Meguro Ward, Tokyo Metropolis, started in 1990 health examination regarding allergy on 3- and 4- months-old infants with the purpose of preventing “Allergic March”.
The subject were selected from 762 3-4 months-old infants who replied the primary questionnaire regarding allergy upon visiting Himonya Public Health Center for the health examination in the period between July 1990 and June 1991.
(1) The number of subjects for the health examination regarding allergy were 102 (13.4%).
(2) The number of subjects was the highest in winter and decreased in summer (15 in February and 2 in August).
(3) The number of infants who visited hospitals for the treatment of eczema before the health examination for 3-4-monthes old infants were 252 (33.1%), of which 175 (70.0%) attended Pediatric departments.
(4) Among the subject infants for the health examination regarding allergy, there were more breast-fed infants than bottle-fed infants.
(5) Regarding food, their positive rates were the highest with egg white, and the correlatively of prick test was also high.

View full abstract

49 cases of patients under the age of 20 who died with asthma attacks were analised. The post-mortem examinations of all these cases were performed in Tokyo Metropolitan Medical Examiner's Office. There were more cases with infancy and with patients over 15 years-old than there were other age groups. The number of asthma deaths increased in September and derceased in March and in August relatively. The time at their death was seen almost all day long. The duration from final attack to death was very short: less than 15 minutes: 15%, less than 30 minutes: 36% and less than 1 hour 56%. In 21% of the cases, the final attacks were not noticed by others, because they could not complain or did not have the time to complain about their dyspnea. Only 26% of them could arrive at hospital. They were diagnosed to have died of asthma attack, pathologically. Complications of them were as follows; 43 of them with lesions of heart and vesseles (hypertrophy and/or enlargement of right ventricule and others), 41 with brain edema, 22% with atrophy of adrenal cortix, 22% with bronchitis or pneumonia, 6% with malnutrition or dehydration, 4% with heamorhage of lung, 4% with vomitus in bronchus, 2% with spontaneous pneumothorax and others respectively.

View full abstract

Although many newly developed drugs have been added to therapeutic regimen for bronchial asthma, morbidity of childhood asthma is still increasing in Japan. To further clarify the recent trend we compared two group of children with asthma, those who visited allergy clinic at our hospital 10 years ago (group A) and those who visited in the recent few years (group B), for their clinical status and therapeutic regimens for them.
1) The age for the first visit to allergy specialists in group B is higher than in group A. Patients in group B had greater number of positive allergens and showed severer chest deformity than those in group A.
2) Theophyline was administered to greater number of patients in group B than in group A. Allergen immunotherapy was done less frequently in group B than in group A.
3) The clinical status of the patients improved after 10 to 12 month of the treatment in both groups. There was no difference in degree and speed of the improvement between the two groups although greater number of drugs were administered in group B.
These results suggest that clinical status of childhood asthma in the recent few years is worse than in 10 years ago, that newly developed drugs do not seem to be beneficial in modulating the clinical course of childhood asthma, and that delay in consulting specialists may have complicated the course.

View full abstract

This study was undertaken to determine whether the measurement of plasma histamine and tryptase concentrations after food challenges provides an additional predictive marker for the diagnosis of food allergy. In 13 patients who were sensitive to food antigen-specific IgE, 21 oral food challenges were performed. In 5 non-atopic subjects (controls), 5 oral food challenges were performed in the same manner.
Plasma histamine concentration was measured by RIA before and 5, 15, 30, 60, 120, 240, min after challenge. Plasma tryptase concentration was measured by RIA before and 60, 120, 240min after challenge.
Significant rise in plasma histamine concentrations was observed at 120 and 240min after challenge in patients who had some hypersensitivity reactions. Plasma tryptase levels were significantly increased at 240min after challenge in the same patients.
No significant change in plasma histamine and tryptase concentrations was observed after the challenges in the controls.
The results suggest the possible relationship between provocation symptoms with food challenge and elevation of plasma histamine and tryptase levels.
Plasma histamine and tryptase measurement of concentrations after food challenge may be useful in diagnosis of food allergy.

View full abstract

Generally the incidence of aspirin-induced asthma (AIA) in adult asthmatics has been reported about 10%. But in children AIA is relatively rare in Japan. Sixty two asthmatic children were admitted to our hospital. Three of them were diagnosed as AIA. Case I was a 16-year-old girl, and diagnosed as AIA by her anamnesis. After avoidance of aspirin and nonsteroidal antiinflammatory drugs and tartrazine, her asthma attacks have remarkablly decreased. Case 2 was a 16-year-old girl, and diagnosed by her anamnesis and positive reaction to inhalation test with Sulpyrin and Venopirin. Case 3 was 12-year-old girl, and severe, intractable and steroid-dependent asthmatic patient. It was suspected that she had suffered from AIA. She was diagnosed by positive reaction to inhalation test.
AIA was characterized by 1) severe and intractable, steroid-dependent, 2) low serum IgE levels with negative allergy skin tests except fungi. Thus in severe and intractable asthmatic children we should consider AIA and conduct examination, then the number of incidences of AIA may increase.

View full abstract

Changes in respiratory resistance (Rrs) upon methacholine inhalation asthmatic children were monitored by “Astograph”, and the Rrs were measured by the forced oscillation method. Seventy two cases of asthma, 18 cases of other allergic diseases and 16 cases of healthy adult were subjected to examination for bronchial hyperresponsiveness. The results were as follows:
1) Control respiratory condactance (Grs cont) was lower in patiants with bronchial asthma compared with that in healthy adults.
2) Methacholine inhalation test showed a higher level of positive rate in severe to mild asthmatics compared with the remission group. And no difference was seen between the remission group and healthy subjects.
3) Bronchial sensitivity (Dmin) was lower in severe asthmatics and there was no difference between the remission group and healthy subjects.
4) Significant correlation between bronchial sensitivity (Dmin) and duration of no asthmatic symptom was found in patiants with bronchial asthma. These results suggest that continuance of duration of no asthmatic symptom is important in improvement of bronchial hyperresponsiveness.
5) There was no difference in bronchial reactivity (SGrs/Grs cont) between the 3 groups.

View full abstract

To evaluate the development of theophylline clearance in young infants and to determine the appropriate dose for intravenous theophylline infusion, we investigated 350 cases given intravenous aminophylline by continuous infusion.
The younger the infant was, the higher the frequency of this treatment was. 72.9% of infants in the first year of life were given this treatment, so we thought this method was very important for status asthmatics in these young children.
Next, we obtained the theophylline clearance rate which was calculated from the infusion dose divided by the serum concentration at steady state in the 161 cases. When the patient groups were studied according to their clearance rate, it became evident that clearance values of young infants were decreased. Especially the clearance rate in infants under 6 months old was 0.0371/kg/h which was about a half of that of elder infants'. These data suggested that theophylline is metabolized more slowly in young infants than in elder infants. We studied intrapatient theophylline clearance variability in 10 patients and followed up for the first two years of life.. Rapid increase of the clearance was noted in all patients by 1 year 2 months old. From these results we recommend that appropriate maintainance doses are 0.5mg/kg/h for under 6 month old, 0.6mg/kg/h for 6 month to 1 year old, 0.8mg/kg/h for 1 to 2 year old, and 0.9mg/kg/h for 2 to 6 year old infants respectively.

View full abstract