Objective : This study was performed to investigate food allergy symptoms in infancy and food avoidance in 1-year-old children.

　Methods : A questionnaire survey regarding food allergy symptoms and food avoidance was administered among guardians of pediatric outpatients visiting clinics or hospitals for stage 1 measles rubella vaccination between October 2014 and November 2014.

　Results : A total of 853 cases from 65 institutes were investigated. In total, 31.1% of the respondents reported having encountered symptoms of food allergy. The most common symptoms were partial urticaria or itching around the face. Guardians reported food avoidance in 27.8% of cases, and 29.9% of these cases avoided multiple foods. Food avoidance was based on doctor's instructions in 57.8% of cases, and at the parents' discretion in 24.6% of cases. The most common reasons for food avoidance were results of blood tests in the doctor's instructions group (82.6%) and concern regarding food allergies in the parents' discretion group (49.0%).

　Conclusions : Many parents avoid giving their infants certain foods based on results of blood tests or concern regarding food allergies.

　Drug-induced hypersensitivity syndrome is one of the severe drug eruptions triggered by oral administration of drugs such as antiepileptics and antibiotics. One of the diagnostic criteria for this syndrome is an increase in peripheral blood eosinophil count (>1,500/μL). We report the case of a 15-year-old boy with no previous history of allergy who was apparently healthy until he had an afebrile convulsion twice, for which oral administration of carbamazepine was started. Fever and erythema appeared 3 weeks after the treatment initiation ; furthermore, hepatic dysfunction, as well as a marked increase in white blood cell (36,440/μL) and eosinophil (21,499/μL) counts was observed. Treatment with a steroid was started, and carbamazepine was discontinued, following which the symptoms became mild and eosinophil count decreased. Drug-induced lymphocyte stimulation test result for carbamazepine was positive ; reactivation of human herpesvirus 6 was confirmed, and the criteria for drug-induced hypersensitivity syndrome was satisfied. Eosinophilia was remarkable, and additional examinations revealed abnormally high thymus and activation-regulated chemokine and interleukin-5 levels as well as aberrant T cell, which are some of the characteristics of lymphocytic hypereosinophilic syndrome ; this possibly explains some of the pathological conditions observed in drug-induced hypersensitivity syndrome.

　Background : With the widespread use of adrenaline auto-injector (EpiPen^®), its inappropriate usage has also been increasing.

　Purpose : The purpose of this study is to clarify whether adolescent patients with food allergy and their guardians are knowledgeable about the pertinent usage of EpiPen^® and its indications.

　Method : The study comprises two methods. The first one includes the direct observation of manipulating techniques of the apparatus in 33 patients and 97 guardians. The second is a questionnaire survey with special emphasis on the following aspects : status of practicing the techniques, the site where the EpiPen^® is kept under control and recognition of indications for its use.

　Results : The direct observations spotted a number of inadequacies, i. e. lack of confirmation of the trainer label, absence of identification of interfering objects through clothing (pockets, seams), an inappropriate selection of the injection site, and insufficient holding the EpiPen^® in place for 3 seconds. The questionnaire study disclosed the failure to practice the technique for longer than one year in the majority of the patients and guardians. Nearly half of the subjects replied that they have not used EpiPen^® even in case of exhausted condition and incontinence dyspnea.

　Conclusion : The current study clearly demonstrated that the instruction of the usage of EpiPen^® should consecutively be continued from the initial prescription.

　Objective : The aim of this study is to search for the relation between the adherence evaluation questionnaire (PAAQ) score and the respiratory function test and FeNO.

　Methods : PAAQ was evaluated in asthmatic patients aged 9 to 15 under inhaled corticosteroid therapy. They were divided into two groups according to the PAAQ score (cutoff value 0.65), and the relationship between these test results and PAAQ score was examined.

　Results : Fifty-four subjects were included. FeNO value was significantly lower in the high PAAQ group, and the PAAQ score and the FeNO value had a negative correlation. However, some exceptional cases with high FeNO value and high PAAQ score were also detected.

　Conclusions : Although the FeNO value shows generally negative correlation with good adherence to inhaled corticosteroid (ICS), measurement of PAAQ score has a potency to detect risk factors other than adherence to ICS.

　Vitamin D has been considered as one of the factors associated with the development of allergic diseases, based on the results of a cross-sectional epidemiological survey that many children have allergic diseases in high latitudes. The basic research and the birth cohort study have also been reported to support it, and recently, the current evidence on randomized controlled trials suggests that vitamin D supplements during pregnancy might have a beneficial effect on recurrent wheezing in infants and toddlers. However, few studies have shown a beneficial effect on the development of eczema, food allergy, asthma, and sensitization by prenatal vitamin D supplementation.

　The current evidence does not support that the vitamin D supplementation in pregnant women and infants prevent the development of allergic diseases. Further study will be required to clarify recommendations.

　Since atopic dermatitis has shown to increase the risk of developing other allergic diseases, prevention of atopic dermatitis has attracted attention. From the viewpoint of preventing percutaneous sensitization by protecting the skin, increasing number of reports state that regular application of moisturizers from the neonatal period reduces the risk of developing atopic dermatitis. However, it remains unclear whether regular application of moisturizers can prevent allergic diseases other than atopic dermatitis. However, percutaneous sensitization is also an “eczematous sensitization,” and early intervention trials for skin inflammation are ongoing. Studies have reported the prevention of food allergy by early introduction of solid foods in order to induce more aggressive oral tolerance. However, it is also important to treat the skin in parallel. In addition, knowledge regarding the hygiene hypothesis and vitamin D hypothesis has recently increased, and it is necessary to consider them from various aspects.

　Chapter 12 of the Japanese Pediatric Guideline for the treatment and management of asthma 2017 describes the management of asthma in daily life, focusing on school and preschool life, exercise, and vaccination. If special consideration is required in school, preschool, or extracurricular activities, the instruction table for school life management and cooperation with parents and school is referred for appropriate action. Exercise-induced asthma (EIA) is a phenomenon in which wheezing and dyspnea occur temporarily during or after exercise. As exercise benefits the growth and development of children, the stakeholders should properly understand EIA and cooperate to eradicate EIA from school children. Vaccination can be administered in asthmatic as well as healthy children. When an asthmatic child is planned for general anesthesia or surgery, asthma should be controlled as much as possible, and treatment step-up and systemic steroid drug administration should be considered, as needed. To prevent unforeseen circumstances such as natural disasters, an action plan should be devised. Brochures are available for use during emergencies.

　Japanese Pediatric Guideline for the Treatment and Management of Asthma 2017 (JPGL2017) set clinical questions relevant to important issues in clinical practice and published recommendations made by the Committee of JPGL2017 based on systematic reviews. The main changes that were made were as follows : 1) infant asthma was defined as age under 5 years, and it was classified to easily distinguish wheezing disorder in early childhood ; 2) the prescription timing of the combination of inhaled steroids and long-acting β₂ stimulants was changed in the regimen for long-term management ; and 3) a recombinant humanized anti-IgE monoclonal antibody (omalizumab) was added in the treatment with long-term controllers. However, there is still little evidence on various aspects of childhood asthma. The items that did not have high-evidence reports were created based on the experience and opinions of experts. Further studies are needed to obtain additional evidence in relation to the pathology, diagnosis, epidemiology, prevention, treatment, and management of childhood asthma.

　The establishment of the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma (JPGL) has enabled the use of standard therapy for treating pediatric bronchial asthma. However, regular administration of basic therapeutic agents for pediatric bronchial asthma is essential. The principal anti-asthmatic agents for children have been listed in chapter 14 of the JPGL2017. These therapeutic agents have remained unchanged over recent years, except the newly approved biological agents, omalizumab and mepolizumab. The main text and list of principal anti-asthmatic agents in chapter 14 of JPGL2017 have included omalizumab, which was introduced as a controller for the long-term management of pediatric asthma, in an additional statement in chapter 7 of JPGL2012. A subsequently approved agent, mepolizumab, was also included. It was prepared based on the information obtained from the Pharmaceuticals and Medical Devices Agency (PMDA). The contraindications and adverse reactions of these drugs were described separately in chapter 14. This article presents brief discussions of the principal anti-asthmatic agents listed in chapter 14, by quoting the information provided in the main text.