Capelin (Mallotus villosus) is generally consumed as food in Japan. In Japan, people only eat female capelin with roe, not male capelin. Although capelin allergy is very rare, we have experienced two cases of anaphylaxis by female capelin with roe. The first case is a 6-year-old boy. He didn't have any history of food allergy. When he ate lunch that included capelin at school, he experienced anaphylaxis. Skin prick test (SPT) was positive for both roe and fish-body. Oral food challenge test (OFC) was positive for both roe and fish-body, which also caused anaphylaxis. Salmon roe and cod roe OFC were both negative. The second case is a 7-year-old boy. He did not have any history of food allergy. He developed eyelid edema after he ate capelin at home. SPT was weakly positive in roe and negative in fish-body. OFC was positive for roe, which also caused anaphylaxis. However, OFC was negative in fish-body. Cod roe OFC was negative. He could eat salmon roe without allergic symptoms at home. We assume that capelin roe has a specific allergen different from other types of fish roe.

 Aim : We examined the learning effects of a children's allergy skill-up course aimed at improving community clinical practice. This course introduced active learning methods such as workshops and hands-on activities.

 Methods : We conducted a questionnaire survey, using Kirkpatrick's four levels of training evaluation, on courses targeted at pediatricians below the 10th year.

 Results : Seventy-one people participated (median age＝31 years). Over 90% of the participants responded that the training in hands-on activities, teaching material content, and student needs was appropriate. Learning achievement significantly improved in all items from an average of 2.4±1.0 to 1.4±0.6 in the 4-stage evaluation (1 [ “possible” ] to 4 [ “not possible” ] ) (p<.05). Participants showed significant improvement in appropriate timing of allergy test, respiratory function test, severity assessment of atopic dermatitis, skin care, and instruction on food allergies after 6 months.

 Conclusion : The course improved pediatric allergy practice.

 Objectives : The aim of the study was to examine if unnecessary restriction of nut intake in patients with nut allergy can be avoided by performing an oral challenge test for several kinds of nuts and using the correlation coefficient for a specific IgE antibody of the nuts.

 Methods : The subjects were 8 patients with nut allergy and restricted intake of several different nuts who underwent an oral challenge test with at least three kinds of nuts from March 2015 to August 2018. There were a total of 32 oral challenge tests in which the correlation coefficient of a specific IgE antibody between the restricted nuts and other nuts was <0.5. A retrospective study of the clinical cross reactivity of the nuts was performed in the 8 subjects.

 Results : One of the 8 subjects was positive in the oral challenge test for nuts other than their allergenic nuts, whereas nuts other than the allergenic nuts could be excluded as allergens for the other 7 subjects. In oral challenge tests performed for 3 subjects to examine their particular allergenic nuts, all were positive.

 Conclusion : An oral challenge test based on the correlation coefficient of a specific IgE antibody can be useful to eliminate unnecessary restriction of nut intake in patients with nut allergy, but it is important to distinguish among nuts because some patients may be allergic to several kinds of nuts.

 Inhalants are essential to the treatment of asthma. Unlike oral medicines, inhalants may not reach the trachea and exert the expected effect unless they are correctly inhaled. The authors concluded that the delivery rate of inhalants to the trachea and their clinical effects can be improved by paying close attention not only to inhaler handling, which can be visually examined, but also to the tongue position in the oral cavity, which cannot be visually examined in adult bronchial asthma.

 The authors created an instructional video and a poster presentation entitled, “Acquire the correct inhalation techniques”, which explains how to use all types of inhalers marketed in Japan in 2015. The instructional video was recorded in a single digital versatile disk (DVD). The DVDs and posters can be distributed anywhere in Japan for free. They have been mentioned in the Asthma Prevention and Management Guidelines since the 2015 version. The authors consider these DVDs as essential educational materials for standardizing the instructions on inhalation techniques throughout Japan. These materials may be helpful for instructing not only adults but also children. This article presents an overview of the efficient instructions on inhalation techniques in asthma management along with the contents of the aforementioned educational materials with adult and child bronchial asthma.

 It became possible to treat pediatric allergic rhinitis by sublingual immunotherapy (SLIT) of cedar pollen and mite in 2018. Currently, SLIT with four drugs (2 for cedar pollen and 2 for mite) is covered by the health insurance. The characteristic differences of these four drugs are the maintenance dose of allergen. The schedule and dosages of SLIT in children and adults are the same. The author has experiences of SLIT for more than 1,300 patients (including adult patients). We reported the good clinical outcome of SLIT of cedar pollen every year since it started in 2014, and the similar outcome can be expected for children as well as adults. Based on our many experiences, we outlined the important points for safe and effective SLIT in children as for treatment age, improvement of adherence, approach to long-term withdrawal, ingenuity for reducing adverse events and sequential SLIT with cedar pollen and mite.

 “Japanese Pediatric Guideline for the Treatment and Management of Asthma : 2017” Chapter 8 Management of acute exacerbation was outlined. In this revision, what was previously called acute attack is more emphasized that bronchial asthma is a chronic inflammatory disease of the airways, and it is no longer described as “attack” internationally. It was referred to as “acute exacerbation” .

 Also, with the aim of making it easy to manage acute exacerbation, a table was newly created to clarify the determination criteria.

 Until now, infant asthma has been described in a separate chapter, but the description is unified to one chapter from JPGL 2017, and the inhalation amount of short acting beta2-agonist (SABA) is 0.3 mL regardless of body weight. A systematic review also suggested that inhaled steroids should not be increased during acute exacerbation and that SABA inhalation is comparable to a motorized nebulizer, even with spacers.

 The maximum dose was shown for systemic steroid drug administration, and it was decided that intravenous and oral administration have the same effect and that loose administration is avoided.

 Chapter 9 of JPGL2017 has been changed from JPG 2012 “Acute Attacks and Long-term Management of Infantile Asthma” to “Characteristics and management of asthma in children 5 years and younger”.

 The main changes are as follows. (1) Until JPGL2012, asthma occurring in infants under two years of age is defined as “infantile asthma”. But there is no evidence to show any differences in pathology, phenotype, treatment response, prognosis etc. until 5 years old. Therefore, asthma occurring in infants under five years of age is defined as “infantile and young childhood asthma” in JPGL2017. (2) Overdose of ICS is a problem for wheezing disorders infantile and young child. Therefore, JPGL 2017 introduced the concept of “diagnostic treatment” to recommend careful use of ICS. (3) If it meets the following items, it is diagnosed as asthma. (a) Recurrent wheezing under 5 years old. (b) Repeated expiratory wheeze lasting more than 24 hours clearly over 3 episodes. (c) Improve expiratory wheeze, effortive respiration and oxygen saturation after inhalation of β 2 stimulant. (d) For expiratory wheeze with poor response to β 2 stimulants, it can be diagnosed “infantile and young childhood asthma” using “diagnostic treatment”.

 This chapter describes the differences between “Infantile Asthma” and “infantile and young childhood Asthma”, characteristics, pathophysiology, onset factors, diagnosis and transition of wheezing diseases, phenotyping of wheezing diseases (phenotype), and differential diagnosis.

 With reference to adolescent asthma, Chapter 10 described the problems originated from adolescent and transitional health care medication. At first, children grow up mentally and physically in period of adolescence, and the, pathophysiology of asthma changes substantially. Based on these changes, we need to consider issues pertaining to the patient and his/her family. Additionally, we need to identify topics relevant to medical treatment, school life, and, medical support, because adolescent patients are capable of participating in asthma treatment independently. Secondly, we need to examine transitional health care medication for adolescent asthma ; however, it cannot be discussed without a sufficient understanding of patients and their family. For this, it is necessary to consider patients' perspectives because they possess a deep and independent understanding of in accordance with their age and maturity.

 Careful assessment of children with asthma is important for identifying any coexisting diseases. Allergic rhinitis, sinusitis, and gastroesophageal reflux disease are frequently associated with asthma. In addition, these diseases are risk factors of asthma, and their optimal treatment may improve coexisting asthma. Sublingual immunotherapy for Japanese cedar pollen and house-dust mite allergies have been approved for use in treating younger children with allergic rhinitis. These may alter the course of allergic diseases, a situation called allergic march. The key to managing asthma is prevention and relief of chronic allergic inflammation in both the upper and lower airways.