Sublingual immunotherapy (SLIT) is a promising treatment for cedar pollen allergy. We report the case of a 14-year-old girl who developed anaphylaxis in response to escalation of the maintenance dose of Japanese cedar pollen extract tablets during SLIT. In this case, among the risk factors for systemic reactions identified by the European Academy of Allergy and Clinical Immunology (EAACI), a high degree of sensitization was the only factor applicable. Individualized management may enable the safe continuation of SLIT for patients with marked sensitization who develop local adverse reactions to each administration.

A 4-year-old girl with a history of cedar pollinosis had experienced perioral wheals after consuming walnuts within the past year. In the present episode, she developed perioral wheals immediately after eating mixed nuts (walnuts, cashews, almonds, and peanuts), followed by severe abdominal pain 1 hour later and vomiting and fever 16 hours later. Her serum amylase level was greatly elevated at 1,320 U/L, and contrast-enhanced CT revealed pancreatic swelling and peripancreatic fluid accumulation. She was diagnosed with severe acute pancreatitis and was treated with fasting, intravenous fluids, and antibiotics. However, a pancreatic fistula was suspected based on increasing ascites, and abdominal drainage was performed. An abdominal MRI performed on the 27th day after onset showed pancreatic atrophy. Antigen-specific IgE levels for walnut and Jug r 1 were markedly elevated at 4.20 and 4.48 U_A/mL, respectively, suggesting the involvement of walnut allergy as a pancreatitis trigger.

Although most cases of pancreatitis induced by food allergies are reported to be mild, there are severe cases that require surgical treatment or have sequelae, such as pancreatic atrophy, as observed in this case. Food allergies should be considered a potential cause of acute pancreatitis.

Protracted bacterial bronchitis (PBB) is a leading cause of chronic wet cough in children but is often misdiagnosed as bronchial asthma. A 9-year-old girl presented with a 5-year history of persistent wet cough. She had been treated for asthma with high-dose inhaled corticosteroids without improvement. Examination revealed squawks and rhonchi. Investigations showed low fractional exhaled nitric oxide (5 ppb), no airway reversibility, and 98％ neutrophils in sputum. Chest CT demonstrated centrilobular opacities and bronchial wall thickening. Suspecting a pathology similar to diffuse panbronchiolitis (DPB), low-dose clarithromycin (CAM) was initiated. Symptoms vanished within one week, and radiological findings resolved within six months. The patient was finally diagnosed with PBB based on the clinical course. She remained symptom-free for 30 months after treatment cessation. In the present case diagnosed with PBB retrospectively, the anti-inflammatory and anti-hypersecretory effects of macrolides were considered effective against the pathology characterized predominantly by neutrophilic inflammation. In Japan, where low-dose macrolide therapy is frequently employed for chronic wet cough, PBB may be an underlying condition. Furthermore, it is crucial to consider PBB as a differential diagnosis in cases of wet cough refractory to asthma treatment.

Honey is generally considered to have low allergenicity, although anaphylaxis induced by honey has occasionally been reported. We present a case of a 10-year-old boy with atopic dermatitis, asthma, and Japanese cedar pollinosis who developed anaphylaxis 30 minutes after ingesting honeycomb. Symptoms included eyelid edema, conjunctival hyperemia, generalized urticaria, wheezing, dyspnea, and facial pallor. Skin prick testing (SPT) with honeycomb was negative, whereas intradermal testing and oral food challenge (OFC) with honeycomb were positive. SPT and OFC with a commercial royal jelly (RJ) capsule also yielded positive results, while OFC with commercial honey was negative. These findings suggest that RJ components present in honeycomb, or cross-reactivity between RJ and honeycomb, were responsible for the reaction. Although most reported cases of honey allergy are attributed to the presence of Compositae pollens, RJ sensitization should also be considered. This case shows that ingestion of honeycomb and RJ can induce severe allergic reactions in children with atopic predisposition. Healthcare providers should be aware of the potential risks associated with honey and RJ-containing products, especially in patients with underlying allergic conditions.

[Objective] Resilience refers to the capacity to adapt to difficult situations. This study investigated the relationship between the Resilience Scale for Pre-adolescent Children with Food Allergies (RS-PCFA), background factors, and Quality of Life (QOL).

[Methods] A web-based survey was conducted from July to September 2024 among food-allergic children aged 8-12. Data including background factors, RS-PCFA scores, and Japanese version of FAQLQ-CF were analyzed for correlations.

[Results] There were 103 valid responses, with a median age of 10 (IQR : 9-12). While total resilience scores showed no significant correlation with background factors or total QOL, subscales revealed distinct associations : “Natural orientation” related to anaphylaxis history, and “Sharing negative emotions” related to age and major food elimination. Additionally, “Inquiry orientation” and “Sharing negative emotions” were associated with lower QOL, whereas “Natural orientation” correlated with better QOL.

[Conclusions] The RS-PCFA is a valuable tool for the multidimensional assessment of psychological characteristics in pre-adolescents with food allergies, facilitating the consideration of practical support.

[Objective] To clarify current at-home practices concerning skin care and eczema management in early infancy and explore which contributions from healthcare professionals can appropriately support them.

[Methods] A questionnaire survey was conducted between September and December 2025 among parents of infants aged 2-4 months who had received their first routine vaccinations at a pediatric outpatient clinic affiliated with a regional perinatal center. Most of the infants were born at the same facility and had received follow-up care since birth.

[Results] Fifty-four parents responded to our survey. Of these, 94％ reported using a foaming cleanser to wash their infant’s face, mainly following instructions provided to them by the maternity facility. All of the respondents reported using moisturizers on their children’s skin, most of which comprised lotions. The perceived burden of moisturizing was significantly higher among the parents of infants with eczema (p＝0.040). Eczema was reported in 52％ of the infants, with～50％ of these showing no symptom improvement over time. Topical corticosteroids were prescribed in 36％ of cases, and 74％ of the parents sought consultations or support from healthcare professionals.

[Conclusion] Most of the parents surveyed practiced routine skin care in early infancy ; however, the additional support needs concerning eczema management were substantial in the subset who were affected by the condition. Vaccination visits may provide opportunities for infant skin assessments and continued guidance concerning appropriate topical therapies.

From the perspective of skin defense, this review highlights the importance of contact allergies in pediatric allergy practice. In recent years, the skin has become recognized as both a target organ for allergic symptoms and an immunological organ involved in percutaneous sensitization. Skin barrier disruption and repeated antigen exposure are common mechanisms underlying food allergies initiated by percutaneous sensitization, allergic contact dermatitis, protein contact dermatitis, and occupational skin diseases.

Environmental exposure among children has markedly increased owing to increasing use of cosmetics, gel nails, electronic devices, topical medications, and daily products. Contact sensitization is thus no longer rare among children and adolescents. Cochineal/carmine allergy and acrylate sensitization are substantial emerging concerns associated with early exposure to beauty-related products. Refractory or localized eczema should thus prompt consideration of allergic contact dermatitis in addition to atopic dermatitis.

Chronic hand eczema and skin barrier dysfunction may contribute to occupational skin diseases. Pediatric allergy management should focus on “what contacted the skin” and “how the skin can be protected” in addition to “what was eaten.” Early skin care and avoidance of irritants may contribute to lifelong prevention, thereby improving quality of life.

In the topical management of pediatric atopic dermatitis, it is essential to rapidly control skin inflammation to induce remission and subsequently prevent relapse in order to achieve long-term disease control. Topical corticosteroids remain the mainstay of therapy, and selecting an appropriate potency according to the severity and location of skin lesions as well as the patient’s age, together with applying an adequate amount, is crucial for achieving remission. After improvement of inflammation, maintenance therapy is often required. Proactive therapy with topical corticosteroids, as well as the use of non-steroidal topical anti-inflammatory agents, allows gradual reduction of the amount and frequency of application and progressive limitation of the treated area. Ultimately, the therapeutic goal is to maintain a stable skin condition without relapse while minimizing the need for topical medication. This article provides an overview of topical therapy for pediatric atopic dermatitis, including the appropriate use of topical corticosteroids, the role and considerations of proactive therapy, and the characteristics and clinical positioning of anti-inflammatory topical agents.

Pharmacologic treatment for atopic dermatitis has undergone a paradigm shift in recent years with the advent of biological agents and oral Janus kinase inhibitors. This paradigm shift applies similarly to pediatric atopic dermatitis. Pediatric atopic dermatitis similarly in children. When initiating systemic therapy, it is important to understand the characteristics of each agent, including approved age indications, route of administration, adverse effects, and efficacy for comorbid allergic diseases. In this article, we provide an overview of pharmacologic treatment for pediatric atopic dermatitis, focusing on biological agents, oral Janus kinase inhibitors, and antihistamines and Kampo medicines.