proportion of frequency of admission during a year before death was as follows ; 37% zero, 15% once, 5% twice, 14% three times or more, 29% unknown or unwritten. The most frequent situation at admission was dead on arrival (58.2%). The most frequent cause of death was asphyxia (59.6%).