Background : Relationship between symptoms and the results in histamine release test (HRT) was analyzed in patients with immediate food allergy (FA).

 Methods : Eighty-eight patients with egg allergy (EA) presenting skin, respiratory or gastrointestinal (GI) symptoms at an oral food challenge test were enrolled. Peripheral blood basophils were stimulated by ovomucoid (OM) in the procedure of HRT, and the results were expressed as percentage of released histamine (%HR).

 Results : %HR was not affected by skin or respiratory symptoms. In contrast, %HR was significantly higher in patients with GI symptoms (GI (+)) than in those patients without GI symptoms (GI (−)) (median, 37.9% vs. 18.8%, p<0.01). In addition, the median age in GI (+) was found to be significantly higher than that in GI (−) (median, 5.0 vs. 2.2 years, p<0.001). Although there were no correlations between %HR and age, the ratio of patients older than 3 years was significantly higher in GI (+) than in GI (−) (64% vs. 19%, p<0.001).

 Conclusion : The results of this study suggest that development of GI symptoms in immediate FA patients is regulated in a different manner from other symptoms.

 Objective : We aimed to retrospectively determine the outcomes of slow stepwise resolution for children who are allergic to hen’s egg, milk, or wheat. Methods : We enrolled 359 children who were allergic to hen’s eggs (n=229), milk (n=76), and wheat (n=54), who had attempted the 1 g oral food challenge (OFC) with known results. Those who passed the challenge underwent a subsequent home challenge with a fixed dose, which was increased on an outpatient basis every two months until they achieved the goal dose. Multiple logistic regression analysis was performed to determine associated factors of the results. Results : Among symptoms induced in 64 (17.8%) children by 1 g or less of the allergen, 31 (8.6%) were severe. Among 249 children who passed the 1 g OFC, 224 (90.0%) reached the goal dose during the subsequent resolution protocol. Severe symptoms within the 1 g challenge was associated with age (4 years or more), food-specifc IgE (class 4 or more), component-specific IgE (class 3 or more), total IgE (less than 1,000 IU/ml). Reaching the goal dose was negatively associated with age and total IgE, while positively associated with complete elimination before the challenge. Conclusion : Further study is needed for safer and more effective resolution by risk stratification of children based on associated factors.

 A 10-year-old girl had several vomiting episodes 2 hours after eating corbicula. She tested weak positive for the short-neck clam-specific IgE. The skin prick test of corbicula was also negative. An allergen-specific lymphocyte stimulation test (ALST) by both the body and the broth of corbicula was positive. In particular, ALST by the broth in her serum showed a stronger response than that of healthy control. An oral challenge test with the corbicula soup induced vomiting 5 hours after ingestion. She was diagnosed with non-IgE mediated gastrointestinal food allergy due to corbicula. Removal of the shellfish was continued. She tested ALST after one year, and it remained positive. Oral challenge tests with body of corbicula and short-neck clam was negative, while broth of them induced vomiting 5 hours after ingestion. These suggest that common water-soluble antigen between corbicula and short-neck clam might be an inducer in patients with non-IgE mediated gastrointestinal food allergy.

 Purpose : This study aimed to assess the safety of stepwise oral food challenge (OFC) with cooked eggs. Subjects and Methods : A retrospective analysis was conducted on OFC results, participants’ food allergy history, and laboratory test values in participants who underwent OFC with cooked eggs at Miyagi Children’s hospital between September 2012 and April 2017. The total food dose classifications were as follows : step 1, 1 g hard-boiled egg white ; step 2, 10 g hard-boiled egg white ; step 3, 1 whole hard-boiled egg ; and step 4, one scrambled egg. Results : Of a total of 1917 participants, 1904 had no missing data and were included in the analysis. OFC-positive rates were 10%, 16%, 9%, and 13% for steps 1, 2, 3, and 4, respectively. Of the 225 OFC-positive participants, two required an intramuscular adrenaline injection. Optimal cut-off values and negative predictive values (shown in parentheses) for the ovomucoid-specific IgE antibody titer (OM-sIgE), at which the negative predictive value was≥90%, were 8.68 (96.4%), 3.24 (92.2%), 2.58 (96.0%), and 0.94 U_A/ml (95.7%) for steps 1, 2, 3, and 4, respectively. Conclusions : The present study established the safety of stepwise OFC. Results suggest that the use of an optimum cut-off value for OM-sIgE further increases the safety of the test.

 Surveys of 1,308 pediatric asthma patients aged 4-15 years old in 89 outpatient clinics in 2008 and 1,044 such patients in 63 outpatient clinics in 2012 using the Japanese Pediatric Asthma Control Program (JPAC) in the Hiroshima area were performed, and JPAC scores were compared between 2008 and 2012, while the associations were studied between JPAC scores and patient background factors such as age and types of consultation facilities, between scores and prescribed long-term management drugs (controller), and between scores and treatment steps. JPAC scores of patients in 2012 were higher than those in 2008 (p<0.001). In all patients, those treated in clinics or hospitals where allergic disorder specialist doctors worked were associated with JPAC scores of 15, and patients treated with inhaled fluticasone-salmeterol were associated with JPAC scores below 14, whereas, in patients treated with step 1 therapy (almost half of the patients were treated with this therapy step), those treated in 2012 were associated with JPAC scores of 15, based on logistic regression analysis. These results suggest that increases of the JPAC scores in 2012 compared with those in 2008 might not have been related to the selection of potent anti-asthma drugs, but to the selection of effective treatment steps.

 With the rising awareness of non-IgE mediated gastrointestinal food allergy in Japan and the rapidly increasing number of patients with eosinophilic esophagitis (EoE) in Western countries, the term “gastrointestinal allergy” has been often used in the field of pediatric medicine, especially in terms of providing care for neonates and infants. Recently, non-IgE-GIFA has been considered as an eosinophilic gastrointestinal disorders (EGID)-related disease in Japan. Besides, with reports of the onset of EGIDs during oral immunotherapy for food allergy and the increasing number of Japanese adult EoE, EGIDs have attracted attention in clinical practice of allergy. Another interesting aspect in eosinophil biology is that the gastrointestinal tract, except for the esophagus, exclusively contains detectable eosinophils even in physiological conditions. This review aims to present information concerning physiological and pathological gastrointestinal eosinophils and the related disorders such as EGIDs and non-IgE-GIFA.

 Objective evaluation is important in diagnosis and treatment of asthma. In the previous version of the Japanese Pediatric Asthma Guideline (JPGL), lung function tests were mainly covered. In the new JPGL2017, the chapter has been comprehensively updated to cover broader area including markers for Th2-deviated immune reactions (IgE, allergen specific IgE, blood eosinophil count and skin prick test), lung function, bronchial hyperresponsiveness and airway inflammation (exhaled nitric oxide and sputum test). Emerging biomarkers such as forced oscillation technique and periostin are also described. Blood gas and SpO₂ tests have been moved to the chapter of management of acute exacerbation.

 Spirometry is the most important test in evaluation of asthma and is explained in detail with special emphasis on testing methods for young children.

 Chapter 6 of JPGL2017 was “Education for patients, and instruction of inhalation”. Chapter 6 made Chapter 10 and Chapter 12 of JPGL2012 one chapter. We brought Chapter 6 before the chapter of treatment, in consideration of importance of education for patients and instruction of inhalation in asthma treatment.

 Even if the physician gives appropriate prescription and the instructions of the treatment of the asthma, if patient does not perform it, the effect is not obtained as good expected. So, the education for patients have very important role of asthma treatment. If physician established the partnership with the patients and the family, they obtain good adherence.

 We described a concrete guidance of instruction of inhalation, so that many medical staffs can use it.

 In this report, we comment on a summary of revision points of Chapter 6 about education for patients and instruction of inhalation.

 The goal of long-term management of pediatric asthma in JPGL 2017 is controlling symptoms, restoring and/or maintaining normal respiratory functions, and maintaining a good quality of life (QOL), though the ultimate one is complete remission or cure. In addition to medication, important factors to achieve this goal are reducing environmental risk factors, and improving patient education and partnership with patients and guardians. The long-term management plan should be based on cycles of “evaluation”, “adjustment” and “treatment”. In JPGL 2017, systematic reviews based on clinical questions were performed and a long-term management plan and treatment drugs are determined based on the latest evidence. The basic treatment of long-term management is anti-inflammatory drugs against airway inflammation, which include inhaled corticosteroids and leukotriene receptor antagonists. Long-acting β₂ stimulants (oral or patch) are included a short-term additional treatment plan, a new concept of treatment in JPGL 2017, which is applied when asthma controls transiently worsen and promptly discontinued when improved. Severe asthma is defined when good control cannot be obtained even with basic treatments of step 4.