Providing support to patients with allergic diseases during disasters is a crucial part of disaster relief. However, dieticians who provide this support to disaster-stricken individuals often face various challenges. Therefore, this study aimed to investigate the current situation of dieticians and their unmet needs to develop better tools for managing allergic diseases during disasters. We conducted an online survey of dieticians who are members of The Japan Dietetic Association; 514 responses were obtained. The results show that in non-disaster times, most respondents preferred obtaining information from electronic media and lectures. While during disasters, print media was most frequently requested as the source of obtaining information. It was found that approximately 26% of the respondents provided support to patients with food allergies during disaster relief activities, and approximately 80% of those who needed medical attention were children. Approximately 80% were able to provide the right foods to patients with allergies, and 70% were able to do so within 24 hours of the disaster. Although few dieticians have actually done so, the majority of them believed it was desirable to collaborate with doctors to work on allergic cases. Based on the needs of the dieticians identified in this survey, it is necessary to develop and disseminate information through electronic media and lectures in normal times and as print media during any disaster.

Objective: We aimed to conduct a questionnaire survey to identify the problems and unmet needs faced by pharmacists involved in providing disaster relief to individuals with allergies. Method: We conducted an unmarked web-based survey among pharmacists through the Japan Pharmaceutical Association and the Japanese Society of Hospital Pharmacists. Results: We received responses from 235 pharmacists. While most pharmacists expressed a preference for receiving allergy information electronically under normal circumstances, the number of pharmacists who desired to receive this information in printed form increased significantly during times of disaster. Only a few pharmacists used the Allergy-portal site and existing materials on allergic diseases. Antihistamines were the most common medications carried and dispensed; however, pharmacists identified issues related to the quantity and dosage forms of allergy-related drugs. Many pharmacists recommended carrying inhalation aids and adrenaline auto-injectors. 79.6% of the pharmacists emphasized the importance of carrying prescription records as guidance during an evacuation. Conclusion: It is necessary to popularize materials and the benefit of using Allergy-portal, and raise awareness about carrying a medicine list and prescription records during disaster relief or evacuations. On the other hand, how adrenaline autoinjectors with a short expiration date, can be supplied in the event of a disaster, needs to be addressed in the future.

We present a case of a girl with food allergies whose total IgE and food- and environmental-antigen-specific IgE levels declined below the detection threshold over time and who finally achieved food allergy remission despite a history of anaphylaxis.

During infancy, she experienced allergic symptoms due to ingestion of wheat, milk, and chicken eggs. At the age of 3, she consumed 8 g of udon noodles during an oral food challenge test and developed an anaphylactic shock. At the age of 4, her maximum level of total IgE was 495 IU/mL, wheat-specific IgE was 55.8 UA/mL, and Dermatophagoides farinae (Der f) specific IgE was >100 UA/mL. However, by the age of 5, her levels of total and specific IgE tended to decrease, and at the age of 6, her total IgE and food- and environmental-antigen-specific IgE levels decreased below the detection threshold. Subsequently, she was able to ingest wheat, milk, and chicken eggs without any symptoms. Of the 50 outpatients with milk-specific IgE and milk allergy who were followed up, 13 patients with Der f-specific IgE were followed up and evaluated. No patient exhibited a decrease in Der f-specific IgE levels below the detection threshold.

It is expected that elucidating the mechanism of IgE level-negative conversion in such patients will lead to the development of new treatment methods.

Non-IgE-mediated gastrointestinal food allergy causes gastrointestinal symptoms mainly through non-IgE-dependent allergic mechanisms after feeding of formula or breast milk in neonates and infants. We conducted a retrospective chart review of 31 patients who were born between 2016 and 2021 in our hospital and were diagnosed with non-IgE-mediated gastrointestinal food allergy. Gastrointestinal symptoms of 28 patients improved after changing the formula, but the symptoms improved only partially and vomiting persisted in the remaining three patients. The finding of gastroesophageal reflux in upper gastrointestinal imaging and the favorable clinical response to treatments such as antacids in these three patients led us to diagnose gastroesophageal reflux disease. We were unable to identify risk factors that are significantly related to the complication of gastroesophageal reflux disease. It is important to consider complications of gastrointestinal diseases such as gastroesophageal reflux disease when neonates with non-IgE-mediated gastrointestinal food allergy have persistent gastrointestinal symptoms such as vomiting even after changing the formula.

Purpose: To compare awareness among nursery staff to prevent allergic reactions during lunchtime between 2013 and 2021 and between nurseries with and without children that experienced anaphylaxis.

Methods: In 2013 and 2021, a questionnaire was distributed to all registered nurseries in Shiga Prefecture, Japan. The free-writing answers to the question "How do you prevent allergic reactions to food as a result of erroneous servings during lunchtime?" were analyzed using text mining.

Results: Answers were obtained from 232 nurseries (87.9%) in 2013, and 251 nurseries (71.7%) in 2021. The most common word in the answers from 2021 and from nurseries with children that experienced anaphylaxis was "confirm". Five categories and 13 codes were extracted by co-occurrence network analysis. The frequencies of the two codes, "distinguish dishes for children with food allergy from those for others" and "perform multiple checks", were significantly higher in 2021 than in 2013. The frequencies of the two codes, "display on the bulletin board" and "isolate the table" were significantly higher in answers from nurseries with children that experienced anaphylaxis than from nurseries without them.

Conclusion: Heightened awareness among nursery staff to prevent allergic reactions during lunchtime was observed between 2013 and 2021 and at nurseries with children that experienced anaphylaxis.

We studied the therapeutic effects of 61 pediatric patients who continued mite sublingual immunotherapy (SLIT) for 3 years. From our own evaluation table using in daily clinical practice, we investigated 21 Visual Analog Scale (VAS) -items about rhinitis and its related symptoms and 17 VAS-items of side reactions and 5 questions about treatment adherence. These were retrospectively investigated at the beginning of treatment, 1,2, and 3 years after treatment. At the start of treatment, "stuffy nose" had the highest median VAS score, followed by "itchy skin." The 11 items such as nasal, skin, and eye symptoms showed significant changes between observation time points, and were significantly decreased at all time points compared to the start of treatment. The total number of adverse reactions at the start of treatment was 35, and after 3 years of treatment was 20. Adverse reactions related to the oral cavity were frequently observed throughout the observation period. Regarding the difficulty of treatment, 1 respondent answered "painful" and 4 responded that it was "a little painful" in the third year of treatment. While the continuation of sublingual immunotherapy for 3 years in children is effective in improving nasal symptoms, some patients complain of side reactions and difficulties in treatment, and continuous support for each patient is desired.

Viral infections are involved in the development and exacerbation of pediatric asthma. There are numerous reports about them, such as rhinovirus, respiratory syncytial virus, etc., and we often meet the patients practically. Recently, it has been reported other viruses, such as, human metapneumovirus, pandemic A/H1N1 2009, A (H1N1) pdm09, and enterovirus D68 can also induce asthma exacerbation. On the other hand, there are fewer reports about the relationships between asthma exacerbation and severe acute respiratory syndrome-coronavirus-2. We report that rhinovirus was predominantly present in specimens of nasopharyngeal mucosa cells from hospitalized asthmatic children with exacerbation between 2012 and 2015. Some patients were hospitalized repeatedly by rhinovirus-induced asthmatic exacerbation, similar to previous reports. During the pandemic of A (H1N1) pdm09, there were a lot of pediatric patients who were hospitalized by severe pulmonary complication, such as pneumonia, severe asthmatic exacerbation, and atelectasis. We tried analysis of the pathophysiology and establishment of the treatment and prevention of severe pulmonary complications in asthmatic children during A (H1N1) pdm09 infection using an animal model as the base. The use of the animal model was because our model showed some similarities to clinical features in A (H1N1) pdm09-infected asthmatic children. In this review, we explain the clinical characteristics and the results of our research about the pathophysiology of virus-induced severe complication in children with bronchial asthma.

Recently, in drug allergy, the importance of "de-labeling" (correcting a misdiagnosis of drug allergy) has been emphasized; further, careful and correct diagnosis is required. To diagnose immediate drug allergy, a skin prick test, an intradermal test, and a drug provocation test (DPT) are performed. A supplementary basophil activation test and drug-specific IgE test can be performed, although they are not covered by insurance in Japan. An intradermal test or patch test is performed for non-immediate drug allergy, followed by DPT. As regards the drug lymphocyte stimulation test, few reports provide evidence to recommend its use; further, caution is warranted while diagnosing drug allergy based on this result alone as it may lead to "wrong labeling". Herein, this paper will outline the definition and classification of drug allergy, the flow to DPT for diagnosis, and the detail of examination for antibiotic allergy, which is the frequent differential diagnosis.

Mepolizumab, a biologic, has been approved for insurance coverage to treat severe asthma in patients aged ≥6 years and eosinophilic granulomatosis with polyangiitis in adults in Japan. It targets interleukin-5, i.e., eosinophils, and is effective in eosinophilic diseases as it works by suppressing eosinophilic inflammation. In asthma, mepolizumab reduces the rate of exacerbation as blood eosinophil count increases. Therefore, the appropriate medicine should be selected based on biomarkers of the disease. In this review, we explain the mechanism of action and indications for mepolizumab in asthma and eosinophilic granulomatosis with polyangiitis, with a focus on interleukin-5 and eosinophil function.

Benralizumab is an anti-IL-5Rα antibody, and has a potent eosinophil-suppressing effect through two different actions, i.e., an IL-5 receptor-mediated action and the induction of eosinophil apoptosis through ADCC activity. In various clinical trials, in patients with eosinophilia, the effect of suppressing exacerbation of asthma, improving respiratory function, and reducing the amount of systemic steroids was observed. Side effects are no different from other biologics. Although there is no self-injection formulation, it is characterized by a long dosing interval of 8 weeks during the maintenance phase. In Japan, benralizumab is not indicated for children, but is indicated for adults. It is a drug that is considered for administration to patients with refractory asthma in adults who have type II inflammation and who have eosinophilia.

Pathophysiology of atopic dermatitis (AD) consists of the interaction between skin barrier dysfunction, allergic inflammation, and itch. Itch is the most important clinical symptom of AD, and has a significant impact not only on the pathogenesis but also on the quality of life (QOL) of AD patients. Recently, interleukin-31 (IL-31) has been identified as a pruritogenic agent and found to be involved in chronic itch. Nemolizumab is a humanized anti-IL-31 receptor alpha (IL-31RA) monoclonal antibody targeting IL-31RA, which is a receptor for IL-31, and competitively binds to IL-31RA, thereby inhibiting IL-31 signaling and suppressing itching. Clinical studies have shown that Nemolizumab improves skin symptoms and the quality of life of AD patients. While it is a new treatment option for AD, there are some problems in its use, and it is important to fully understand these problems before using it in the treatment of patients with atopic dermatitis who suffer from itch.

Phosphodiesterases (PDEs), which were discovered by Sutherland and Rall in 1958, are enzymes that hydrolyze phosphate diester bonds in molecules such as cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Among the 11 PDE subfamilies, PDE4 is the most diverse and is expressed in numerous cell types. Signaling pathways involving cAMP and cGMP play crucial roles in regulating various physiological functions, including those related to inflammatory diseases and cardiovascular, immune, and central nervous systems. Although PDE inhibitors were recognized for their potential therapeutic benefits, their widespread application was delayed due to the associated systemic side effects. Rolipram is the first PDE4 inhibitor and was developed in 1977. However, its use was discontinued due to side effects such as nausea and vomiting. The PDE4 has four subtypes, PDE4A, PDE4B, PDE4C, and PDE4D, which share similar sequences and structures; therefore, the development of subtype-specific inhibitors is challenging. Difamilast ointment is a PDE4 inhibitor which was introduced for topical treatment of atopic dermatitis in 2022, addressing previous challenges by enhancing PDE4 subtype selectivity and topical formulation. Phase III trials for difamilast ointment in both adults and children with atopic dermatitis demonstrated significant efficacy and safety, with proven effectiveness over a 52-week period. Japan's approach to topical treatment for atopic dermatitis has evolved, positioning difamilast ointment as the fourth treatment following topical steroids, tacrolimus ointment, and delgocitinib ointment. This article reviews the evolution of systemic PDE4 inhibitors and compares crisaborole ointment, a topical PDE4 inhibitor, with difamilast ointment.

The JAK/STAT pathway has a role in the signal transduction of many cytokines involved in inflammation in atopic dermatitis. Delgocitinib, which was recently released in Japan, is a topical agent that inhibits the activity of all JAK family kinases and achieves its therapeutic effect by suppressing various cytokines involved in inflammation in atopic dermatitis. Phase 2 and 3 clinical trials of delgocitinib ointment in children found that the drug decreased the severity of atopic dermatitis and reduced the itching score. It may therefore take its place among topical steroids and tacrolimus ointment as a new topical agent for atopic dermatitis. The present article describes the molecular mechanism of cytokines in the pathogenesis of atopic dermatitis and the pharmacological activity of delgocitinib ointment against the disease.

JAK inhibitors, which primarily inhibit JAK1 and JAK2, are garnering attention as new therapeutic agents for atopic dermatitis. These drugs exert a favorable therapeutic effect by blocking the intracellular signaling of multiple cytokines involved in the pathogenesis of atopic dermatitis, such as IL-4, IL-13, IL-22, and thymic stromal lymphopoietin. Additionally, they are unlikely to cause serious side effects, even when systemically administered, because they have a little effect on molecules in the JAK family except JAK1 and JAK2. One of the clinical characteristics of JAK inhibitors is their ability to rapidly exert their effect after their administration. The administration of JAK inhibitors can reduce the itching sensation within a few days. Notably, this effect does not diminish even in cases where they are administered for an extended period; however, the effect quickly dissipates after discontinuation of their administration. Until June 2023, three orally administered JAK inhibitors were available in Japan to treat atopic dermatitis; however, these inhibitors are expensive. Nevertheless, their high therapeutic responsiveness can be utilized for remission induction in patients with moderate to severe disease or used to deliver adjunctive therapy to topical steroids in acute exacerbations.