For the correct diagnosis and evaluation of pediatric asthma, it is essential to accurately assess the severity and frequency of asthma exacerbations. However, there the overdiagnosis or underdiagnosis of this condition may occur due to a gap in recognizing "wheezing" between physicians and guardians and uncertainty in guardians' memory of wheezing episodes. For a proper diagnosis, it is essential to communicate asthma symptoms to the guardians in an easy-to-understand manner and to conduct careful medical history taking. It is also necessary to carefully check for symptoms that raise the suspicion of asthma and for symptoms that raise the suspicion of conditions other than asthma. Since the exhaled NO test, which evaluate airway inflammation, can be easily performed in an outpatient setting, it should be utilized for the correct diagnosis and evaluation of pediatric asthma.

In pediatric asthma, the evaluation of the transition to medical care in adulthood is still considered insufficient. As the number of exacerbations often decreases during adolescence, there are cases where continuous medical treatment is not provided. With an eye on the prognosis in adulthood, it is essential to evaluate not only asthma control levels but also the patient's readiness for transition and psychological status.

There are certain diagnostic criteria for diagnosing atopic dermatitis, including Hanifin & Rajka, UK Working Party, and Japanese Dermatological Association criteria. The Japanese Dermatological Association criteria helps in differentiating between multiple diseases presenting with similar signs and symptoms; however, it is difficult for a pediatrician to distinguish between these diseases. Therefore, one should only differentiate the diseases that are exacerbated because of the treatment of atopic dermatitis. If atopic dermatitis is suspected, a pediatrician should frequently observe the skin lesions and confirm the diagnosis. For example, infant eczema and atopic dermatitis do not necessarily have to be distinguished because the treatment for both the conditions is similar. For the assessment of severity of eczema, main assessment scales for healthcare professionals are Severity Index, Investigator Global Assessment, EASI, and SCORAD. EASI and SCORAD assessment scales are not suitable for the assessment of severity of eczema in routine clinical practice as they are time-consuming. However, assessment with EASI is essential before treatment with biologics even by pediatricians. Main assessment scales for patients are POEM and PO-SCORAD. These can also be used at home by patients themselves for understanding the skin condition apart from having to visit clinics.

Immunoglobulin-E (IgE) -dependent food allergy is diagnosed by "allergic reactions induced by foods" and "presence of antigen-specific IgE antibodies". If the causative food cannot be identified, the diagnosis of food allergy is confirmed by an oral food challenge (OFC). It is necessary to select the medical institution and OFC method to improve the safety of OFC. If it is difficult to perform OFC at the respective facility, the physician needs to refer the patient to a medical institution that can perform OFC immediately.

However, there are still cases in which patients are instructed to avoid food without a correct diagnosis. In cases of infantile atopic dermatitis, we experienced cases in which the patients were instructed to avoid multiple foods due to positive antigen-specific IgE testing only without treatment of eczema. There have also been cases of people who were diagnosed with food allergies in infancy and continued to avoid the causative food without undergoing OFC until adolescence. We have also experienced cases in which patients were instructed to avoid foods on which they have incorrect knowledge of cross-reactivities, such as peanuts, tree nuts, and crustaceans. In this article, we aimed to describe the correct diagnosis and evaluation of food allergy in childhood and contribute to the improvement of the quality of food allergy treatment.

For children with asthma and their families, breathlessness, sleep disturbance due to coughing, restrictions on daily life and exercise, hospital visits, environmental maintenance, and anxiety about acute exacerbations have a significant impact on QOL. In particular, coughing at night not only interferes with sleep, but also depletes physical strength and significantly worsens QOL. It has also been suggested that childhood asthma is deeply related to outgrow, future respiratory function, and chronic obstructive pulmonary disease (COPD) in the Extreme long term. Therefore, I will review sleep disturbance caused by cough in acute and long-term management, and COPD in extreme long-term management, based on the recent information and our own results.

The management of allergic diseases has been discussed from the perspective of understanding pathophysiology and the severity of each patients and providing the treatment. From the point of view of consumers, management and education by skill mix and the measurement of Quality of Life (QOL) has been expected. Factors that affect quality of life in atopic dermatitis include itching, appearance, burden of treatment, and anxiety. QOL questionnaire of atopic dermatitis, there are Skindex-16 and Dermatology Life Quality Index for adults, Children's Dermatology Life Quality Index for children, available in Japanese. For younger children, caregivers are the primary providers of care, so an assessment of caregiver burden is needed. There are Quality of life in Primary Care givers of children with Atopic Dermatitis and its short version, QP-CAD shortened to 9 questions. The Japanese Culturally Modified Version of the Childhood Atopic Dermatitis Impact Scale, which is a modified version of the Childhood Atopic Dermatitis Impact Scale for Japanese patients, is also available. Open dialogue is a possible method of providing medical care from the perspective of consumers.

Currently, there are no effective treatments for food allergies that are guaranteed to be safe. In cases with history of anaphylaxis, there is anxiety that symptoms will appear, intake is not progressing, and social life is restricted. For children with severe food allergies and their caregivers, it is effective to conduct programs that aim to maintain quality of life (QOL) (allergy classes, summer camps), but a questionnaire to measure QOL has not been developed in Japan. Therefore, a disease-specific QOL questionnaire for children with food allergies can be used to evaluate children with food allergies and when their condition changes, compare between treatment groups, and establish programs aimed at maintaining QOL. We have started to develop scales for children that the child responds to, for children that the caregiver responds to and for the caregiver himself.

In the field of pediatric allergy, there are few QOL questionnaires developed in Japan that can be used to determine the therapeutic efficacy, so there are situations where the judgment from the patient's point of view is vulnerable. Developing a questionnaire for determining the patient's QOL by the medical staff who practice the medical treatment will lead to the tailor-made food allergy treatment selected by the patient.

In the event of a disaster, patients that have allergic diseases are considered "people requiring special care" as there are certain environmental measures and dietary requirements that must be taken into consideration for their safety.

Although the role of municipality in disaster is not small, few studies have examined municipalities' disaster preparedness for allergic diseases.

To clearly understand the current state of preparedness and extract the unmet needs from the municipalities, we conducted a questionnaire survey on the preparedness for allergic diseases in municipalities across Japan. As a result, the following problems were identified: insufficient stockpiling of allergy-preventive foods and milk, uneven stockpiling by city size, insufficient disclosure of stockpiling information, insufficient countermeasures for prolonged disasters, and insufficient sharing of stockpiling information. The reasons for this were thought to include a lack of basic knowledge about allergic diseases and the inability of local governments to understand the current status of allergy patients during disasters. On the other hand, "enlightenment of self-help from doctors to patients" was mentioned as an initiative that the government would like the academic society to take.

Background: Patients with allergic diseases are regarded as "persons requiring special care and consideration" in disaster, and require appropriate environment, food, and other factors. Existing materials on dealing with allergic diseases in disaster are not made for municipalities that operate evacuation centers. In order to prepare for disasters in the future, it would be useful to understand the problems municipalities faced with allergic diseases in past disasters. In this study, we surveyed municipalities that had undergone disasters about their experiences in dealing with allergic diseases. Method: A written questionnaire was sent to municipalities to which the Disaster Relief Act was applied from 2015 to 2020. Results: We analyzed 323 municipalities. Seventy-seven percent of the disasters were floods and 21% were earthquakes, and 88% of all municipalities set up shelters. Thirty-eight percent of the municipalities took measures for food allergy when providing food and meals at the shelters. Although only 1-3% of the municipalities responded that they had problems in dealing with allergic diseases, we were able to learn about specific requests and problems through free descriptions. Conclusion: Based on the results, it is expected that a support system will be established to provide information to municipalities in preparation for large-scale disasters in the future.

Background

There is insufficient information regarding disaster measures for patients with allergies.

Purpose

To evaluate the awareness and preparedness of patients and their families for large-scale disasters and elucidate their unmet needs in this regard.

Methods

We conducted a nationwide questionnaire survey from January to February 2021 using Google Forms among patients with allergies or their caregivers and analyzed the responses of the patients' caregivers aged <20 years.

Results

A total of 1,221 cases (92% female) were analyzed. Among the respondents, 83%, 58%, and 83% did not know about "consultation services and pamphlets from academic societies or local governments," "allergy portal," and "allergy-friendly food at public evacuation centers," respectively. Moreover, 72% of the respondents stockpiled more than 3 days' worth of food at home and 15% stockpiled more than 7 days' worth. In the event of a disaster, "alternative methods when there is no medicine" was the most desired answer, and many wanted it in a written format, considering power outages. The most common problem in patients with a disaster experience was "worsening of skin symptoms," and 24% of the respondents "wanted to consult but did not know where to go."

Conclusion

In addition to raising awareness on self-preparedness, this survey demonstrated the need for adequate public assistance and understanding from the people around such patients.

Patients with allergic diseases are considered "people requiring special care" in the event of a disaster and require treatment in shelters. We conducted a questionnaire survey of disaster medical workers to evaluate current tools, such as pamphlets and consultation services, used for treating allergic patients during disasters and investigate the unmet needs of the disaster medical workers. Electronic media and lectures were the most requested methods for receiving information regarding allergies under normal circumstances, whereas smartphone applications and paper media were requested during disasters. Awareness regarding existing tools, such as the Allergy Portal, was not high, ranging from 10-30%; 66% stated that COVID-19 would have a negative impact on allergic disease response during a disaster, while 73% of disaster medical workers wanted a single point of contact for allergy response during a disaster. There were several opinions regarding requesting tools to educate patients about self-help and track patient information. These results suggest that it is necessary to expand and further disseminate allergy disease manuals, create a system to integrate inquiries about allergy treatment, and actively provide information on self-help for patients with allergies.

Background: Allergic diseases are diverse, and each disease is treated by different specialists. Consequently, the cooperation of doctors from various departments is necessary to appropriately respond to allergic diseases in disaster situations. Furthermore, collaboration with government entities, pharmacists, nurses, nutritionists, patient groups, and related companies is essential for eliciting more appropriate responses. Here, we identified and analyzed existing problems and accordingly developed proposals for establishing a collaborative approach to respond to allergic diseases in disaster situations.

Methods: To identify existing problems, we conducted interviews with relevant academic societies and organizations and collected questionnaire data from relevant government entities, patient groups, and disaster medical staff. Based on these results, we devised proposals for establishing a more collaborative approach.

Results: We found that although each organization had been individually conducting activities, there had been no collaborative effort and that differences in prioritizing which diseases to address were evident among the academic societies. There was also a lack of awareness of activities being conducted and an evident demand for a unified assistance service.

Conclusions: As a solution, we propose establishing a unified assistance service, whereby specialists will respond to the contents of electronic forms. Initially, the target group will be patients, and it will later expand to ideally incorporate relevant government entities and disaster medical stuff. Careful consideration is necessary when deciding on its location and how to implement and operate the service.

The Japanese government and medical societies have provided information, manuals, and applications for use in disaster preparation, and a great deal of allergy-related disaster prevention information is available on websites. However, our surveys have shown that the self-help, mutual help, and public help sectors are unable to utilize this information fully or respond adequately to potential disasters. Furthermore, the disaster-management related materials prepared by allergology societies are not widely used by disaster medical assistance personnel, and the information we have provided is apparently "unavailable" or "inaccessible" to the people we wish to target.

We are therefore currently working to improve the materials by conducting an inventory of the existing materials, supplying missing information, and providing updates. Our aim is to create a site that can be used by as many people as possible by clearly indicating when (during the preparation period or at the time of a disaster) and by whom (the general public, government officials or medical professionals, etc. ) new tools are to be used.

The oral food challenge (OFC) is the gold standard for diagnosing an immediate-type food allergy.; however, other tests can be used in combination to reduce the risk of OFC.

Although probability curves predicting the probability of symptom induction based on specific IgE antibody titers have been reported, they are affected by the target population's age and the OFC method. Recently, allergen component-specific IgE antibody tests have become available for clinical practice, and cutoff values for ovomucoid in hen's egg, ω-5 gliadin in wheat, 2S albumin in seed nuts, Ara h 2 in peanut, Jug r 1 in walnut, and Ana o 3 in cashew nut have been reported.

A positive skin prick test (SPT) would lead to diagnosis in infants even if the specific IgE antibody test is negative. Additionally, SPT of buckwheat is more useful than the specific IgE antibody test for diagnosis.

Although advances in immunological testing have improved the diagnostic accuracy of immediate-type food allergy, it cannot be used as a definitive diagnosis at present-the importance of assessing the risk before OFC is increasing. The development of applications to facilitate stratified diagnosis is needed.

"Pollen-food Allergy syndrome (PFAS) " is a term used when in a patient, sensitized to pollen, allergic symptoms are triggered by the ingestion of fruits or vegetables that have cross-reactivity with pollen antigens. Clinical symptoms mostly localize to the oral cavity, and then can be referred to as "Oral allergic syndrome (OAS). " However, a small subset of patients does not only have OAS but also systemic symptoms, which may lead to anaphylaxis.

Medical history is paramount in PFAS diagnosis. PFAS patients have histories of pollinosis and of experiencing symptoms when eating fresh fruits and vegetables, though not when eating processed foods. Plant molecules well-known for their involvement in PFAS are Bet v 1 homologues, and there also has been a recent interest in profilin and GRP. Unfortunately, only a few types of PFAS allergens are available as recombinant proteins. Therefore, auxiliary diagnosis is mainly performed by prick-to-prick tests that use food itself. Because there are allergenic differences between fruits and vegetables depending on their variety, site, and maturity, it is imperative to further develop standardized test reagents for improvement of PFAS diagnosis.

Asthma is a heterogenous chronic inflammatory disease of the airways. The main phenotypes that have been identified include (1) early-onset allergic asthma, (2) early-onset allergic moderate-to-severe remodeled asthma, (3) late-onset nonallergic eosinophilic asthma, and, (4) late-onset nonallergic noneosinophilic asthma. Further, asthma can be subdivided into Type 2 (high) and non-type 2 (or type 2 low) endotypes. For Type 2 high asthma, potential biomarkers could be serum-specific IgE (sIgE), fractional exhaled nitric oxide (FeNO), blood or sputum eosinophils, and, periostin. Moreover, Type 2 cytokines (IL-4, IL-5, and, IL-13) and innate (epithelial) cytokines (IL-25, IL-33, and, thymic stromal lymphopoietin (TSLP) ) can also be important biomarkers. In addition to the markers, clinical aspects such as onset of age, exacerbation factors, complication as well as physiological lung function are useful for selecting the appropriate therapy. Recent omics techniques including gene analysis may be useful at the stage of assessing the risk of asthma, may help define an endotype, and contribute to the prediction of responses to the given treatment.

Purpose: To collect data on accidental ingestion in Nara Prefecture, Japan, for use in patient education and the development of a safe environment for children with allergies.

Methods: We conducted a questionnaire survey on the accidental ingestion of allergens. The participants were parents of children who visited either of the eight hospitals and clinics in Nara Prefecture and had accidentally ingested an allergen between November 2019 and October 2020.

Results: Of the 80 accidental ingestion cases, 51 cases occurred at home, followed by a restaurant and at school lunch. Improper ingredients check and minimal child supervision caused the majority of cases in households. At restaurant, an insufficient ingredients check was the leading cause of accidental ingestion, and during school lunches, the primary cause was meal serving mistakes.

Discussion: There are many cases of accidental ingestion of allergens at home caused due to improper ingredients check. Hence, this is crucial in patient education. It is necessary to inform and educate parents and patients with food allergies about the importance of carefully checking for allergens in foods that have not been cooked by them or are being eaten for the first time, without making judgements or assumptions based on the appearance. Everyone in the child's life should be aware of the risks of food allergies in order to ensure the safety of children with food allergies in everyday life.

[Introduction] There are few reports on the long-term changes in anxiety and the burden regarding the avoidance of antigens due to food allergies and the burden of treatment of oral immunotherapy.

[Method] An annual questionnaire survey was conducted for 45 children with food allergies (egg, n=21; milk, n=10; and wheat, n=14) and their parents who underwent rush oral immunotherapy at Aichi Children's Health and Medical Center.

[Results] Before the immunotherapy, 90% of parents felt a burden when choosing restaurants and anxiety regarding anaphylaxis, and 90% of children felt a burden from food avoidance. Although burdens related to avoidance gradually improved after oral immunotherapy, persistent exercise-induced allergic reactions and the presence of other food allergies were associated with difficulty in improving them. The burden of oral immunotherapy itself was larger and gradually improved in parents, but did not improve in children.

[Conclusion] We should provide children and their parents with sufficient information regarding the burdens that may persist, even after oral immunotherapy. The shared decision making of parents and the strong willness of children are essential for oral immunotherapy.

Pertussis is an infectious disease associated with whooping, staccato cough and apnea. Adolescents and previously immunized children sometimes do not display any typical symptoms. We are reporting three cases of pertussis in adolescents with asthma, whose main symptom is coughing. At first, they were treated as asthma exacerbation cases. We later diagnosed pertussis, because they were coughing strongly at night and quick-relief medications were not effective. Patients with asthma tend to be treated as having asthma exacerbation when they are coughing. In the situations in which their coughing does not improve, different diagnoses, including pertussis, should be considered. Patients should then be treated with appropriate medications.