Background: Skin care during the neonatal period is important, and midwives are often the primary providers of skincare instructions. In this study, we examined the effect of neonatal skin care instructions provided by midwives on changing the skin care behavior of mothers and the skin condition of their children.

Methods: Consent was obtained from the mothers of infants born in the maternity department of our hospital between September 2021 and October 2022. The participants were randomly assigned to either the conventional skin care group or the novel skin care group. We evaluated their skin conditions and administered a questionnaire at the one-month visit.

Results: Finally, 48 pairs from the conventional group and 51 pairs in the novel group, respectively, were included. There were no differences in the background characteristics between the two groups, and there was no significant difference in the skin conditions at the one-month visit. The novel group showed a higher frequency of moisturizing and a higher rate of adherence to washing with foam and handwashing compared to that in the conventional group. The novel group was more likely to cite midwives as the source of skincare information.

Conclusion: The neonatal skin care instructions provided by midwives were more influenced in the novel skin care regimen. Collaboration with midwives is important during the neonatal period to prevent allergic diseases.

Objectives: To investigate and analyze the current state of allergy management in childcare facilities.

Methods: A questionnaire-based survey of 58 childcare facilities in Tempaku ward, Nagoya city was conducted after obtaining ethics review approval from our hospital.

Results: Of the 33 facilities (5 public daycare centers, 24 private daycare centers, and 4 kindergartens), instruction charts (for allergic diseases) were used in 60.6% of all facilities (100% of public daycare centers and 0% of kindergartens). Allergy management training and emergency response role plays were used in 87.6% (100% of public daycare centers and 25% of kindergartens) and 60.6% (100% of public daycare centers and 0% of kindergartens), respectively. Concerns about the decision to use adrenaline self-injection medication and its use were 42.4% and 45.5% overall (both in 20% of public daycare centers and 100% of kindergartens), respectively. Facilities that did not utilize the charts and an emergency manual had lower rates of training implementation and a higher percentage of respondents concerned about emergency response.

Conclusions: The use of the charts was only 2/3 of the total, with a particularly low diffusion rate among kindergartens. Since the use of the chart and the formulation of an emergency manual will lead to an increase in training opportunities and the elimination of concerns about emergency response, it is desirable to raise awareness of the use of the charts and to establish a training system in cooperation with medical institutions.

Background: There are a certain number of children with uncontrolled asthma who do not improve even with guideline-based treatment.

Objective: To clarify the examination for complications, the effects of confirming and instructing inhalation techniques, and the use of biologics in children with uncontrolled asthma.

Methods: Children who were prescribed bronchial asthma medication at our hospital during the past 8 years were included in the study. Of these children, those who were under long-term management of asthma treatment STEP 3 or higher were selected, and the examination, diagnosis, and treatment were reviewed.

Results: 485 children were receiving STEP 3 or higher treatment, and 110 of them were assigned to uncontrolled asthma. Most of the cases were complicated with chronic sinusitis or gastroesophageal reflux disease, but rare diseases such as diffuse panbronchiolitis were also observed. Four children were treated with biologics. Approximately 70% of children with uncontrolled asthma were able to step down in treatment after patient education such as confirming and instructing on proper inhalation techniques.

Conclusion: This study reaffirms the importance of examining complications and patient education before intensifying the treatment in children with uncontrolled asthma.

In recent years, the number of patients in Japan with egg yolk-associated FPIES has increased. However, the prognosis and long-term management of egg yolk-associated FPIES have not been established, and the remission time remains uncertain. We retrospectively investigated the timing of remission in 50 patients with egg yolk-associated FPIES who underwent an oral food challenge (OFC) at our hospital between June 2014 and December 2023 based on their medical records. The median age at onset was 8 months; median age at the first OFC for diagnosis or remission confirmation was 15 months; and median ages at the second and third OFC were 23 and 39 months, respectively. Remission was observed in 20 of 50 patients after the first OFC, 4 of 22 after the second, and 2 of 9 after the third. The cumulative remission rates at 24 and 36 months were 35.6% and 51.0%, respectively. Based on the low cumulative remission rate at 24 months, we concluded that it is difficult to achieve early tolerance through the complete removal of egg yolk from the diet. Patients who test positive in the first OFC often test positive in the second and subsequent OFCs as well. Thus, methods for achieving early remission are being sought.

There are many reports that casein is the main allergen in cow's milk allergy, and cases of sensitization to whey alone are limited. While casein is heat-resistant, whey is known to lose its antigenicity due to structural changes caused by heating, and there is a discrepancy in antigenicity of whey between unheated milk and milk-containing processed foods. In this case, a child with milk allergy who could consume milk-containing processed foods did not recognize whey as milk protein and developed anaphylaxis after consuming a whey protein drink. The patient was a 14-year old boy who had anaphylaxis to bread porridge at 6 months of age and was diagnosed with milk allergy. He had received oral immunotherapy using unheated milk at another hospital, and was able to ingest 100 mL of unheated milk two years ago, but had discontinued it voluntarily a year ago. However, he consumes processed milk products, such as bread and cheese, on a daily basis. On the day of his visit, a friend recommended a whey protein drink on his way home from school, and immediately after taking his first sip, he developed a cough and shortness of breath, which led to his visit to our hospital. Tests conducted after his visit revealed that he had a whey allergy. In this case, he was able to ingest baked milk without any problems. One of the causes of the symptoms was failure to recognize the antigenicity of whey. Identifying the causative allergen in milk allergy is important for diagnosis and treatment.

Atopic dermatitis (AD) significantly affects the quality of life of pediatric patients and their families. The itching associated with AD severely impairs academic performance, work productivity, and daily living activities. For school-aged children, academic achievement is a crucial outcome measure. However, the impact of disease management and treatment on academic performance in children with AD remains largely unclear. This case report examines the multifaceted effects of hospitalization for induction therapy in three adolescents with severe AD, focusing on improvements in academic performance. Common factors contributing to their improvement included alleviating skin lesions and pruritus, establishing a stable daily routine, and enhancing self-management skills through disease education. This report highlights the potential of AD management to improve academic performance and psychosocial outcomes and underscores the utility of inpatient treatment.

We report two cases of non-IgE-mediated gastrointestinal food allergies that appeared to show changes in clinical subtypes depending on the degree of milk protein degradation.

Case 1: A 24-day-old formula-fed neonate showed symptoms suspected cluster 1 and these improved with an extensively hydrolyzed formula. However, at 2 months, she developed gross blood in the stool and anemia and appeared to have a low nutritional status, which were resolved after switching to an amino acid-based formula. We performed oral food challenges from 9 months old and confirmed remission.

Case 2: A 7-day-old neonate showed poor weight gain on a standard infant formula and was switched to an extensively hydrolyzed formula from day 15. Although her weight gain improved, she developed gross blood in the stool and anemia and appeared to have a low nutritional status at 2 months. These symptoms were resolved after switching to an amino acid-based formula. We performed oral food challenges from 9 months old and confirmed remission.

Conclusion: Clinical subtypes of non-IgE-mediated gastrointestinal food allergies may appear to change depending on milk protein antigenicity. Careful follow-up of these patients is required.

Background: Immediate-type symptoms in food allergies can potentially lead to posttraumatic stress reactions (PTSR) and stress disorders (posttraumatic stress disorder: PTSD).

Methods: We surveyed children over 7 years old with food allergies and their caregivers using the revised Impact of Event Scale (IES-R) to assess PTSR and an anxiety score (0-10 points) based on the most frightening episode of immediate symptoms for children.

Results: There were 61 respondents. Episodes occurred at a median age of 5 years (IQR 2-7 years). The average anxiety score for the children was 5.4±2.8, and the average IES-R score was 4 (median, IQR 1-11), with 5 individuals exhibiting PTSR. One of them was diagnosed with PTSD. Multivariate analysis identified neurodevelopmental disorders (OR 46.1) and vomiting symptoms (OR 4.8) as significant factors associated with the IES-R score.

Conclusion: Immediate-type symptoms of food allergies indicate PTSR and PTSD.

Objective: This study aimed to investigate the current status, challenges, and future directions of oral food challenge (OFC) in Hiroshima prefecture.

Methods: A web-based survey was conducted targeting all 258 members of the Hiroshima Prefecture Pediatric Association.

Results: The response rate was 49.6%. Among respondents, 63% were private practitioners, and 34% were hospital-based physicians. OFC was conducted in their own facilities by 41.1% of respondents (implementation group), while 21.9% expressed a desire to perform it if conditions permitted (aspiration group), and 36.7% did not perform it at all. Hospital-based physicians tended to target for OFC more severe cases or higher specific IgE antibody cases compared to private practitioners. Among the implementation and aspiration groups, 67% preferred a broader implementation of OFC according to risk levels.

Conclusion: Private practitioners tended to follow individual criteria when conducting OFC, while hospital-based physicians often faced situations where they had to conduct tests regardless of their experience or the severity of cases. The future of OFC in Hiroshima Prefecture should focus on stratification strategies for both patients and healthcare providers.

In recent years, Japan has experienced a high frequency of disasters such as floods and earthquakes. Patients with allergic diseases are considered "people requiring special consideration" and need special care in shelters during disasters. Based on this, the government has implemented various measures. However, many challenges remain in practical operations. These include insufficient stockpiles of allergy-friendly foods, a lack of established methods for sharing supply information and distributing goods, inadequate tracking of evacuated patients, and poor coordination both within government departments and between the government and aid organizations.

Self-help from patients is also a challenge. Many households do not have enough food stockpiled for the recommended period, and preparation of tools to show allergy information, such as copies of their medication notebooks, is not progressing. Medical professionals point to the difficulty of gathering information on affected patients and a shortage of allergy specialists.

It is crucial for us, as allergy specialists, to be prepared on a daily basis. This includes ensuring patients' diseases are well-controlled, promoting self-help awareness, providing guidance on disaster response, understanding the regional disaster prevention system, collaborating with related organizations, and creating disaster response manuals.

Japan's healthcare system for allergic diseases has been developed based on the Basic Act on Measures against Allergic Diseases, enacted in 2014, and the Basic Guidelines for the Promotion of Measures against Allergic Diseases, issued in 2017. These efforts have been further guided by the Report of the Study Group on the Ideal Structure of the Medical Care System for Allergic Diseases, also issued in 2017. Guided by the Ministry of Health, Labour and Welfare, efforts have focused on enhancing collaboration between national core hospitals and Prefectural Core Hospitals for Allergic Diseases, standardizing care, and improving quality. These initiatives have made notable progress in the past decade. However, recent studies have pointed to emerging challenges, including shifts in disease patterns, particularly in food allergies, and uneven access to specialized care across regions. Continued coordination among government agencies, local authorities, medical institutions, and patients is vital to ensure that all individuals with allergic diseases receive equitable, high-quality care, regardless of their location or age group.

Chapter III of the "Japanese guidance for the prevention and treatment of pediatric atopic dermatitis 2024" provides an overview of differential diagnosis and severity assessment. An accurate evaluation of severity is essential for selecting treatment options and determining their effectiveness in atopic dermatitis. Biomarkers such as serum thymus and activation-regulated chemokine and serum squamous cell carcinoma antigen 2 are primarily used to assess disease severity and treatment response. For clinical evaluation, simple tools such as the investigator's global assessment scale and eczema area and severity index score are used in daily practice and for those undergoing systemic therapy, respectively. Additionally, repeatedly differentiating atopic dermatitis from other diseases is necessary if there are any inconsistencies in the characteristics of individual skin lesions or their response to anti-inflammatory topical medications.

Atopic dermatitis is evaluated based on skin symptoms, itch, quality of life, etc. POEM and PO-SCORAD are used to evaluate skin symptoms, while RECAP and ADCT are used to evaluate the control level of the disease; both are self-assessment indices completed by patients or their caregivers. NRS and VAS are used to evaluate itch. QOL assessments include the QPCAD and QP9 for caregivers of infants, the CDLQI for children themselves, the IDQOL for infants, and the DFI for families. These assessment indices are useful for determining treatment strategies, but there are no standards for which indices should be used, and further research is needed.