[Objective] This study aimed to clarify the current state and burden of home care management instruction in the treatment of pediatric atopic dermatitis.

[Methods] A web-based survey was conducted in December 2024 targeting physicians who are members of the Japanese Society of Pediatric Allergy and Clinical Immunology. The survey asked regarding the content and burden of home care management instruction.

[Results] The analysis included 688 participants (response rate; 17.1%). Of these, 94.3% reported home care management instruction, with no significant differences between hospital- and clinic-based physicians. The frequency of instruction was "as needed" for 56.6%, and the average duration was "5-15 min" for 59.4%. Experience with biologics and oral Janus kinase inhibitors was reported by 57.8%, and 60.7% of these patients received regular home care management instruction. Although 97.6% of respondents felt that the instruction contributed positively to treatment outcomes, 87.1% reported experiencing a burden related to it. The most significant factor contributing to this burden was the "time for instruction", with the highest adjusted odds ratio of 15.4 in the multivariate analysis.

[Conclusion] Most responding physicians instructed home care management of pediatric atopic dermatitis and feel it is beneficial. However, there is a significant burden associated with the time and effort required for such instruction.

Introduction: The current status of calcium intake in children with cow's milk allergy that persists after school age and the calcium intake after desensitization of full dose of cow's milk need to be clarified based on the actual dietary content.

Method: Nutritional intake was evaluated based on the results of a dietary survey conducted using the dietary record and photographic methods in children with persistent cow's milk allergy after school age who visited the Aichi Children's Health and Medical Center from March 2018 to August 2019. Children in the Elimination group who completely eliminated or consumed < 5 mL of milk were compared with children in the Desensitization group who consumed ≥ 200 mL.

Results: Calcium intake in the Elimination and Desensitization groups were 47.3% and 61.3%, respectively (P=0.104). Most affected children in both groups (91% and 85%) did not reach the estimated average requirement.

Conclusion: Although cow's milk intake achieved full dose after school age, daily intake of dairy products was low and calcium intake remained inadequate. Regular nutritional intake surveys and nutritional dietary guidance are necessary even for those children who have achieved full-dose intake.

[Objective] This study aimed to clarify the conditions for inhalation guidance and medical reimbursement in outpatient care for infants and toddlers with asthma.

[Methods] We conducted a web survey targeting 4,018 members of the Japanese Society of Pediatric Allergy and Clinical Immunology who had registered their email addresses.

[Results] Among the 688 respondents (response rate: 17%), 675 (93%) reported providing instruction on the use of a spacer when prescribing inhaled corticosteroids. Physicians were the most common providers of inhalation guidance 514 (84%), followed by pharmacists in external pharmacies 198 (32%). Regarding the reimbursement for asthma management (280 points for Asthma Guidance and Management Fee 2; AGMF2), the cost of spacers borne by medical institutions was most commonly from JPY 2,501-3,000 86 (36%). Upon the initial guidance, the cost of the spacer was borne by patients in 321 (53%), followed by 181 (30%) covered under AGMF2. However, for subsequent spacer costs, the patient burden increased to 482 (82%). Ideally, 268 (46%) of the respondents indicated that spacers should be replaced annually. However, in practice, 385 (65%) replaced them only if they became unusable.

[Conclusion] Physicians primarily provided inhalation guidance. Approximately 50% of the patients borne the initial spacer cost, and the AGMF2 was insufficient to cover the spacer cost, with only one-third using it.

Background: In recent years, the treatment of atopic dermatitis (AD) has progressed, and not only topical corticosteroids (TCS) but also anti-inflammatory oral drugs and topical drugs have emerged, and proactive topical therapy has become widely used. However some patients have difficulty in managing skin symptoms under proactive therapy (PT).

Objective: To evaluate the efficacy and safety of Delgocitinib ointment (DEL) in combination with TCS every other day after quenching inflammation in patients with AD inadequately controlled by PT with TCS.

Methods: Fifty-four patients with AD who visited our clinic between January and August 2022 were randomized to two groups: PT with TCS alone or Alternating Proactive Therapy (APAT) with TCS+DEL after resolution of inflammation, and the required endpoints were followed for 12 weeks.

Results: The APAT group had significantly lower EASI scores and a higher rate of achieving EASI-50 at 8 weeks compared to the PT group with TCS alone. NRS and sleep VAS scores were also significantly lower at 8 weeks. The incidence of adverse events did not differ between the two groups.

Conclusion: APAT with TCS+DEL may be more effective than PT with TCS alone for pediatric AD.

It is well known that approximately 30 to 50% of young children experience wheezing until the age of 3, due to the anatomical and physiological characteristics of their respiratory system. However, about half of these children outgrow wheezing by school age. In contrast, most school-age children diagnosed with asthma begin experiencing asthma symptoms before the age of 3. Therefore, the preschool period represents a crucial time window that influences the long-term prognosis of childhood asthma. However, obtaining objective measures of lung function and airway inflammation in young children is challenging. Additionally, diagnosing asthma using conventional criteria and managing it with guideline-recommended treatments is more difficult in younger children with recurrent wheezing compared to school-age children. This paper reviews recent advances in clinical practice for managing asthma/recurrent wheezing, focusing on new approaches to understanding the underlying pathology of asthma in preschool-aged children.

Costimulatory molecules on the surface of T cells enhance or suppress T cell activation by binding to their ligands expressed on antigen-presenting cells. CD226 and TIGIT bind to a common ligand, CD155 and regulate immune responses by activating or suppressing CD4⁺ T cells, respectively. CD226 and TIGIT play important roles in immune function, not only in the activation of CD4⁺ T cells, but also in the enhancement of regulatory T cell function, the differentiation of follicular helper T cells and the activation and subsequent elimination of innate lymphocytes. In this review, the functions of CD226 and TIGIT in each immune cell and their roles in allergic diseases are discussed.

The Japanese guidance for the prevention and treatment of pediatric atopic dermatitis was created in accordance with the Guidelines for the management of Atopic Dermatitis 2024 (ADGL), with the aim of producing an easy-to-use guide for primary care settings, where clinicians frequently manage atopic dermatitis that develops in early infancy.

The diagnostic and treatment algorithm is basically consistent with the ADGL, with an additional pathway included for referring cases whose remission induction or maintenance proves challenging to specialists. Differential diagnoses and potential complications are based on the diagnostic criteria established by the Japanese Dermatological Association, taking into account diseases that are prevalent or characteristic in pediatric populations. For cases requiring early diagnosis, the UK Working Party's diagnostic criteria are also referenced.

Remission induction involves the continuous application of appropriately potent topical anti-inflammatory agents. Maintenance therapy is tailored to either proactive or reactive approaches, depending on the patient's response. In refractory cases, combined systemic therapy may be considered, with the primary objective of achieving treatment goals: absence of symptoms or only mild symptoms that do not interfere with daily functioning and require minimal ongoing medication.

Atopic dermatitis (AD) is a chronic inflammatory skin disease involving complex interactions among skin barrier dysfunction, Th2-skewed immune responses, an itch-scratch cycle, and dysbiosis of the skin microbiome. Clinical features vary by age: infants often present with exudative lesions on the face, while lichenified lesions on flexural areas predominate in later childhood. Pediatric skin is characterized by a thinner stratum corneum and reduced water retention capacity, resulting in immature barrier function. AD frequently persists beyond school age, with a prevalence of 10-15%. This review summarizes the pathophysiology, age-specific clinical manifestations, characteristics of pediatric skin, and epidemiology of AD.