Since the application of sublingual immunotherapy (SLIT) of house dust mite has been expanded to under 12 years old in 2018, there are still few reports of its clinical effects on children. We create our own evaluation table for 21 evaluation items and 17 side reactions of this therapy using the Visual Analogue Scale (VAS). Using this table, we examined the therapeutic effect in pediatric patients with allergic rhinitis caused by mites from the start until the 6th month and considered future challenges.
The average VAS score of 14 evaluation items significantly decreased during the observation period. The number of complaints of side reactions increased in the first month after the start of the therapy, itching in the oral cavity and throat were the most common. In this period, 20% of patients complained of pain during the therapy. 14 patients discontinued therapy and 3 of them complained of gastrointestinal side symptoms. Cedar pollen-specific IgE level were significantly higher in the discontinuation group than in the continuation group.
It was suggested that the clinical effect of SLIT in children can be expected from a relatively early stage. In order to continue long-term therapy more effectively, it can be said that active involvement with patients and guardians is important, such as giving sufficient explanation of side reactions and giving advice on how to deal with them appropriately.
We examined allergic factors aggravating the severity of recurrent respiratory syncytial virus (RSV) infection. Thirty-one cases were divided between a severe group with exacerbation after the first episode (9 cases) and a non-severe group showing no change (22 cases), according to second or third positive RSV antigen rapid tests between April 2015 and March 2020. In patients with atopic dermatitis or wheezing, no significant difference was apparent between the severe and non-severe groups, but the frequency of food allergy was higher in the severe group than in the non-severe group. These results suggest food allergy as an allergic factor aggravating the severity of recurrent RSV infection.
Aim: We investigate natural history of egg allergy (EA) in Japan and identify risk factors for prolonged EA children.
Methods: EA children who diagnosed at Okinawa-kyodo hospital were enrolled in the EA cohort retrospectively. We evaluated the proportion of the children who acquired tolerance in each age and identified risk factors for prolonged EA children at the age of six.
Results: Two-hundred-ten children were enrolled in the cohort. The proportion of children who were released from egg elimination diet were 12% (2y.o.), 34% (3y.o.), 54% (4y.o.), 68% (5y.o.) and 79% (134/170) at 6 years old. We divided the children according to the status of EA at 6 years old into 3 groups: released group (n=134), prolonged group (n=36) and drop out group (n=40). Complete avoidance (CA) of egg products (odd's ratio: 13.80, P<0.01) and higher egg-white specific IgE titer (EW sIgE) at 1 year old (odd's ratio: 3.84, P<0.01) were significantly associated with prolonged EA, however no significant associations were observed in sex and history of anaphylaxis.
Conclusions: About 80% of EA children acquired tolerance by 6 years old in our cohort. CA of egg products and high EW sIgE at 1 year old were identified as risk factor of prolonged EA at 6 years old.
Kawasaki disease (KD), first described by Dr. Tomisaku Kawasaki in 1967 in Japan, is one of the most common pediatric systemic vasculitides of unknown etiology. The most serious clinical issue in KD is formation of coronary artery lesions due to severe inflammation of the coronary arteries. Prevention of this complication is the most important goal of treatment of acute-phase KD. In the 2000s, intravenous immunoglobulin (IVIG) has become the standard treatment for acute KD. IVIG effectively suppresses coronary artery inflammation and has dramatically reduced the incidence of aneurysms. Many clinical and genomic studies have led to further advances in KD treatment. In particular, an immunosuppressant drug, cyclosporine, was recently approved for KD. That was an important accomplishment based on basic genome research, and it represents the direction that future research should take. On the other hand, despite advances in treatment, about 300 patients still develop cardiac sequelae annually in Japan. KD is the leading cause of childhood-onset acquired heart disease in developed countries, including Japan. To overcome this problem, we need to continue developing more disease-specific, effective therapeutic agents based on pathological mechanisms.
A systematic review was conducted to examine epidemiological and other medical findings regarding 8 clinical questions to investigate associations between passive smoking and allergic diseases in childhood. Passive smoking was associated with the following in childhood: increased risk of onset, aggravation, and impaired respiratory function in asthma; increases in coughing and sputum. Maternal smoking during pregnancy was associated with onset of asthma in childhood, and persistent impairment of respiratory function from birth. Passive smoking was suggested as a risk factor associated with onset and aggravation of allergic rhinitis, and was also associated with increases in total IgE levels and positive specific IgE test and skin prick test results. In particular, passive smoking during early infancy was significantly associated with sensitization to food and indoor allergens. Reported studies on atopic dermatitis and food allergies were limited, and findings on their associations with passive smoking were contradictory. Thus, their causal relationship was inconclusive in this study. In sum, passive smoking has serious impacts on allergic diseases in childhood and proactive avoidance of passive smoking is recommended.
The Japanese Pediatric Guideline for The Treatment and Management of Asthma (JPGL) has been created based on the policy of Medical Information Network Distribution Service (Minds) since the previous version (JPGL2017). The latest version, JPGL2020, consists of 14 chapters with 12 clinical questions (CQ). In Chapter 1, we described the process of how to revise the guideline and how to decide recommendation for each CQ. A systematic review was conducted for each CQ by referring to the relevant Cochrane review and searching literature from several medical databases including the Japan Medical Abstract Society. Information obtained from the extracted literature was reviewed in an integrated manner, and the body of evidence was evaluated along with biases. JPGL2020 shows recommendation for each CQ which was decided with an anonymous vote by the guideline committee members along with the voting result and commentary.
In chapter 2 of Japanese Pediatric Guideline for The Treatment and Management of Asthma (JPGL) 2020, the definition, pathophysiology, diagnosis, and severity classification of childhood asthma are described. In this revision, the definition of childhood asthma was revised, and a figure/description of the pathophysiology of childhood asthma with emphasis on type 2 airway inflammation, a diagram related to the differentiation of asthma, and a column on vocal cord dysfunction, which is essential in differential diagnosis, were added. Besides, descriptions that is duplicated in other chapters were deleted from this chapter. Understanding the pathophysiology of childhood asthma and making an appropriate differential diagnosis are important steps in the correct diagnosis, treatment, and management of childhood asthma. In this article, we explained the changes from JPGL2017 in chapter 2 of JPGL2020.
Chapter 3 ( "Epidemiology" ) of Japanese Pediatric Guideline for The Treatment and Management of Asthma (JPGL) 2020 contains data on the prevalence, mortality, complications, and prognosis of childhood asthma. One of the most notable findings of recent epidemiological studies is the number of asthma deaths in the vital statistics gathered by the Ministry of Health, Labour and Welfare. The pediatric asthma mortality rate in Japan is very low by international standards; the number of deaths in patients younger than age 14 years was reportedly zero in 2017 and 2018. It is hoped that the JPGL will be used widely as a tool for asthma treatment and contribute to eliminating pediatric asthma-related deaths.
The Japanese Pediatric Guideline for The Treatment and Management of Asthma (JPGL) 2020 was based on JPGL 2017 with updated information on the risk factors for pediatric asthma and their managements. Additionally, the main changes were as follows: 1) New sections about the recent awareness of "Microbiome," "Antibiotics," and "Maternal medication"; 2) Explanations and figures on the "Key points of indoor environmental intervention"; and 3) "Prevention of asthma development and exacerbations in other countries' guidelines" were added and summarized in a table. However, there is still little evidence on the necessity of control of house dust mite for the management of asthma in Japan. During the coronavirus disease 2019 (COVID-19) pandemic, the number of emergency visits and hospitalizations for asthma has decreased, which is suggested to be associated with preventive measures for viral infections and reduction of allergen exposure by wearing masks.
During the 1980's and 1990's, natural rubber latex (NRL) derived from Hevea brasiliensis emerged as a major allergen among healthcare workers. Subsequently, an increasing number of clinical and laboratory findings demonstrated that using latex-free and powder-free gloves with low protein levels can reduce the risk of occupational NRL allergy. However, children with anaphylactic shock caused by NRL continue to be reported in Japan, where NRL allergy remains an important issue in the healthcare setting.
Fifteen Hevea brasiliensis-related allergens have been included in the latest nomenclature of the World Health Organization/International Union of Immunologic Societies Allergen Nomenclature Sub-committee. The major NRL allergens are Hev b 1, Hev b 3, Hev b 5 and Hev b 6. Patients with latex allergy may also experience hypersensitivity to banana, avocado, chestnut, kiwi, etc., known as latex-fruit syndrome. Physicians should therefore alert patients with latex allergy to the potential for this complication.