Twenty-four children aged from 8-14 (ave. 10.4y) who have bronchial asthma in children, inhaled MDI by three different methods. And then we observed flow volume curve, spirogram, and clinical symptoms of the patients. This study tested in three groups cross-over design, in 13 clinical centers.
The three inhaling methods are as follows:
group I: Patients keep MDI 4cm away from their mouths and inhale with widely open mouths.
group II: Patients take its adapter between their teeth and inhale with widely open mouths.
group III: Patients hold its adapter between their lips and inhale with closed mouth.
The result of this experiment is that the inhaling method with the lower efficacy is group III compared with group I and II. Then comparing these groups, group II is obiously more effective than group I.
Therefore in conclusion, the most effective method of MDI for childhood asthma is to take adapter between teeth and inhale with widely open mouth.

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Sixteen children with idiopathic nephrotic syndrome (INS) were investigated to study the relationship between INS and allergy. The patients were found to have a greater incidence of asthma and allergic rhinitis than the control group. Two children had nasal discharge and asthma attack, related to relapse. In 2 children with INS, proteinuria was reduced by house dust and mite avoidance. Serum total IgE levels in children with INS were significantly higher at both the time of onset and the time of relapse than at the time of remission. It was particulary true in children who were older than six and had atopic disorder and frequent relapses. Moreover, it tended to be higher at the time of remission than the control group. Children with INS had a greater incidence of positive specific IgE antibody against Dermatophagoides farinae, egg and bean.
These results suggest that clinical and immunological features of atopy were more common in children with INS, and allergic factor may be a cause of INS.

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We observed the remarkable thrombocytosis in a patient suffering from severe asthmatic attack. The number of platelets decrease gradually along with the improvement of the symptome Thromboelastogram showed the accelation of coagulation and thrombocytosis. However thrombocyte function was normal judging from the result of coagulation function test. Furthermore, we aloso observed the number of the platelets in the patients suffering from astmatic attack was significantly higher than that of healthy children, suggesting the involvement of platelets in asthmatic attack as a inflamation.

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It has been known that responsiveness of airway smooth muscle to various contracting substances is enhanced by destruction of epithelium. One of the proposed mechanism is impairment of production of epithelium derived relaxing factor (EpDRF) which is supposed to be produced in epithelial cells. Contraction of guinea-pig airway smooth muscle against acetylcholine (10^-4M) was examined before and after the treatment of 1N HCl. One normal HCl (100μl, 300μl or 500μl) was added to 10ml organ bath for 5min in order to cause chemical damage to epithelial cells. No difference was demonstrated in contraction of airway smooth muscle against acetylcholine after the treatment of 100μl 1N HCl. However, contraction was increased from 7.1×10^-2g to 8.×10^-2g (N=9, p<0.05) after the treatment of 300μl 1N HCl and from 9.2×10^-2g to 13.0×10^-2g (N=6, p<0.05) after the treatment of 500μl HCl. Dose-response curve against acetylcholine (10-6-10-3M) and histamine (10-7-10-4M) shifted to the left and the maximal contraction increased after the treatment of 300μl 1N HCl. As arachidonic acid metabolite has been reported to be involved in this phenomena, 6keto-PGF_1α, a stable metabolite of PGI₂ and one of the relaxing prostaglandins, in the organ bath was measured by radioimmunoassay. No significant change in the concentration of 6keto-PGF_1α was demonstrated after the treatment of 1N HCl, which indicates that PGI₂ is not involved in this phenomenon as EpDRF.

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In order to predict the later onset of atopic manifestations of young infants by the routine laboratory examinations in the outpatient clinic, a 3-4ml sample of blood was taken for estimation of total IgE levels, RAST (egg white, cow's milk, soybean and mite), complements (C3, C4 and CH50 ) and an eosinophil count under 3 months, at 6-7 months and at a year of age.
The eosinophil count showed a significant increase under 3 months of age in the patients who had an elevation of RAST score after 6 months of age, but did not in those who had a RAST score of 1 or less during the course. Total IgE levels and complements did not indicate any difference between the two groups.
We concluded that the eosinophil count plays an important role to predict the infant's onset of allergic diseases in the future.

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We reported on four children with food-dependent exercise-induced anaphylaxis. They were one boy and three girls, and the age of onset ranged 13 to 16 years. The causative foods were shellfish in two cases, wheat and potato in one case, and wheat only in another. Their symptoms were urticaria, dyspnea and unconsciousness. The exercise related to the symptoms were running, volleyball and walking at a quick pace. The intervals between meal and exercise ranged 10 minutes to 2 hours. Specific IgE antibodies to the causative foods were detected in all cases. All cases performed exercise challenge test. The exercise did not induce any symptoms. The skin wheal to compound 48/80 after the exercise seemed to be larger than that before the exercise in all cases except Case 2. These results suggest that type I allergic reaction relates to these symptoms, and change of mast cell releasability by exercise may be involved in the development of these symptoms.

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To evaluate the aggravating factors for asthma, we compared children with frequent admission or long term hospitalization for asthma with those with mild asthma without hospitalization. The mean age of 49 children with severe asthma ranging from 2 to 21 years was 12.5±4.8 years of age. The sex ratio was 1.6. Each experienced 10 episodes of admission or 182 days of hospitalization, and 4.4 episodes of status asthmaticus on the average for 3 years since 1986 to 1988. Mechanical ventilation was performed in one case, and 10 cases were steroid-dependent.
In comparison of the severe asthma with 98 cases of age-and sex-matched mild asthma, the severe asthma had a greater rate of early onset of asthma before 2 years of age, positive history of atopic dermatitis and food allergy. No differences were observed for serum IgE levels and RAST to egg white and house dust mite. Psychosomatic involvements were recognized in some cases with severe asthma.
These findings showed that treatment and prevention of severe asthma is important in management including that of atopic skin disease and food allergy as well as enviromental contorol since infancy and early childfood. Psychologic approach may increase management skills for adolescence cases.

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