A 14-year-old boy was diagnosed with bronchial asthma at 2 years of age, and long-term management was initiated. However, in spite of the long-term treatment using asthma controllers he was hospitalized for acute exacerbations of asthma 30 times by the age of 12 years. In junior high school, the severity of asthma increased. Even with the use of a medium-dose inhaled corticosteroid/long-acting beta2-stimulant combination, he exhibited wheezing and dyspnea daily, which seriously affected his school life, including physical education classes and club activities (track and field team). He presented to our hospital and the diagnosis of asthma was confirmed. We added dupilumab to his regular treatment. Two months after commencing the drug, he no longer experienced wheezing or dyspnea. The maximal decrease rate of FEV1.0 after exercise provocation test improved from 78% to 29%. However, a re-evaluation 1 year and 3 months after commencement of the drug showed no further improvement. This case demonstrates the effectiveness of dupilumab in managing severe asthma in children. The long-term effects of dupilumab on respiratory function and exercise-induced bronchoconstriction will also be evaluated.

A 3-year-old boy had eaten fish with every meal since he was 5 months old. At the age of 10 months, he developed severe vomiting 2 hours after each meal, followed by sobbing and decreased activity levels, which improved after vomiting 3-4 times. Similar symptoms and bouts of vomiting occurred when he ate foods other than fish. However, these symptoms did not require emergency medical attention and did not meet the diagnostic criteria for food protein-induced enterocolitis syndrome (FPIES). At the age of 3 years 6 months, vomiting was induced 3 hours after ingestion of salmon in an oral food challenge test, leading to the diagnosis of FPIES due to salmon.

Cases of FPIES may not be diagnosed due to milder symptoms. In the present case, the symptoms of FPIES due to fish intake were observed since early weaning. However, a definitive diagnosis of FPIES was difficult because of the absence of serious systemic symptoms and vomiting caused by foods other than fish. Because FPIES symptoms may not always be severe, the diagnostic criteria for FPIES may not be met. New diagnostic criteria for FPIES, including mild FPIES, are needed.

(Background) The effects of the early introduction of eggs to sensitized infants are not elucidated.

(Methods) This prospective study included six-month-old infants who tested positive for a skin prick test (SPT) against eggs. They were introduced to a heated egg yolk, then a small amount of egg white (0.02 g), and then gradually fed increasing amounts. They underwent SPT at ages 9 and 12 months. The SPT results and occurrence of egg allergy were compared to those of a previous cohort in which eggs were introduced later in infancy.

(Results) We followed 38 and 75 infants with positive SPT in the new and previous cohorts, respectively. At 9 months, significantly fewer infants in the new cohort showed a positive SPT (P = 0.02). The average wheal size of SPT in egg-allergic infants was significantly smaller in the new cohort at 12 months (P = 0.03). Although 12 (32%) infants were diagnosed with egg allergy in the new cohort, none of them showed severe allergic reactions or eliminated eggs. In contrast, 27% of infants in the previous cohort eliminated eggs during infancy.

(Conclusion) Early introduction of eggs to sensitized infants may attenuate the sensitivity.

Patients with allergic diseases are "people requiring special care" during disasters, and appropriate care must be provided in shelters. We conducted a questionnaire survey of disaster medical workers to evaluate existing tools such as pamphlets and consultation services for dealing with allergic patients in disasters, and to investigate unmet needs. A total of 266 participants responded to the survey and were analyzed. Participants requested electronic media and lectures by specialists as a means of obtaining information on allergic diseases in normal times, while smartphone applications and paper media were requested during disasters. Awareness of existing tools such as websites related to allergies was not high, ranging from about 10-30%; about 66% of participants indicated that COVID-19 would have a negative impact on the management of allergic diseases during a disaster. Of the 73% disaster medical workers, a centralized consultation office for allergic diseases in the event of a disaster was requested. Many respondents requested tools to educate the patients about self-help and to provide information of the affected patients. In conclusion, there is a need to actively improve the allergic disease manual, including providing information for disaster medical workers.

Anaphylaxis is an acute systemic hypersensitivity reaction, representing the most severe form of an allergic reaction, and all physicians must provide appropriate initial treatment at the onset of the reaction. The World Allergy Organization Anaphylaxis Guidance, revised in 2020, and the Anaphylaxis Guideline 2022, based on the 2020 revision, have updated the definition and diagnostic criteria for anaphylaxis to prevent errors in treatment decisions. Adrenaline intramuscular injection remains the first-line treatment, and the prescription of an adrenaline auto-injector for self-management at the onset of symptoms is still recommended. However, the prescription rate of adrenaline auto-injector for anaphylaxis patients remains low, indicating a need for resolution. In Japan, the findings of a large-scale epidemiological study, including a nationwide survey of anaphylaxis cases and analysis of drug-induced anaphylaxis using the adverse drug reactions database, were reported last year. This review focuses on the latest findings on anaphylaxis with specific emphasis on the revised guidelines.

This article discusses the mechanism of action, indications, administration methods, and side effects of omalizumab, an anti-IgE antibody, with a focus on pediatric bronchial asthma. The indications and ages for omalizumab in the treatment of chronic idiopathic urticaria and seasonal allergic rhinitis are also addressed. Omalizumab has been attracting attention as a promising treatment for severe or refractory pediatric bronchial asthma. By discussing important considerations and evaluation points when introducing omalizumab, we aim to provide useful guidance for its appropriate use in clinical practice.

Dupilumab is a biologic medicine that has been approved for coverage in 2019 for the treatment of asthma in patients aged 12 years and older. Its use in children is increasing. In adults, it is also indicated for atopic dermatitis and chronic sinusitis with nasal polyps. Because dupilumab targets the basic pathophysiology of allergic inflammation, it is expected to be effective not only in these but also in a variety of other allergic diseases. In fact, numerous clinical studies have been conducted on dupilumab in various allergic diseases, and data have been accumulated showing that dupilumab is useful even in pediatric patients. On the other hand, dupilumab is an expensive drug, and its use requires a thorough understanding of its indications, adverse events, and precautions, as well as appropriate use in the right patients. Especially in pediatric patients, it is necessary to pay attention to data on long-term safety as well as efficacy.

Physicians who treat patients with food allergy should understand the allergy labeling system and provide guidance and support to the patient and family. Labeling of foods containing allergens is regulated by the Food Labeling Act, administered by the Consumer Affairs Agency. Eight specific raw materials (shrimp, crab, walnut, wheat, buckwheat, egg, milk, and peanut) are required to be labeled as allergenic foods based on number and case severity. In addition, 20 materials equivalent to specified raw materials are recommended for labeling. Labeling requirements apply only to containerized and packaged processed foods, and do not apply to eating-out industry and home meal services, so caution should be exercised when consuming such foods.

In December 2015, the Basic Act on allergic disease control came into effect, and measures that deal with allergic diseases are now defined by law. Measures to be taken in schools, kindergartens, and daycare centers are based on the "Guideline on Measures for Allergic Diseases at Schools" and "Guideline on Measures against Allergy at Nursery". When a child with food allergy requests any type of accommodation at a facility, it will be required to submit a "Certificate for School Life Management (for allergic diseases) " or "Certificate for Nursery Life Management" based on a diagnosis from a physician. The physician should be familiar with the guidelines and should provide necessary information to be shared regarding lifestyle and circumstances of the child. In the case of school meals, the highest priority is to ensure safety. For this reason, provision of school meals should be based on a choice between complete elimination or no elimination, as opposed to the minimum necessary elimination at home. Physicians are expected to actively and appropriately provide advice and guidance to school allergy and emergency committees. When participating in school events or overseas trips that involve overnight stays or meals out, physicians are instructed to make advance preparations, including gathering sufficient information about local social conditions, emergency medical systems, and planned meals.

In a large-scale disaster involving the shutdown of lifelines, patients with food allergy may probably face a difficult situation. Disaster preparedness can be categorized into self-help (household preparedness), mutual help (joint preparedness with others), and public help (public preparedness). It is said that immediately after a disaster strikes, the ratio of self-help, mutual help, and public help will be 70%, 20%, and 10%, respectively. In terms of self-help, it is recommended that households stockpile at least a three-day supply of food, preferably a week's supply. In terms of mutual help, it is important for the patients or family to have connections with the community, and to have relationships to help each other on a daily basis. In public assistance, physicians are expected to pick up requests from patients who need assistance during a disaster and provide information to local governments or organizations providing disaster relief.

Physicians should instruct patients and their families to stockpile specific food elimination diet on a regular basis and help them get the support they need in a disaster.

The effectiveness of reducing house dust mite (HDM) antigen levels in the environment of asthmatic children was assessed in a systematic review. An electronic search identified 25 randomized controlled trials (RCT) that were included in a meta-analysis. We analyzed O1: Subjective symptom improvement; O2: Asthma symptom scores; O3: Medication usage; O4: Days of sick-leave from school or work; O5: Number of unscheduled physician or hospital visits; O6: FEV1 (forced expiratory volume in one second); O7: PEFR (peak expiratory flow rate); O8: PC20 (provocative concentration causing a 20% decrease in FEV1); and O9: FeNO (fractional exhaled concentration of nitric oxide). For O3, O5 and O7, intervention to reduce HDM antigen showed a significant beneficial effect, but O3 and O5 were referenced in only one study. No significant effect of interventions was seen for the other outcomes. Our results suggest that intervention to reduce HDM antigen levels in the environment of asthmatic children does not have a significant effect. However, given the variety of the climatic conditions and life-style of the countries that were the focus of studies included in our meta-analysis, careful interpretation is needed and questions should be addressed to determine whether these results are applicable to Japan.

We performed a systematic review to determine the effectiveness of glucocorticoids in treating acute viral bronchiolitis in infants and young children. The review included 18 studies (seventeen by the Cochrane Database of Systematic Reviews, one by Alansari et al. ). No significant differences in the primary endpoints of admission and lengths of stay between the glucocorticoids group and placebo group were found. Regarding the secondary endpoints, glucocorticoids significantly improved clinical scores at 3-6 hours and 6-12 hours post-administration in the inpatient group and significantly lowered oxygen saturation at 3-6 hours post-administration in the outpatient group. There were no differences before or after either of these treatments and they were considered to be temporary. Furthermore, there were no significant differences in the respiratory and heart rates or the readmission rates and return healthcare visits between the two groups. This study had some limitations since the type, method, dosage, and duration of glucocorticoid administration varied. In addition, the analysis was limited to the first-episode wheezing, and further studies are needed about recurrent episodes of wheezing.

[Objective] This study aimed to investigate the current state of nutrition and diet guidance for children with food allergies and to expand the target age group for such guidance to include children younger than 16 years.

[Method] A web-based survey was conducted on 3,757 medical doctors who had registered their email addresses. The study received 376 responses, resulting in a response rate of 10%.

[Results] The survey revealed that 48% of respondents calculated the guidance fee for children younger than 9 years old, while 87% believed such guidance is essential for children 9 years and older. The respondents stressed the importance of indicating the range of foods that children can safely consume, providing guidance on precautions when eating out or eating ready-made meals, and explaining cross-reactive allergens such as nuts and fruits. Approximately half of the respondents answered that fewer than one child with food allergies aged 9-15 years received guidance every several months, and 77% of respondents stated that the current level of guidance was insufficient. Reasons cited for the lack of dietitians' education included food allergy nutrition (62% of hospital doctors), a shortage or absence of dietitians (77% of clinic doctors), and a failure to calculate guidance fees (48% of all respondents).

[Conclusion] The findings of this survey suggest that medical fees for the guidance provided to children between the ages of 9 and 15 need to be reviewed and updated. The study also highlights the need for improved food allergy education in dietitian training programs, regularly updated allergy treatment, and the use of communication devices to provide guidance more efficiently. This study's findings may contribute to providing high-quality allergy treatment nationwide.