Objectives: For proper management of food allergy in schools, utilization of the School Life Management and Instruction Chart (for allergic diseases), hereinafter the Chart, is essential. To know the problem to be solved, we reviewed the contents of the Chart written by physicians.

Methods: Descriptive statistics were performed for each item in the food allergy section of the Charts submitted to elementary and junior high schools in Mie Prefecture in 2020.

Results: The total number of submissions was 2,387 and 2,364 cases were analyzed, excluding cases other than food allergy (lactose intolerance, etc.).

Results: The eliminated foods were eggs, milk and dairy products, fruits, crustaceans, and nuts, in that order, which was different from hospital-based survey results previously reported. The percentage of the Charts stating two or more reasons for the necessity of elimination was 78% for eggs, 68% for wheat, and 64% for milk, but much lower percentages for other food, such as buckwheat (30%) and meat (15%). There was wide regional variability in the percentages. Contrary to the principle of elimination in school lunches, instructions for partial elimination were found in 8.7% of cases.

Conclusions: Problems with the Chart, such as food elimination instructions with little evidence, were revealed. It is important to educate physicians about the correct entry of the Chart.

This case involved an 11-year-old boy. The patient started playing rugby at the age of nine, and wheezing and breathing difficulty developed during exercise. The patient was diagnosed with bronchial asthma, and inhalation of fluticasone 100 μg/day and oral leukotriene receptor antagonist were initiated for prevention. Wheezing during exercise did not improve, and the patient was gradually administered inhaled corticosteroid to fluticasone furoate/vilanterol 200 μg/day. The addition of theophylline 200 mg/day did not improve the patient's condition. The patient was referred to our hospital and underwent an exercise challenge test. From spirometry, we suspected exercise-induced laryngeal obstruction (EILO), and a definitive EILO diagnosis was made based on laryngeal fiberscope findings during subsequent exercise. After recommending inspiratory muscle training and ultimately suspecting gastroesophageal reflux as an exacerbating factor for EILO, oral administration of a proton pump inhibitor improved the symptoms. Therefore, the following are of paramount importance: (1) considering EILO in cases with poor response to treatment as exercise induced asthma; (2) performing exercise load and spirometry at an easily manageable and conducive level for children; and (3) endeavoring toward appropriate diagnosis and treatment.

Objective:

The symptoms and backgrounds of patients presenting to emergency institutions with tree nut-allergy remain unexamined. In this study, we aimed to clarify the clinical characteristics of such patients.

Methods:

We included 29 cases (27 patients) that visited our emergency department with tree nut-allergy reactions from February 2016 to October 2021. We retrospectively reviewed the causative food, patient background, symptoms, and treatment from medical records.

Results:

Causative foods were walnuts, cashews, macadamia nuts, almonds, and pecans in 12, 12, 3, 1, and 1 cases, respectively. 15 cases developed anaphylaxis, 5 of which were anaphylactic shock. 13 cases required intramuscular adrenaline injection, one of which required continuous intravenous adrenaline. 11 cases were hospitalized, three of which were admitted to the intensive care unit. 22 were first-episode cases, 14 of whom had other food allergies.

Conclusions:

Patients who visited the emergency department with tree-nut allergy tended to be young, had other associated food allergies, and experienced their first-episode of anaphylaxis. Appropriate medical and social interventions may prevent future unpredicted serious cases.

Objective

Resilience is the ability to recover from psychological impairment and stress. Resilience is essential for adolescent children with allergies undergoing treatment for psychological conflicts. However, no scale currently measures resilience in children with allergies. This study developed a resilience scale for adolescent allergic children and tested its reliability and validity.

Methods

The participants were fourth- to ninth-grade children with allergies visiting cooperating medical facilities. The survey was conducted in questionnaire format from September to November 2021. Scale drafts were created, and exploratory and confirmatory factor analyses were conducted on the scale items obtained from item analysis.

Results

Six hundred twenty-one questionnaires were distributed, and 179 valid responses were included in the analysis. The allergic diseases covered were bronchial asthma (136 participants), food allergy (83 participants), and atopic dermatitis (80 participants). The Resilience Scale for Adolescent Children with Allergies consisted of 15 items with four factors (problem-solving orientation, exploration orientation, naturalistic orientation, and shared negative emotions). The scale was found to be reliable and valid.

Discussion

A resilience measurement scale for allergic children was developed and can be used for transition support and other related research.

Objective: We quantified the anxiety among mothers about food allergies with baby food and investigated the factors that enhanced the anxiety.

Methods: During a 2-month period from March to April 2020, mothers of infants seen for late-term infant health examinations at pediatric outpatient facilities were asked if they had experienced food allergy with baby food and were surveyed about this anxiety using a Likert scale. In addition, the anxiety about food allergy was compared to the anxiety about aspiration and food poisoning.

Results: A total of 533 questionnaires were collected from 36 institutions. Among the respondents, 16.4% had experienced food allergy symptoms. Most of the food allergy symptoms were mild, but even mild symptoms, such as partial urticaria, were significantly high on the anxiety scale and led to food avoidance (P < 0.01). The anxiety scale was highest for aspiration, followed by food poisoning, and lowest for food allergy.

Conclusion: Although most mothers' anxiety about food allergy was not high, the experience of even mild food allergy symptoms led to increased anxiety about weaning and food avoidance.

The detailed mechanism of acetaminophen hypersensitivity remains unclear, but two sets of immunological and pharmacological mechanisms have been assumed. In addition, there are no reports of remission in cases in which an immunological mechanism is assumed without complications of hypersensitivity to other NSAIDs. Herein, we describe two cases of acetaminophen hypersensitivity, with immunological assessment. The first case was a 15-year-old girl. She had developed nausea, vomiting, and high fever after taking 8.5 mg/kg of acetaminophen. The skin test was unevaluable and other tests were negative; however, the drug provocation test (DPT) produced generalized flushing, nausea, and peripheral cold extremities at a total dose of 10 mg/kg, which necessitated an intramuscular adrenaline injection. The other case was an 8-year-old boy who had developed cough and wheals for the first time despite having taken acetaminophen several times before. The skin test was negative, but the DPT produced nasal obstruction, eyelid swelling, and multiple wheals at a total dose of 0.9 mg/kg. Twenty-two months later, he had a negative DPT at a total dose of 14 mg/kg. Even in patients with previously diagnosed acetaminophen hypersensitivity, the DPT should be considered after some time due to the possibility of remission.

The composition of liquid infant formula (IF) and powdered infant formula (IF) are considered equivalent. Here, we report a patient with a systemic allergic reaction after taking liquid IF without any allergic reaction to powered IF.

The patient was a 7-month-old breastfed male infant with a history of taking a 10-mL powdered IF (Company A) without any allergic reactions; however, the patient complained of vomiting and facial rashes after eating the baby food containing a 0.5-mL liquid IF (Company B and C). Results of the skin prick test (prick to prick) for Company A's powdered IF, Company B's liquid IF, and Company C's liquid IF were 0 × 0 mm (negative), 8 × 5 mm (positive), and 3 × 3 mm (positive) in diameter, respectively. Specific IgE antibodies to cow's milk, α-lactoalbumin, and β-lactoglobulin (BLG) were 1.85 UA/mL, <0.10 UA/mL, and 1.99 UA/mL, respectively. The patient was diagnosed with milk allergy sensitized by BLG. Company A's powdered IF consisted of partially degraded whey protein, whereas Company B and C's liquid formula had undecomposed milk protein. Similar to this case, infants with cow's milk allergy may have systemic allergic symptoms depending on the type of IF. Therefore, people should be educated to not consume different types of milk than usual, especially liquid IF, for the first time during emergencies.

Atopic dermatitis is defined as chronic, recurrent, intractable eczema with atopic diathesis. Considering its pathophysiology as the skin irritability and hyperreactivity due to skin barrier disruption represented by FILAGGRIN mutations, atopic dermatitis itself could be a kind of autoinflammatory or immunodeficiency disease. On the other hand, in clinical practice, it is necessary to distinguish without delay atopic dermatitis-like skin symptoms that appear as partial symptoms of distinct primary immunodeficiencies. Immunodeficiency diseases listed in the latest Japanese Guideline for Atopic Dermatitis that need to be differentiated from pediatric atopic dermatitis include Netherton syndrome due to skin barrier disruption, Wiskott-Aldrich syndrome due to impaired cytoskeletal remodeling, hyper-IgE syndrome due to altered cytokine signaling, Omenn syndrome due to T-cell repertoire restriction, and IPEX syndrome due to immune tolerance failure. Understanding the pathophysiology of these "primary atopic diseases" is expected to deepen our understanding of the complex pathophysiology of atopic dermatitis.

The most important allergy to vaccines is anaphylaxis. The diagnosis is made according to Brighton's case definition for retrospective review, but in actual clinical practice, if anaphylaxis is suspected at all, it should be treated promptly according to anaphylaxis guidelines. Although cases leading to anaphylaxis are very rare, one should always be prepared for a sudden and serious adverse reaction. Gelatin and chicken egg proteins were considered to be causes of vaccine allergy, but gelatin was removed from most vaccine products for young children and no association between vaccine anaphylaxis and egg protein-containing vaccines has been confirmed. Tests to investigate the cause include the prick test, basophil activation test, and specific IgE antibodies, but the usefulness of these tests still to be established.

Polyethylene glycol was suggested as a major culprit to cause anaphylaxis following COVID-19 vaccination, but recent evidence has denied the hypothesis, and mechanisms and the diagnostic methods for the newly emerged adverse event is still to be investigated.

The diagnostic methods for vaccine allergy must be established for each vaccine. We have to pursue safe alternatives for the patients who had anaphylaxis following vaccination to protect from the infectious disease that vaccine can only prevent.

The principle of managing food allergy is the minimum avoidance of causative foods based on an accurate diagnosis. This term has two meanings: to eliminate only the correctly diagnosed causative food, and to allow the patient to consume in lower amounts or hypoallergenic forms of the causative foods within the symptom threshold. The patients and their families should be educated, if possible, by a registered dietitian on how to prevent accidental consumption of the causative foods and maintain adequate nutritional status. Concomitant allergies must be controlled well to reduce the risk of severe allergic reactions.

The Japanese Guidelines for Food Allergy 2021 define oral immunotherapy (OIT) as a "treatment for patients who are not expected to acquire tolerance naturally, after confirming the threshold for induction of symptoms by oral food challenge test (OFC) in advance." Patients are given continuous intake of the causative food orally under the physician's guidance. The ultimate goal of treatment is to acquire tolerance to causative foods after a state of desensitization or sustained unresponsiveness. Although the guidelines do not recommend OIT as a general approach to food allergy, its efficacy and safety have been evaluated based on clinical questions (CQ). Furthermore, the future application of OIT treatment is expected.

Chapter 12-1 on Hen Egg Allergy, Chapter 12-2 on Milk Allergy, and Chapter 12-3 on Wheat Allergy in the Japanese Guidelines for Food Allergy 2021 were reviewed. In the previous Japanese Guidelines for Food Allergy, descriptions of each allergen were present across chapters such as epidemiology, food allergens, and diagnosis and testing. However, at present, we aim to describe each allergen solely in Chapters 12-1, 12-2, and 12-3 to provide the reader with an overall understanding of the latest findings of each allergy by explaining the natural course, clinical type classification, prognosis, allergen components, diagnosis, and dietary treatment.

Many studies of hen egg, milk, and wheat allergen-specific IgE antibodies have been reported. The probability curve for each food can be used as a reference to diagnose each food allergy. To manage dietary treatments with minimum food exclusion, it is necessary to gain an understanding of the protein content in allergens that may be present in processed foods, methods of low allergenization, and cross-reactive foods that may carry risks similar to those of an allergen.

In the Japanese Guidelines for Food Allergy (JGFA) 2021, the new chapter 12-4, 5, 6, 7 were added and updated with the latest data on allergies to peanut, tree nut, soybean, sesame, and buckwheat. Notably, the main changes were as follows: 1) "Natural history for each food" was added and summarized in a table; 2) Detailed explanation of "component-resolved diagnosis"; 3) "Diagnostic usefulness of buckwheat allergy" was added and summarized in a table. Since the late 2010s, the prevalence of allergies to tree nuts, especially walnuts and cashews, has been increasing remarkably in Japan. Walnuts are slated to be added to the mandatory labeling of specified ingredients. Seeds are undergoing some changes in allergy prevalence and diagnosis, and we hope that this guideline will help improve food allergy practices.