An oral food challenge test (OFC) is recommended in treating children with food allergies.

We studied how to safely consume allergic foods at home.

Eight children were hospitalized between January 2017 and February 2019 following an anaphylactic shock. The foods that they consumed were in lesser quantity than those that were approved by taking the previous OFC.

It was observed that anaphylaxis occurred in 7 children due to the consumption of cow's milk and in one child who had eaten an egg.

The triggering factors were considered to be lack of continuous intake, insolubilization by flour to make it hypoallergenic, physical condition at the time of intake and exercise after intake. Half of the children did not like the indicated foods and did not consume them as directed. Regular follow-up is necessary to ensure continued safe intake.

Objective: This study aimed to reveal the association between oral allergy syndrome (OAS) and sensitization against alder pollen in children.

Method: The participants included children aged < 15 years who visited Department of Pediatrics, Daisan hospital, The Jikei University School of Medicine from April 1, 2018 to March 31, 2020, and serum antigen-specific IgE levels against alder and cedar pollen were measured. Patients' information was obtained from the medical records. We also measured airborne alder and Japanese cedar pollen in 2019 and 2020 seasons using the Durham's sampler method.

Result: A total of 490 children were included, and the serum antigen-specific IgE levels were positive in 165 (39%) children aged < 15 years. OAS group were 41 (8.3%), non-OAS group were 257 (52%), and patients whose data of OAS was not available were 192 (39%). The median antigen-specific IgE levels against alder pollen in the OAS group was 9.87 UA/mL (IQR, 0.94-57.15 UA/mL), which was higher than in the non-OAS group. The rate of OAS patients in this study increased along with high specific antibody to alder pollen. In 2019 and 2020, mean airborne alder pollen count per year was 57/cm³ and cedar was 3,667/cm³.

Conclusion: Although alder pollen count was extremely low, the serum antigen-specific IgE levels were positive in 39% and there was a correlation between antigen-specific IgE levels against alder pollen and OAS.

【Introduction】Formula milk for a low birth weight (FM-LBW) is mainly used in the neonatal specific intensive care unit because of its excellent nutritional value.

【Case】A 4-month-old boy with bradycardia noted from during the fetal period. Decreased fetal movement and fetal hydrops were observed 2 days before expected date of birth, and the patient was born by an emergency Caesarean section. After birth, the patient was diagnosed with neonatal asphyxia due to bradycardia and entered a neonatal specific intensive care unit. Milk was started at 10 days of age with an improvement in his general condition. He had a fever at 19 days of age and had a positive blood culture test. He was diagnosed with sepsis and started antibiotic treatment. He was changed to FM-LBW diet at 32 days of age. After the change, gastrointestinal symptoms such as abdominal distension and vomiting, increased fever, an inflammatory reaction with no response to antibiotics, and marked increase in the peripheral blood eosinophils (25.2%) were observed. We suspected a non-IgE mediated the gastrointestinal food allergy and terminated FM-LBW diet as a removal test and changed to breast milk or milk. Then, gastrointestinal symptoms and fever improved, and the peripheral blood eosinophils rapidly decreased.

【Discussion】Although the clear mechanism of allergic symptoms in this case is unknown, it was considered that the high amount of milk protein contained in FM-LBW was the cause of the induction of the symptoms.

The allergenicity of the hen's egg depends on its heated state. This retrospective study aimed to examine the relationship between the results of oral food challenge (OFC) using a lightly heated whole egg (LHWE) and various variables, the safety of LHWE-OFC, and the reliability of egg white-, egg yolk-, and ovomucoid-specific immunoglobulin (Ig) E in LHWE-OFC. In 227 LHWE-OFC (47 positives), the median age (positive: 45 months; negative: 31.5 months), allergic rhinitis complication rate (positive 21.3%; negative 5.0%), and total immunoglobin E (IgE) and egg-specific IgE (egg white-specific IgE, egg yolk-specific IgE, and ovomucoid-specific IgE) levels [positive: 302 IU/mL, 7.98, 1.29, and 4.86 UA; negative: 131 IU/mL, 3.42, 0.64, and 1.08 UA/mL (all median) ] were significantly higher in the positive group than in the negative group. In positive cases, the median grade of the allergic symptoms was 2, and based on this, LHWE-OFC was considered safe. The receiver operating characteristic curve analysis of the three types of egg-specific IgE levels revealed that their negative predictive values could be reliable. LHWE-OFC could be useful for the decision of withdrawing the elimination of the hen's egg. Although LHWE-OFC could be safe, we should be careful of the provoked symptoms when performing LHWE-OFC in pediatric patients with high age, allergic rhinitis, high total IgE level, and high egg-specific sIgE levels. When every egg-specific IgE level is low, the elimination of the hen's egg could be withdrawn.

We report a case of a 5-month-old boy who was admitted to our hospital with exacerbation of eczema, decreased vitality, and weight loss. He had a history of seborrheic eczema on the face from the age of 1 month, and the eczema spread to the whole body by 4 months of age. He had no history of sesame intake. His parents usually applied commercially available topical sesame oil-containing ointment to the skin.

Blood tests at admission showed high serum total IgE levels and sesame-specific IgE antibody titers. We discontinued the sesame oil-containing ointment and provided treatment for the eczema.

During an infancy, sesame seeds had been removed from the diet, and at 1 year 3 months, a 0.3 g food allergy test was conducted. Consequently, wheals and pruritus promptly developed throughout the body, which was diagnosed as sesame allergy.

Sesame oil-containing topical drug application to the eczema area during early infancy possibly resulted in immediate allergy due to induction of percutaneous sensitization.

Thus, considering the possibility of percutaneous sensitization to food ingredients, it is necessary to pay attention to the food ingredient content in certain over-the-counter topical drugs, including pharmaceuticals and quasi-drugs, before their application on patients with impaired skin barrier function.

Recent progress in researches about the pathogenesis of atopic dermatitis (AD) and the expansion of biotechnology and pharmacology have contributed to the development of novel pharmacological agents for AD. Many pharmaceutical agents, including biologics targeting type 2 cytokines, which play pathogenetic roles in AD, e.g. interleukin (IL) -4, IL-13, and IL-31, Janus kinase inhibitors, and phosphodiesterase 4 inhibitors have been developed. These agents are expected to be effective in AD patients with skin signs and/or symptoms that are refractory to conventional treatments including topical corticosteroids and calcineurin inhibitors. Some of them have been studied regarding the efficacy and safety in pediatric patients with AD. In the management of AD, maintenance of long-term remission in addition to achieving remission is important. The safety profile of novel pharmaceutical agents not only in clinical studies but also in the real world should be observed carefully for a long time.

The COVID-19 pandemic has had an enormous impact on the treatment of pediatric allergy, and has urgently necessitated the introduction of telemedicine. Direct auscultation by physician cannot be performed in telemedicine. Consequently, home medical equipment is required to detect a child's attack rapidly and accurately. However, no such equipment exists at present.

We have conducted lung sound analysis in patients with bronchial asthma since 2003 and have successfully developed an automatic home wheezing detector. The device is a portable machine that can record resting breathing for 30 sec via a microphone attached to the right precordia. When the machine is recording wheezing, the orange light is turned on. An algorithm based on the definition of wheezing is loaded into the device to distinguish voice, surrounding noise and heart sounds from wheezing, which precisely cancels out different kinds of noise. This algorithm has been validated in Japan, the United States and China and the results demonstrate automatic detection of wheezing.

In 2020, device approval was obtained in the United Kingdom and the 28 EU countries and it is currently being marketed there. The device is currently under application for approval in the United States and China, and in preparation for application to the PMDA in Japan. If the device can be applied in telemedicine, attacks in infants and adolescents that would otherwise be overlooked can be detected, hoping of contribute greatly to the improved long-term prognosis of asthmatics.

Objective: To investigate the impact of the COVID-19 pandemic on asthma in children.

Methods: A web-based survey of caregivers of asthmatic children < 15 years old was conducted to elucidate their asthma and respiratory infection status before and during the pandemic.

Results: A total of 820 caregivers responded to the survey. There were no cases COVID-19 infection. The asthma status during the pandemic was "good" in 42.3%, and "unchanged" was reported for 44.9%. "Worse" asthma was reported for only 8.5% of the patients. The frequency of the common cold was "decreased" in 61.8%, "unchanged" in 31.5%, and "increased" in a mere 4.3%. Logistic analysis revealed that (1) poor pre-pandemic control of asthma was an independent risk factor for worsening of the asthma status, with an odds ratio (OR) of 5.88 (95% confidence interval: 2.54-13.60), while (2) use of asthma controllers was independently associated with a lower risk for worse asthma, with OR 0.45 (0.26-0.77). Passive smoke and poor asthma control before the pandemic were independently associated with a higher risk for the common cold during the pandemic.

Conclusions: No COVID-19 cases were reported. Overall, asthma control was good during the pandemic. Risk factors were identified for worse asthma control and an increase in respiratory infections.

Following the Japanese Pediatric Guideline for the Treatment and Management of Asthma: JPGL 2017, the objective tests required for the diagnosis and treatment of pediatric bronchial asthma are described. The evaluation of the Th2-type response, which is the basic immune abnormality in asthma, is discussed, including serum total IgE level, peripheral blood eosinophil count, allergen-specific IgE antibodies and skin prick test. Practically, evaluation of respiratory function [including spirometry, forced oscillation technique (FOT) and bronchial hyperresponsiveness test] and fractional exhaled nitric oxide (FeNO) measurement, which are important for diagnosis of asthma, evaluation of severity and therapeutic effect, are described in detail. Since spirometry is the most important test, the principle of measurement, the interpretation of results and the points to be noted in the pediatric patients are explained. Other new techniques for evaluation of airway condition and airway inflammation are also introduced.

Chapter 6 of JPGL2020 was "Education for patients, and instruction of inhalation".

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.

In the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2020, several newly applied drugs for pediatric use such as formoterol fumarate hydrate/fluticasone propionate, mepolizumab, and dupilumab have been incorporated into the long-term management plan. The title of the table, "Drug treatment plan in long-term management of asthma" was changed to "Long-term management of asthma" in the JPGL2020 because it contains items on risk factor management, patient education, and patient-doctor partnership. Biologics are placed on the top of the drugs list in the "additional therapy" of Step 4 treatment for patients aged 6 years and older. In addition, evaluation items and checklists are presented in the tables to ensure the proper use of biologics. We also added evidence-based suggestions for assessing asthma control status and mite allergen-specific immunotherapy for asthma. Difficult asthma is defined as asthma that remains uncontrolled even with the "basic therapy" of Step 4 treatment after differential diagnosis of asthma, and severe asthma is defined as difficult asthma that remains uncontrolled even after the risk factors have been addressed.

Background: Oral immunotherapy for patients with IgE-mediated hen's egg allergy is presently not a recommended treatment in Japan, due to a lack of evidence concerning the efficacy and safety of the treatment.

Objectives: To determine the efficacy and safety of oral immunotherapy in patients with IgE-mediated hen's egg allergy by a systematic review.

Methods: An electronical search was conducted and randomized controlled trials comparing oral immunotherapy with placebo or an elimination diet, in patients with IgE-mediated hen's egg allergy, were selected. Data about efficacy and safety of the intervention were extracted for meta-analysis.

Results: 12 studies were included in the systematic review. The number of patients with an increased amount of egg that can be tolerated was significantly higher in the oral immunotherapy group compared to the complete avoidance group. Concerning the safety of the treatment, the incidence of adverse events was significantly higher in the immunotherapy group.

Conclusion: Since oral immunotherapy seems to be an effective treatment compared to complete avoidance, it may be considered as a therapeutic option for patients with IgE-mediated hen's egg allergy. However, careful attention to adverse events should be paid during the treatment period. Further investigation about the efficacy and safety of oral immunotherapy protocols is needed.

A systematic review (SR) and meta-analysis were conducted to determine whether oral immunotherapy (OIT) for IgE-dependent cow's milk allergy is more useful than avoiding milk. Randomized controlled trials (RCTs) were selected from previously published SRs; the search was up-to-date as of October 1,2012. RCTs published until March 2019 were additionally searched from CENTRAL, MEDLINE, Embase, and database of the Japan Medical Abstracts Society, and RCTs in Japanese were searched from this database. Five RCTs were selected from a previously published SR, and four RCTs were additionally selected.

The groups of patients who increased their threshold and those who were desensitized to the daily dose (200 mL) both showed the benefit of OIT. None of the studies assessed sustained unresponsiveness. No serious adverse events were observed in any of the studies, and adverse events including adrenaline use were significantly more common in the OIT group than in the control group. As for immunological changes, the endpoints were different, and no information was available for our meta-analysis. Although the methods and targets of OIT are different and patient safety should be considered, OIT was found to be useful in both threshold elevation and desensitization to daily dose of cow's milk.