Background: Recently, misuse of adrenaline auto-injectors (AAIs) for anaphylaxis has been reported. To prevent such accidents, we assessed the characteristics of 9 cases with misuse of AAIs.

Method: We retrospectively examined electronic medical records of pediatric patients who were prescribed AAIs at our hospital from February 2012 to January 2021.

Results: 1,333 AAIs in 246 patients were prescribed during the period. 9 cases of misuse of AAIs were detected. Except for 1 case with the mother unintentionally misusing the AAI to her child with anaphylaxis, 8 cases of unintentional misuse were done by children. They were all male and the median age was 6.5. Two cases were the same patient with attention-deficit hyperactivity disorder (ADHD), and there was 1 case of a 3-year-old boy with suspected ADHD. Four cases were unintentional misinjections into their body, but they were untreated and had no serious adverse events.

Conclusion: Unintentional misuse of AAIs is likely to occur in school-age boys who are less self-inhibited and children with ADHD. Pediatricians should pay attention to the patient's developmental characteristics, and moreover, place more weight on teaching about the precautions in managing the AAI to patients who are less self-inhibited.

Aim: This study aimed to see the effect of School life guidance & management form (Allergy Form) evaluation and workshops based on the evaluation on the subsequent Allergy Form entries.

Method: Allergy Forms submitted by elementary and middle schools in Aira City and Kanoya City were evaluated by a subcommittee of the Kagoshima Prefecture Medical Association, and workshops were held based on the evaluation. Changes in the numbers of submission of Allergy Forms, the numbers of Allergy Forms with positive oral food challenge results in the diagnosis columns, the numbers of diagnoses of anaphylaxis were compared before and after carrying out the evaluation and workshops.

Results: In both cities, the numbers of Allergy Form submissions decreased and the numbers of Allergy Forms with positive oral food challenge results in the diagnosis columns increased. Additionally, the numbers of Allergy Forms with diagnoses of anaphylaxis decreased in both cities and all of these Allergy Forms included positive oral food challenge results in the diagnosis columns.

Conclusion: Allergy Form evaluation and content feedback lead to proper entries of Allergy Forms and may ease the burden on schools.

[Background] The Japanese Pediatric Guideline for Food Allergy 2016 describes oral food challenge (OFC) doses as low, middle, and full. However, the influence of patient characteristics remains unclear. The present study evaluated the utility of specific IgE (sIgE) in the selection of the total egg amount in each dose.

[Method] The total volume of 20-min boiled egg whites was adjusted according to the egg white-sIgE levels for OFCs performed on infants who have never ingested hen's eggs or who are suspected of having allergies to hen's eggs.The OFC positive rate, egg white and ovomucoid (OVM) sIgE levels, and area under the curves (AUCs) were compared among doses.

[Result] The OFC positive rates in the low, middle, and full doses were 66.6, 27.9, and 8.3%, respectively. The AUC values of egg white and OVM sIgE were 0.61 and 0.65 (P=0.71), 0.58 and 0.69 (P<0.05), and 0.92 and 0.91 (P=0.89) for the low, middle, and full doses, respectively.

[Conclusion] Adjusting the total amount of egg white according to the egg white-sIgE in the OFC may be used as an effective index of egg allergy.

Galactose-α-1,3-galactose (α-Gal) syndrome is an allergic reaction to red meat caused by a tick bite. We report a case of suspected delayed anaphylaxis caused by beef that manifested 2 days after a tick bite. A 15-year-old girl was asymptomatic after consuming beef, pork, and chicken at a barbecue, but 2 days later, she developed anaphylaxis 5 hr after consuming the same beef and pork at a barbecue. Her specific IgE levels (UA/mL) were 0.62 for beef, 1.48 for pork, and negative for chicken. The patient had 14 cats, had a history of multiple tick bites, and had been bitten by a tick 2 days before the onset of anaphylaxis. The allergen component-specific IgE level was α-Gal 3.61, and both Fel d 2 (cat serum albumin) and Sus s 1 (pork serum albumin) were negative. Since the heated pork challenge test result was negative, beef was considered the cause. Alpha-Gal syndrome can occur in patients with no history of allergic symptoms, induced by the ingestion of red meat, but tick bites can cause delayed anaphylaxis. An early diagnosis and appropriate dietary guidance are thus important.

Our society established a working group to construct a framework for supporting society members who wished to continue learning pediatric allergology. In this study, we requested the society members to complete a survey questionnaire to understand the current state of our efforts. Responses to the questionnaire were obtained from a total of 668 members (353 men and 315 women), of whom 340 (54.8%) (56.6 % men and 52.5% women) were certified allergists. Full-time physicians accounted for 93.5% of the men and 77.3% of the women. A total of 11.0% of the men and 75.6% of the women experienced a break in their career. Among both men and women, training in their specialized fields was the most common answer to the question about the most important factor for successful career development. A total of 85.6% of the men and 92.1% of the women believed that the society needed to promote the diversity further. Although some commented that the society should take actions to support career continuation during child-rearing and reinstatement after the career break, others argued against the stereotypical view of "career support = support for women. " The society states that career support espoused by the society is for all members regardless of their gender and is determined to provide its members with continued support in accordance with the diverse perspectives and values of its members.

The prevalence of allergic rhinitis is increasing, and the prevalence of Japanese cedar pollinosis is on the rise even in children. Medical interviews are an important part of diagnosing allergic rhinitis in children; however, a more detailed interview is important in cases where the initial interview does not provide enough information. Since performing examinations can be difficult in children, a diagnosis is made by combining feasible examinations. The diseases associated with pediatric allergic rhinitis should be differentiated according to age and it is important to make a diagnosis with that in mind. The condition might also be complicated by other diseases, and in cases where a patient has sought a consultation with the complaint of concomitant diseases, care must be taken to accurately determine the presence of allergic rhinitis. For the treatment of allergic rhinitis in children, as in adults, it is of course important to communicate with the patient and to eliminate and avoid antigens. However, in cases where drug therapy is not sufficiently effective, allergen immunotherapy is considered because of its high efficacy and the expectation that it will modify the natural course of the allergy. Sublingual immunotherapy is a type of allergen immunotherapy that is considered very safe, and actively starting such therapy in children is desirable if there is an indication. In the event of severe symptoms and findings, surgical treatment might also be effective.

In JPGL2020 Chapter 8, "Management of acute exacerbation (attack), " Clinical Questions have been established for important issues in clinical practice, such as what should be selected as the optimal treatment for acute exacerbations.

The severity of acute exacerbation (attack) varies from mild to severe, and possibly leads to respiratory failure, therefore early and appropriate treatment is necessary to rapidly improve symptoms. A management to acute exacerbations (attack) includes "treatment at home" and "treatment in the hospital". At home, it is important to take appropriate cares from the early stage of an acute exacerbation (attack) to prevent the aggravation and prolongation. In the hospital, the severity and complications should be assessed as well as treatment, and other diseases should be differentiated. In addition to evaluating the triggers, severity, and frequency of acute exacerbations (attacks), efforts should be made to understand the child's and family's understanding of the disease, and the adequacy of their treatment at home. As well as providing guidance on appropriate treatments to acute exacerbations (attacks), these efforts are also involved in providing appropriate lifestyle guidance and reviewing long-term control medications, which will lead to improved asthma control.

Chapter 9 of JPGL 2020 describes "Specificity and management for infant and preschool asthma." JPGL2020 has added a new procedure "diagnostic treatment" to the flowchart for infant and young childhood asthma revised in JGL2017. It follows "Diagnosis," "Phenotype," "Diagnostic Flowchart," "Age transition in Infant Expiratory Wheezing," and "Differential Diseases" This has made it easier to diagnose. In this paper, Chapter 9 of JGPL2020 is described.

Currently, many adolescent patients with asthma still visit the pediatric department of a hospital for treatment. In 2014, the JAPAN PEDIATRIC SOCIETY published the literature "Statement of health care transition of patients with childhood-onset chronic diseases". The Japanese pediatric guideline for the treatment and management of asthma (JPGL) 2017 included "transition for adolescent asthmatic patients" in a chapter on adolescent asthma. Furthermore, JPGL 2020 showed that the consistent and smooth transition of treatment from JPGL to asthma prevention and management guideline (JGL) and transition from pediatric healthcare to internal medicine healthcare are important in the chapter "Adolescent asthma and health care transitions." Additionally, JPGL 2020 has specified that pediatricians should monitor health care transitions until their patient becomes independent. Therefore, the concepts behind the transition from JPGL to JGL were shown through a chart.

Since the guideline has become widely available, the management of childhood asthma has been remarkably improved. But some not-well-controlled cases still remain due to the lack of appropriate treatment of exacerbating factors and comorbidities. This chapter's title has been changed from previously named "Respiratory complications and comorbid conditions of childhood asthma" to "Management of childhood asthma comorbidities" to also encourage the management of any non-respiratory comorbidities. Therefore, we showed the flowchart of the asthma management considering comorbidities, and described obesity and psychosocial factors in addition to allergic rhinitis, sinusitis, and gastroesophageal reflux disease. If the therapy is inadequate, it is important to manage the suspected comorbidities appropriately, with confirming the correct diagnosis and severity of asthma, environment control, and the adherence.

Background: IgE-mediated egg allergy is a common food allergy worldwide. Patients with egg allergy are known to easily achieve tolerance compared to other allergens such as nuts. Oral food challenge (OFC) is often performed on patients diagnosed with or suspected of having IgE-mediated food allergy, but whether hen's egg OFC is useful in IgE-dependent egg allergy patients to avoid complete elimination remains unknown.

Methods: We identified articles in which OFCs were performed in Japanese patients diagnosed with or suspected of having IgE-mediated egg allergy. We evaluated whether the OFCs were useful to avoid the complete elimination of eggs by assessing the following: (1) the number of patients who could avoid complete elimination; (2) the number of patients who experienced serious adverse events (SAEs); or (3) adverse events (AEs); (4) improvement in quality of life (QOL); and (5) immunological changes.

Results: Fifty-nine articles were selected in the study; all the references were case series or case studies in which OFC was compared to pre-challenge conditions. The overall negative ratio against egg OFC was 62.7%, but an additional 71.9% of OFC-positive patients could take eggs when expanded to partial elimination. Of the 4,182 cases, 1,146 showed AEs in the OFC, and two cases reached an SAE. Two reports showed an improvement in QOL and immunological changes, although the evidence was weak.

Conclusions: OFCs against eggs may be useful to avoid complete elimination, but medical professionals should proceed with the test safely and carefully.

Background: Cow's milk, along with hen's egg, are common causes of food allergies in children worldwide. Accidental ingestion of milk is common and often induces severe allergic reactions. Oral food challenge test (OFC) is usually performed in patients with or suspected of having a food allergy. However, the evidence of whether cow's milk OFC is useful in IgE-dependent cow's milk allergy patients to avoid total elimination is not known.

Methods: After setting the clinical question and outcomes, we performed a systematic review for relevant articles published from January 1, 2000 to August 31, 2019 using PubMed^® and Ichushi-Web databases. Each article was then evaluated for level of evidence. All positive results of OFC were defined as adverse events.

Results: Forty articles were selected in this study. Our review revealed that cow's milk OFC was able to avoid the complete elimination of cow's milk in 66% of patients with cow's milk allergy. We also found that adverse events occurred frequently (50.5%).

Conclusions: This analysis supports the recommendation of conducting cow's milk OFC to avoid complete elimination of cow's milk, however the test should be conducted with careful consideration of the patient's safety. As the methods of OFC and subjects varied among the articles selected in this study, further studies are needed to obtain higher quality evidence.