Purpose: Patient Centered Care (PCC) is an essential component of quality of health care, and Shared Decision Making (SDM) is a decision support method to achieve PCC. Aiming to improve the quality of care in pediatric allergy in Japan, we assessed the needs for PCC/SDM in this field.

Methods: Both allergy practitioners and other practitioners were surveyed regarding the degree of PCC/SDM awareness, and values emphasized in the SDM-Q-Doc questionnaire. The numbers and percentages of references related to SDM in each disease area and within the pediatric allergy area in Igaku-Chuo-Zasshi (ICHUSHI) and PubMed were searched.

Results: There were 60 respondents, 39 of whom were allergy practitioners (34 of whom were pediatricians). Between allergy practitioners and other practitioners, 12/39 (31%) and 5/21 (24%) had never heard of PCC and 12/39 (31%) and 4/21 (19%) had never heard of SDM, respectively. The percentage of references related to SDM in allergic diseases in ICHUSHI was 0.04% of total references for allergy. The percentage of SDM references for allergy in PubMed was 0.08%. The number of references related SDM in child allergic diseases in ICHUSHI was 1.

Conclusion: PCC/SDM has not been well recognized or commonly discussed. To further improve the quality of pediatric allergy care in Japan, we need to add a PCC/SDM perspective in addition to safety and efficacy.

As a result of recent advances in neonatal medicine, the number of children who undergo tracheostomies, and gastrostomies, and constantly receive medical care is increasing yearly. Moreover, it is expected that the number of children with medical care who have or are suspected of having food allergies will increase, but no reports have been made to date. In this study, we performed five transgastric food challenge tests on three children under medical care. We ensured that the target dose was minimal and urged caregivers and staff who have experience in nursing to constantly observe closely. By conducting a transgastric challenge test, the amount of food ingested increases with the possibility of using elemental nutrients, which was previously impossible. We hope more experience with the transgastric challenge test will be accumulated, and the number of facilities that can perform this test will increase.

Purpose: To conduct a survey on patients regarding the actual situation of school lunch provision to children with food allergies.

Methods: In July 2017, we surveyed food allergy patients visiting our department who had asked their elementary schools to eliminate food items included on the menu list and obtained details concerning the provision of eggs, milk, and wheat.

Results: The number of valid responses was 184 from 36 municipalities (33 communal kitchens). Twenty-five (13.6%) did not receive school lunch and brought their own lunch every day for their meal, and the other 159 asked their schools to provide school lunches catering to food allergies (eggs in 94 (59%), milk in 67 (42%), and wheat in 24 (15%) ). The frequency of menu lists that restricted to provide food items containing eggs, milk, and wheat as side dishes for 0 to 2 days were 32%, 55%, and 0%, respectively. Regardless it was a main dish or a side dish, 58% of egg-, 79% of milk-, and 84% of wheat-containing dishes were almost canceled to the allergic children. Using processed foods requiring cooking only in the final preparations made it difficult to provide alternative meals.

Conclusion: The number of meals not using eggs, milk, or wheat should be increased, as should the use of processed foods not containing wheat, in order to safely provide as many meals as possible to patients with food allergies while also taking into consideration the cost of school lunches and the burden on schools.

Objective: The aim in this study was to analyze the solubility and immunoglobin E (IgE) -binding ability of the egg white proteins in boiled eggs during boiling.

Methods: Boiled eggs were prepared by cooking large commercial hen's eggs in boiling water. Protein extraction from the raw (boiled for 0 min) and boiled egg whites, after lyophilization, was performed with phosphate-buffered saline (PBS), sodium dodecyl sulfate and urea solution, and 2-mercaptoethanol (2-ME) solution; the extracts were analyzed using the inhibition ELISA, SDS-PAGE, and IgE immunoblotting.

Results: The amount of ovalbumin (OVA) in the PBS fraction decreased significantly over time during 7 and 9 minutes of boiling. The SDS-PAGE results showed that the ovotransferrin, OVA, and lysozyme disappeared over time in the PBS fraction but were detected in the 2-ME solution fraction. Additionally, the band presumed to be ovomucoid (OVM) did not disappear from the PBS fraction after 20 minutes of boiling. The bands of IgE-binding proteins in the PBS fraction decreased at approximately 5 and 10 minutes.

Conclusions: Egg white proteins except OVM gradually became insoluble in water up to 10 minutes of boiling time and did not change thereafter. The results of this study provide basic data on the guidance of heated egg consumption.

Background: Most cases of food allergy (FA) are managed by non-allergy specialists (NS).

Objectives: This study aimed to identify current medical practices by NS for children with FA.

Methods: We analyzed the contents of lifestyle management guidance forms (LMGF), from the 2017 fiscal year, at nursery schools in Toyama City.

Results: Of the 11,292 children attending the nursery schools, LMGF forms were submitted for 740 (6.6%) FA; most (58.2%) were written by NS. Anaphylaxis occurred significantly less frequently among the children whose FA was managed by a NS than those by allergists. There was no significant difference in the number of foods eliminated by NS or allergists. Allergists were more likely than NS to cite oral food challenge as the reason for eliminating hen's egg (8.8% vs 1.0%) and cow's milk (8.9% vs 1.7%). NS was more likely to recommend elimination of foods containing trace quantities of culprit foods - e.g. eggshell calcium and lactose - than allergists.

Conclusion: NS managed more than half of children with FA and recommended more strict elimination than allergists. It is necessary to promote equal management level for FA through collaboration between allergists and NS.

Non-IgE-mediated gastrointestinal food allergy (non-IgE-GIFA) is a type of food allergy that is not dependent on IgE antibodies and is caused by cellular immunity. Non-IgE-GIFA can be divided into acute food protein-induced enterocolitis syndrome (Acute FPIES), which presents with an acute reaction of vomiting, and the Chronic type, which presents with chronic inflammation of gastrointestinal (GI) tract. International guidelines (Nowak et al. J Allergy Clin Immunol 2017) established diagnostic criteria for Acute FPIES. At the same time, the incidence of Acute FPIES caused by egg yolk increased rapidly in Japan. It became popular in the pediatric field. On the other hand, the Chronic type has been on the increase since the late 1990s. This type is more common in the neonatal period and early infancy, and chronic inflammation of the GI tract can lead to malnutrition and neurodevelopmental delay. In the Chronic type, some patients do not meet the subgroup criteria because of the narrow definition of the diagnosis. Revision may be needed to fit more patients. In this article, I would like to review the current status of the syndrome by organizing information from current international and Japanese practice guidelines and presenting new findings.

In recent years, tree nut allergies have significantly increased globally, particularly in advanced countries, including Japan. The 2020 nationwide survey on immediate-type food allergies in Japan revealed that tree nuts ranked third among causative foods, showing a sixfold increase compared to 2011. Tree nut allergies manifest severe symptoms, and walnuts and cashew nuts in particular cause frequent reactions. Clinical features include early childhood onset, a high frequency of allergic reactions, including anaphylaxis at the first intake of tree nuts, and frequent complications of atopic dermatitis and other food allergies. Raising awareness to prevent unforeseen tree nut anaphylaxis is crucial. For very high-risk children, evaluating specific IgE antibody titers before the first intake, and based on the results, conducting oral food challenge tests or carefully introducing the allergen at home are considered beneficial. This approach contributes to overall patient well-being by reducing unnecessary food avoidance. Based on the latest literature, this article provides a comprehensive overview of tree nut allergies and offers recommendations for preventing tree nut-induced anaphylaxis.

Tocilizumab is the first anti-interleukin (IL) -6 receptor monoclonal antibody developed in Japan. Tocilizumab binds to the soluble or membrane-bound form of the IL-6 receptor to inhibit the binding of IL-6 to its receptor, which suppresses subsequent signaling and reduces IL-6-related systemic inflammation. Tocilizumab is currently used to treat rheumatic diseases such as juvenile idiopathic arthritis and Takayasu arteritis. Furthermore, tocilizumab was recently approved to treat cytokine release syndrome induced by tumor-specific T-cell infusion therapy and pneumonia caused by SARS-CoV-2, in addition to various rheumatic diseases. This study describes the mechanism of action, application, pre-introduction evaluation, side effects, and prospects of tocilizumab. This will provide useful guidance for its appropriate use in clinical practice.

In juvenile idiopathic arthritis (JIA) and Kawasaki disease (KD), the most common pediatric rheumatic diseases, there is a certain number of patients who are refractory to anchor drugs such as methotrexate and immunoglobulin. With the advent of tumor necrosis factor (TNF) inhibitors, these refractory cases can now be treated. In Japan, TNF inhibitors first became available for use in pediatric patients in 2009 and currently include etanercept (ETN), a soluble receptor construct, adalimumab (ADA), a fully human monoclonal antibody, and infliximab, a chimeric monoclonal antibody. For JIA with active polyarticular joints refractory to methotrexate, ETN is injected subcutaneously at 0.2 to 0.4 mg/kg twice weekly, and ADA is injected subcutaneously at 20 or 40 mg every two weeks. The efficacy of ETN and ADA in arthritis is comparable, but it is hoped that further clinical trials will allow stratified treatment. ADA is more effective in uveitis. For Kawasaki disease refractory to intravenous immunoglobulin (1st line), infliximab is given as a single 5 mg/kg intravenous infusion. It can be administered from the 2nd line, but should be administered in specialized centers experienced in the use of the 3rd line.

IL-1 inhibitors are monoclonal antibody that can inhibit the function of human interleukin (IL) -1β. IL-1β is an inflammatory cytokine induced by the activation of inflammasome. There are several diseases due to the involvement of IL-1β activation in those inflammatory pathogeneses. In this article, we describe the functional mechanism, efficacy, and prospects of canakinumab, an anti-IL-1β antibody which is available in Japan. The worldwide current options of therapeutic drug to suppress the IL-1β signaling are canakinumab, a fully human anti-IL-1β antibody, anakinra, an IL-1 receptor antagonist, and rilonacept, an IL-1 trap. These IL-1 inhibitors can be used not only for autoinflammatory diseases such as cryopyrin-associated periodic fever syndrome, but also for systemic juvenile idiopathic arthritis globally. Additionally, in US and Europe, canakinumab is indicated for the patients with adult-onset still disease and gouty arthritis. Further clarification of the role of IL-1 in various inflammatory response should lead the elucidation of the pathogenesis of human intractable diseases and control of disease activity by using IL-1 inhibitors.

Thymic stromal lymphopoietin (TSLP) is an epithelial cell-derived cytokine that plays a critical role in the induction of type 2 inflammation through both innate and adaptive immune pathways. Tezepelumab, a human IgG2 monoclonal antibody that inhibits the binding of TSLP to its receptor, is a novel biological agent for asthma.

Several clinical trials, such as PATHWAY, NAVIGATOR, NOZOMI, UPSTREAM, CASCADE, SOURCE, and DESTINATION, have been conducted to evaluate the efficacy and mechanism of action of tezepelumab in asthma. The results suggest that tezepelumab, a broad-target biological agent, is effective for patients with asthma that is difficult to control with inhaled steroids, regardless of phenotype. However, the mechanism of action of tezepelumab, its efficacy in non-type 2 phenotype patients, and its impact on oral steroid-dependent asthma remain unclear, necessitating further research.

The selection of biological agents for treating pediatric asthma has not yet been established, necessitating consideration of appropriate treatment options based on the patient's pathology.

The Japanese Pediatric Guidelines for the Treatment and Management of Asthma 2023 are like the existing guidelines and were created in accordance with the Minds Clinical Practice Guideline Creation Manual. The clinical questions (CQs) in the guidelines aim to provide evidenced-based therapy. The CQs are related to asthma treatments with differing opinions among experts. This guideline continued the 12 CQs sets presented so far and added two new CQs. Of the two new CQs, one was the effectiveness of environmental mite allergen countermeasures (which were traditionally administered as part of patient guidance) and the other was the effectiveness of steroid medication administration for viral wheezing in infants, which is often conducted in daily clinical practice. The systematic review referred to previous reports on each CQ, conducted an updated review using the same method, and was compiled into a report. The main databases were MEDLINE, Embase and CENTRAL. The recommendations for CQs were determined by a vote from the guideline committee, based on the report. When using the recommendations for CQs, clinicians should also check the explanations provided in the guidelines. Furthermore, reports on CQs published in the journal (Japanese Journal of Pediatric Allergy and Clinical Immunology) are also useful.

Japanese Pediatric Guidelines for The Treatment and Management of Asthma 2023 have been published. Chapter 2 describes 'definitions, pathophysiology, diagnosis and severity classification'. In recent years, the widespread use of JPGL and advances in treatment have led to uniform treatment across the country, a reduction in asthma mortality and a decrease in severe cases. However, some cases are classified as moderate persistent or severe persistent, and some cases have been classified as adults and beyond, and the use of biologics is now possible even in the treatment of children. The basic pathology of asthma is chronic airway inflammation and airway hyperresponsiveness, but in recent years, attention has been focused not only on the atopic form, which is common in children, but also on the non-atopic form due to innate immunity. In many cases, it is difficult to diagnose asthma in children due to the unique pathology of infancy. Knowledge of the pathophysiology of asthma may enable differential diagnosis, appropriate selection of treatment steps and selective use of biologics according to the condition.

The chapter structure of Japanese Pediatric Guidelines for The Treatment and Management of Asthma (JPGL) 2023 underwent reorganization from JPGL 2020, resulting in two significant changes. Firstly, the discussion on the epidemiology and risk factors associated with asthma development, previously described throughout various chapters, is now consolidated into a single chapter. Secondly, the description of risk factors for acute exacerbations now occupies a separate chapter (Chapter 6).

Additionally, the main changes were as follows: 1) Updating the data from "Epidemiological surveys conducted by the Ministry of Health, Labour and Welfare and the Japanese Society of Pediatric Allergy and Clinical Immunology" to the latest version; 2) Substantial revisions to the "Table of prevalence in Japan" based on findings from recent large-scale surveys; and 3) Incorporation of "latest findings" based on more than 30 new articles, primarily from Japan, published after 2020. Despite limited evidence linking SARS-CoV-2 to development and acute exacerbation of childhood asthma. The epidemic pattern of each viral infection has undergone a significant change since the onset of the COVID-19 pandemic.