Background : The recognition of the Japanese pediatric guideline (JPGL) for the treatment and management of asthma and the propriety of its revised points in JPGL2017 among pediatricians remains unclear.

 Methods : A questionnaire survey on the recognition and content of JPGL was administered to pediatricians who participated in the 121st Annual Meeting of the Japan Pediatric Society held in April 2018 (Fukuoka, Japan).

 Results : The number of questionnaire responses was 366 ; 32% of them were members of the Japanese Society of Pediatric Allergy and Clinical Immunology. About 93% of the respondents answered that they had read the JPGL, and 89% recognized JPGL2017. Regarding the clinical questions introduced in JPGL2017, 93% answered that they were suitable for daily clinical practice. The following revised points in JPGL2017 were considered appropriate : 88% reported the “changed long-acting β₂ stimulant (oral/tape) to short-term additional treatment,” 85% reported that “the dose of β₂ inhaled stimulant was made similar for infants and children,” 89% reported the “diagnosis of preschool childhood asthma,” and 86% reported the “diagnostic treatment method for preschool childhood asthma.”

 Conclusion : We confirmed that JPGL is widely recognized, and that revised version of JPGL2017 has a certain understanding.

 Objective : We investigated the clinical utility of analyzing Jug r 1-specific IgE antibodies in diagnosis of walnut allergy.

 Methods : Participants with suspected walnut allergy based on a positive walnut extract-specific IgE test were enrolled from 8 facilities. Specific IgE to walnut extract, Jug r 1 and Jug r 3 were tested using ImmunoCAP. We analyzed diagnostic value of these tests using Receiver operating characteristic (ROC) analysis.

 Results : Of 144 patients (median age 6 years) 98 were regarded as walnut allergy and 46 were regarded as non-walnut allergy. The specific IgE levels to walnut extract and Jug r 1 showed significantly higher in allergic group than tolerant group. ROC analysis showed area under the curve values for specific IgE to Jug r 1, walnut extract and Jug r 3 of 0.858, 0.787 and 0.284, respectively. A positive predictive value of 95% for Jug r 1-specific IgE was obtained at 0.98 U_A/mL. The corresponding sensitivity was 78.6% and the specificity was 91.3%.

 Conclusion : Jug r 1-specific IgE testing is a valuable marker for diagnosis of walnut allergy in patients suspected walnut allergy.

 Purpose : The study evaluated the tolerance of patients with mild hen's egg allergy to increased consumption of egg white (EW).

 Methods : The clinical characteristics of patients who passed an oral food challenge (OFC) with 10 g of heated EW were retrospectively evaluated. Patients underwent gradually increasing consumption of heated EW at home or next OFC with heated whole egg. The consumption of heated EW and allergy symptoms were evaluated within 1 year after the OFC.

 Results : A total of 133 patients were included and stratified by presence or absence of the next OFC with heated whole egg within 1 year, and whether or not they could perform gradually increasing consumption at home. The proportion of patients who could eat heated whole egg within 1 year were 84% in Group A (increased consumption＋/next OFC within 1 year＋), B (＋/−) 48%, C (−/＋) 81%, and D (−/−) 0%. The proportions of patients in the four groups with allergic reactions at home were not significantly different.

 Conclusion : Gradual increase in consumption of EW at home may be acceptably effective and safe in patients with mild egg allergy.

 Background : House dust mite sublingual immunotherapy (HDM SLIT) tablet (Actair^®) for adolescent allergic rhinitis in Japan has been rarely studied.

 Methods : A retrospective observational study of 75 subjects aged 12 to 18 years was conducted using a clinical questionnaire.

 From the result of 57 subjects who got the answer of the questionnaire, those who answered ‘very good’ and ‘good’ to the question about symptom improvement were categorized as improvement group, and others were categorized as non-improvement group.

 Results : The improvement group was 66.7%. The presence or absence of adverse drug reactions during the first 4 weeks did not affect the efficacy.

 In the comparison between the improvement group and the non-improvement group, the significant difference was confirmed in both groups in 2 items of ‘duration of treatment continuation’, and ‘medication adherence’. There were 6 subjects who discontinued the treatment due to worsening of symptoms.

 Discussion : It was shown that the efficacy could be expected, if the administration can be habituated, even if the adverse drug reactions appeared after the HDM SLIT tablet initiation. It was important to continue first, and it was proven that the symptom improvement rate rose by continuation of HDM SLIT tablet administration.

 Background : We aimed to assess the characteristics of specific IgE for milk allergen components in patients with non-IgE-mediated, milk-related gastrointestinal food allergy having positive milk-specific IgE.

 Methods : We retrospectively assessed clinical courses as well as milk- and casein-specific IgEs and their ratio in patients diagnosed with non-IgE-mediated, milk-related gastrointestinal food allergy between 2010 and 2017 ; these parameters were compared with those in patients with IgE-mediated milk allergy. Furthermore, the correlation between milk-specific IgE and milk allergen component—specific IgE was assessed.

 Results : Five patients were examined in this study. The median maximum milk- and casein-specific IgE levels were 70.5 U_A/mL and 1.5 U_A/mL (the median of casein-specific IgE/milk-specific IgE ratio, 0.04), respectively. Casein-specific IgE and casein-specific IgE/milk-specific IgE ratio in these patients were significantly lower than those in age-matched patients with IgE-mediated milk allergy. Notably, α-lactalubumin—specific IgE among milk allergen components was most strongly correlated with milk-specific IgE.

 Conclusion : The trend of specific IgE for milk allergen components differs between patients with non-IgE-mediated, milk-related gastrointestinal food allergy having positive milk-specific IgE and patients with IgE-mediated milk allergy.

 Background : In the management of food allergy, minimum necessary elimination of diet based on oral food challenge (OFC) is recommended.

 Objective : To investigate safety and utility of OFC for infants

 Methods : Retrospective analysis of OFCs performed for infants at Mie National Hospital from 2016 to 2018

 Results : A total of 173 OFCs in 129 infants were analyzed. Tested foods were hen's egg (n＝100), milk (n＝38) and wheat (n＝35). The challenge dose was individually determined based not only on specific IgE levels but history and other factors. The OFC was positive in 18%, 32%, 26% for hen's egg, milk and wheat, respectively. Induced symptoms with Anaphylaxis Scoring Aichi≧15 points were observed in 8% (13/173), and 40 to less than 60 points were observed in 2% (3/173). No patients required intramuscular adrenaline. After OFC, the caregivers were instructed to give infants a safe amount of allergen food or continue elimination on diet based on the OFC results. Consequently, 99 of 141 cases who were on complete elimination diet before OFC safely consumed 0.1g or more of the allergen food at 3 months after OFC.

 Conclusion : With individualized challenge dose, OFC can be safely performed for infants with food allergy.

 In children, IgE antibody specific to egg white is produced at first, which is followed by the synthesis of house dust mite-specific IgE antibody, and finally Japanese cedar pollen-specific IgE antibody is upregulated. To clarify the cause of this phenomenon, the function of allergen-specific T lymphocytes should be studied because IgE synthesis is regulated by those lymphocytes. Lymphocyte stimulation test is an immunological test to estimate the responsiveness of allergen-specific T lymphocytes by measuring the proliferation or the production of cytokines upon stimulation with a specific allergen. Analyses of the proliferation of allergen-specific lymphocytes suggest that the timing of sensitization of T lymphocytes is not significantly different among those allergens. However, there are clear differences in the profile of cytokines produced by allergen-specific T lymphocytes, which may be related to the gap in the timing of IgE synthesis among those allergens. Lymphocyte stimulation test is also useful for the study of the pathophysiology and the diagnosis of non-IgE-mediated gastrointestinal food allergy in neonates and infants which is caused mainly by cow's milk proteins. Although cow's milk-specific IgE antibody is usually negative in patients with this disorder, a remarkable increase in the proliferation of cow's milk-specific T lymphocytes is observed in most patients. Allergen-specific lymphocyte stimulation test may be useful for the diagnosis of this disease.

 Plants that disperse pollen as allergens are classified as either woody or herbaceous. Children with atopic dermatitis and food allergies are more likely to be sensitized to herbaceous pollen, such as those from grasses. The grasses known to produce allergenic pollen include Phleum pretense (Timothy) and Dactylis glomerata (orchard grass) from the Poaceae family, and Ambrosia artemisiifolia (ragweed) and Artemisia (mugwort) from the Asteraceae family. Poaceae pollen shares common allergens across different genera ; its major allergens are believed to be Phl p 1 and Phl p 5. In contrast, the antigenicity of Asteraceae pollens differs greatly across genera ; thus, it is necessary to distinguish from among them. Amb a 1 and Amb a 11 are the major allergens in ragweed pollen ; Art v 1 is the major allergen in mugwort pollen. Those three antigens are thought to cause pollen-food allergy syndrome (PFAS). Affected patients should be made aware of cross-antigens, which include Phl p 12 for grass pollen, Amb a 8 for ragweed pollen, and Art v 3 and Art v 4 for mugwort pollen. The pollen dispersal distance of herbaceous plants is shorter than that of Japanese cedar and Japanese cypress, and is strongly influenced by the surrounding vegetation.

 It is estimated that pollen allergies affect half of allergic individuals and may cause not only allergic rhinitis but also pollen food allergy syndrome. In general, tree pollen allergy is caused by trees belonging to the order of Pinales, Fagales, Lamiales and Proteales. The geographical distribution of allergenic plants affects patients’ sensitization profiles. In Japan, pollen allergy is caused by cedar and cypress belonging to the Cryptomeria family in the Pinales, and alder and birch belonging to the Betulaceae family in the Fagales. Molecule-based profiling of allergic sensitization has helped to elucidate the immunological connections of allergen cross-reactivity. The knowledge of the taxonomical and molecular relationship between different tree species allows the prediction of cross reactivity between closely related plants, which share homologous molecules not found in unrelated plants. These will be of great help in identifying causal allergens in pollinosis practice.