Pectin is a common food ingredient. Cross-sensitization between cashew and pectin has been reported but not well recognized.

A one-year and 10-month-old girl was referred to our hospital because of anaphylaxis of unknown cause. She had been diagnosed with cashew and walnut allergy at the age of one year and 3 months based on acute urticaria after ingestion of a mixed nuts snack and positive specific IgE to the nuts. Six months later, she was rushed to the emergency room because of generalized urticaria and lethargy after ingestion of fruit gummies not containing nuts. The food components of the gummies were found to be pectin, starch syrup, sugar, and several fruit extracts, which had been eaten without symptoms except for pectin. We suspected pectin allergy and performed a prick-to-prick test and basophil activation tests using individual allergen extracts contained in the snack. Both tests revealed positive reactivities to pectin, not to the other allergens tested, and a diagnosis of pectin allergy was made.

In some cashew nuts allergic patients, a complication of pectin allergy has been reported. Since the prevalence of cashew nut allergy has been increasing in recent years and pectin allergy should be suspected when unexplained anaphylaxis develops in a cashew nut-allergic patient.

Objectives: To propose improvement measures to address food allergies (FA).

Methods: We conducted a questionnaire survey of individuals in charge of school lunches at childcare facilities.

Results: The nutritional value of allergy-friendly school lunches did not fulfill the target quantities of nutrients to be supplied in school lunches (8.6%) and was often not considered (29.6%). Only a few facilities (53.8%) used a lifestyle management guidance form, and many facilities (39.1%) did not perform nutritional evaluations. Ongoing interviews with guardians were performed at 73.6% of facilities, which was lower than the initial interviews. Facility staff consulted with commissioned doctors about FA at a few facilities (22.2%). Evaluations of the state of addressing FA by individuals in charge of school lunches were particularly low for the following items: "cooperation with the family doctor" and "cooperation with the commissioned doctor. "

Conclusions: Issues addressing FA included a lack of consideration of the nutritional value of allergy-friendly foods, lack of usage of a lifestyle management guidance form, lack of cooperation with the commissioned doctor, lack of nutritional evaluations, and not performing ongoing interviews. As an improvement measure, childcare facilities must provide commissioned doctors with a lifestyle management guidance form to create an information-sharing system, and we propose that a comments section be added, such as for nutritional evaluations by the childcare facility.

Galactose-α-1,3-galactose (α-Gal) syndrome is a syndrome in which delayed allergic symptoms are induced by veterinary meat containing the sugar chain α-Gal as a consequence of percutaneous sensitization to α-Gal via tick bites. It is expected that avoidance of ticks, which are the source of sensitization, may cause remission of this syndrome. We report here a case in which α-Gal-specific IgE levels decreased after instruction in tick avoidance, and the syndrome was considered to be in remission. A 15-year-old girl presented with anaphylaxis thought to be caused by beef, and was diagnosed with the syndrome because of a positive α-Gal-specific IgE level. The patient had a history of tick bites and kept many cats indoors and outdoors, and was instructed to keep cats outdoors for tick avoidance. α-Gal-specific IgE levels decreased from 3.61 before instruction to 0.40 17 months later. A 100 g heated beef challenge test conducted 25 months later was negative, indicating that the patient was in remission. Cats played an important role in α-Gal sensitization in the patient, and it was thought that the syndrome may have gone into remission because the patient was less likely to be bitten by ticks.

OBJECTIVE: To compare learning achievement and behavior change between face-to-face and online pediatric allergy education seminars using active learning.

METHODS: Face-to-face and online seminars were conducted. Learning achievement was assessed immediately after the seminar (40 items), and the status of pediatric allergy care was evaluated 6 months later (15 items).

RESULTS: A total of 217 pediatricians attended the face-to-face seminars and 142 attended the online seminars. Both groups showed a significant increase in learning achievement for all after the seminar. Hands-on sessions conducted face-to-face received greater appreciation than online sessions. In terms of behavioral change, all 15 items showed improvement compared to pre-seminar scores, and 2 items showed greater improvement in the online sessions than in the face-to-face sessions.

CONCLUSION: The online seminars showed similar learning achievement and subsequent behavior change as the face-to-face seminars. On the other hand, the hands-on experience with the actual medical devices was useful.

Although several groups have reported cases of immediate allergy to anisakis in adults, reports in children are limited. Here, we report a case of anaphylaxis due to anisakis in a school-age child.

An 8-year-old boy experienced anaphylaxis symptoms 2 hours after ingesting squid sashimi and vinegared mackerel. His symptoms rapidly resolved after administration of intramuscular adrenaline. The patient was diagnosed with anisakis allergy, as his serum-specific IgE level for anisakis was 54.4 UA/mL; he was negative for allergies to other seafood that he ingested at that time.

In this case, the boy had ingested and touched raw fish since childhood. We speculate that it is possible that it was a factor by which the anisakis allergy developed at such an early age in this patient. Diagnosis of anisakis allergy is of great value because there are many reports of anaphylaxis and because anisakis may parasitize many types of fish and shellfish. Even in children, it is important to consider anisakis allergy when anaphylaxis occurs after ingesting seafood.

The Epidemiology Committee and the Asthma Death Committee of the Japanese Society of Pediatric Allergy and Clinical Immunology have received an abundance of information from the members and their patients and have reported their findings at annual meetings as well as in the Japanese Journal of Pediatric Allergy and Clinical Immunology. The Asthma Death Reports, conducted since 1990, are based on the registration and analysis of asthma deaths. The Asthma Severity Study, which has been in progress since 2006, has reported trends in asthma severity and treatment over time. These studies have identified Japanese trends in childhood asthma, and the findings are reflected in daily clinical use through their incorporation into the Japanese Pediatric Guidelines for Treatment and Management of Asthma. In the present article, I would like to review these surveys and consider the allergy march from its beginning following the onset of allergic disease.

Although the prevalence of allergic diseases is rapidly increasing, the full picture of the associated factors remains unclear. The birth cohort study, i.e., a prospective, rather than a retrospective, study of the general population close to the population, preventing bias, is considered the highest level of evidence for capturing disease changes over time and making causal inferences about exposures and outcomes. Two birth cohort studies are currently being conducted: The T-Child study, a single-center study at the National Center for Child Health and Development, and the Japan Environmental Children's Study (JECS), the first nationwide prospective cohort study in Japan. These studies revealed various findings: Actual conditions of allergic disease onset in the Japanese population, various related factors including maternal exposure, actual conditions of the allergic march beyond adolescence, and positions of pollen-food allergy syndrome (PFAS), which has recently been attracting attention, in the allergic march. Based on these reports, this paper, as much as possible, summarizes the actual situation and related factors of allergic march in Japanese children that have been clarified to date.

Allergic march (AM) is a phenomenon that children predisposed to allergy develop multiple allergic diseases with age despite the discrepancy between the causative antigen and the organ affected. Although atopic dermatitis (AD) in infancy is considered as the starting point of AM, several reports indicate that only a small percentage of children completely follow the typical AM, and population-level prevalence patterns often show individual distinct clusters of allergic disease trajectories. We conducted a nationwide survey targeting staff and their families at designated allergy disease medical hospitals and found that the prevalence of allergic diseases increased progressively with age. AD had the highest prevalence in the first year of life, followed by subsequent increases in food allergies, bronchial asthma, and allergic rhinitis with advancing age. The transition in age of onset and peak prevalence for these conditions suggested an AM. However, only 3.0% of children followed the typical AM encompassing all allergic diseases. These results suggest that various factors beyond AD are important in the onset and progression of allergic diseases.

WJSAAC (West Japan Studies of Asthma and Allergies in Childhood) uses the same method every 10 years, from the 1982 Phase I trial of 55,000 elementary school children in 11 prefectures in western Japan to the 2022 Phase V trial of 30,000 children. It has been held for 1st to 6th grade students in the same district and same elementary school. Analysis is currently underway, but the summary is that the prevalence of bronchial asthma (BA) peaked at 6.5% in Phase III, that decreased in Phase V. Among other comorbid allergic diseases, allergic rhinitis (AR) had the highest rate, followed by atopic dermatitis (AD), allergic conjunctivitis (AC), and pollinosis (P).

For the first half of a century in Japan, clinical research and research on pediatric allergies focused on BA, but energy has also started to be focused on AD, AR, AC, and food allergies (FA). It became as to be "total allergy". This background can be seen in the WJSAAC allergy epidemiology results.

The current environment in which we consider changes in symptom prevalence is undergoing major changes, and epidemiological methods, including treatment and management methods, need to be modified. However, accurate and continuous epidemiological surveys are necessary to formulate future plans for allergic diseases. This work is essential for the government and discussions at the national level are urgently needed.

As the threat of COVID-19 to children in Japan still exists, the Japan Pediatric Society continues to recommend vaccination as a means of prevention, and all children aged 6 months to 17 years should be vaccinated against the new virus.

The outbreak of COVID-19 has had a major impact on society as a whole, and it has caused various changes. The outbreak had an impact on medical facilities, pediatric care, pediatric allergy care, and allergy workshops. We have reviewed the changes in allergy care and allergy workshops at this Hospital since the outbreak of COVID-19 to determine COVID-19's impact. Soon after the outbreak of COVID-19 in 2020, the number of children seen for allergies decreased dramatically. The number subsequently increased over the years, and it is now returning to its previous level, which includes children admitted for bronchial asthma. There was a substantial decrease in the number of children with allergies in 2020, but it was smaller than the decrease in the number of children seen by Pediatrics overall. In addition, wards were closed and visits were restricted as doctors and nurses contracted COVID-19 and clusters of cases occurred. Moreover, face-to-face allergy workshops had to be cancelled or postponed. In place of face-to-face meetings, support for workshops online and via video streaming became widely available. These workshops using information technology (IT) will presumably be a key venue for pediatric allergy care and training in the future as well.

The COVID-19 pandemic affected various aspects of food allergy. Mainly during the first state of emergency in Japan, the number of oral food challenges was limited temporally in many facilities; however, they have reported to be recovered soon. Safety protocols of oral immunotherapy were preferred during the COVID-19 pandemic. Consequently, some patients could be affected by such restrictions. Diagnosis and treatment for children with allergies have positive impact on the revenue of pediatric department as childhood patients with infectious diseases declined. Parental treatment and judgement for immediate allergic reaction, including emergency department visit, were believed to be appropriate; however, some cases with anaphylaxis were difficult to transport to an emergency medical center due to COVID-19. Development of food allergies was not affected significantly based on publicly available official data.

Pediatric bronchial asthma is known to be acutely exacerbated by respiratory infections, so there was concern at the beginning of the COVID-19 pandemic induced acute asthma exacerbation. However, a systematic review has not reported any evidence that COVID-19 exacerbates bronchial asthma, and acute pediatric bronchial asthma hospitalization surveillance has shown that hospitalizations have decreased and that among hospitalized cases, there were few positive SARS-CoV-2 cases, and no cases requiring artificial ventilation were reported.

On the other hand, an internet survey conducted among parents of children with bronchial asthma found that although many children were in good physical condition during the pandemic, a few children who were not receiving long-term control medications and/or who were exposed to passive smoking has been developed acute asthma exacerbation.

According to these findings, COVID-19 does not induce acute bronchial asthma exacerbation in the acute phase, but we need to once again raise awareness about bronchial asthma management, such as daily control and prevention of passive smoking. In addition, it is necessary to examine the long-term prognosis of children with bronchial asthma who were suffering from COVID-19.

The concept and chronology of "healthcare transition" for patients with childhood-onset chronic diseases were proposed for the first time by the Japan Pediatric Society. In this report "Transition support" has expanded beyond medical care and includes a broader perspective on patient health and welfare to help patients become independent and functioning adults of society. The Japan Pediatric Society proposed 20 items related to four main items (basic attitude, comprehensive support with a lifelong perspective, support for changing departments, system development, and other necessary measures) to promote transition support and emphasize that pediatric physicians be familiar with the importance of transition support.

Pediatric allergic diseases often transition into adulthood, necessitating specialized support during this critical phase. This support involves the simultaneous development of medical care and fostering of independence (autonomy). Given the complexity of allergic diseases, which are often associated with multiple disorders, adults with these conditions frequently need to engage with various departments.

The scarcity of specialists catering to adults in food allergies complicates the seamless transition of patients to different departments. Achieving independence (autonomy) support requires the acquisition of health literacy and a shift toward medical care that respects the right to self-determination. Specifically addressing food allergies, a comprehensive program is essential for affected children. This program aims to enhance the understanding of allergen labels and empower them to self-administer adrenaline self-injection medications during emergencies. The Allergy Center is a crucial hub in ensuring a seamless and comprehensive transition for individuals with pediatric allergic diseases into the complexities of adult medical care. This involves medical considerations and a broader support network encompassing various facets of life. In transition support, the center is expected to share information to facilitate a smooth transition from pediatric to adult medicine. Furthermore, it should actively contribute to support initiatives related to independence (autonomy), welfare, schooling, and employment, drawing on the expertise of various professions.

A total allergist is an allergist who treats mild to difficult-to-severe allergic diseases in their own expertise and can treat allergic diseases in other expertise as long as they are mild or complicated. Because pediatric patients often develop or have complications from multiple allergic diseases which affect each other, it is important to take a multidisciplinary approach in the treatment of these diseases. The prevalence and severity of pediatric allergic diseases are associated with psychological stress and social conditions; hence it is important to take a comprehensive approach to treatment based on a bio-psycho-social model that focuses not only on the biological but also on the psychological and social aspects of the disease. In transitioning to departments of the adult, there is not a sufficient system in place to provide holistic, cross-disease treatment for severe cases.

Viral upper respiratory tract infections and subsequent rhinosinusitis are common illnesses in children. It is sometimes difficult to differentiate these diseases from allergic rhinitis. The points in the differential diagnosis of rhinosinusitis are symptoms, local findings, and nasal cytology. Symptoms of rhinosinusitis include nasal congestion, mucopurulent rhinorrhea, postnasal drip, productive cough, and headache. Among them, productive cough is an important symptom that is observed in more than 60% of children with rhinosinusitis. Nasal findings show mucopurulent nasal discharge, and mucopurulent postnasal drip is observed on the posterior pharyngeal wall in patients with rhinosinusitis. Fiberscopic examination can reveal mucopurulent discharge flowing from the middle meatus into the posterior nares. Observation of neutrophils and eosinophils by nasal cytology is also useful. Diagnosis should be made comprehensively based on symptoms, local findings, and nasal cytology. Most cases of pediatric rhinosinusitis improve quickly with treatment. We need to carefully observe and treat nasal symptoms in children, always considering whether they are infectious or allergic.

Pediatric allergic rhinitis has increased rapidly in recent years. Symptoms of allergic rhinitis include nasal discharge, nasal obstruction, and sneezing, and it is very useful for children and their parents to learn how to care for nasal symptoms at home. The ultimate goal of nasal care is for children to be able to perform nasal care on their own initiative, and there are three tips for learning nasal care. The first is to keep it simple. Complicated procedures that are difficult to understand are undesirable. The second is to have fun. When children enjoy and are praised, they are more likely to participate actively. The third is to make it a habit. The nasal care technique should be "easy" and "fun" to perform, and this will lead to "habituation". Nasal care is useful in all phases of allergic rhinitis treatment. It is important to share the instructional strategies among medical personnel, including Pediatric Allergy Educators and Clinical Allergy Instructors, and to collaborate with parents and with teachers at childcare facilities and schools.

It is important to efficiently understand clinical symptoms and promote appropriate treatment within the limited consultation time. In the case of atopic dermatitis, severity evaluation methods such as SCORAD and EASI are used to determine the effectiveness of treatment. In the case of bronchial asthma, we conduct a questionnaire that allows us to easily and objectively evaluate the control status over the past month during daily medical treatment, and evaluate respiratory function using a spirometer and peak flow. However, there are few evaluation charts that pediatricians can easily use for allergic rhinitis and allergic conjunctivitis. Sublingual immunotherapy for cedar hay fever and treatments for perennial mite allergic rhinitis are also being used in children, and the challenge is how to evaluate their therapeutic effects. Symptom severity (total nasal symptom score: TNSS), score considering drug therapy (total nasal symptom/medication score), and QOL questionnaire introduced in the Nasal Allergy Treatment Guidelines 2020 Edition (PG-MARJ2020) are also included. To assess the risk of allergies in children, we used the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ), the International Guidelines for Allergic Rhinitis and Its Impact on Asthma (ARIA), and the Visual Analogue Scale (VAS) of the Facial Scale. Introducing research using. Let's think about what kind of evaluation chart is needed to treat rhinitis and hay fever.

OBJECTIVE

This study aimed to clarify the actual situation and problems in the treatment of pediatric allergic rhinitis in Japan.

METHODS

An online survey was conducted on members of the Japanese Society of Pediatric Allergy and Clinical Immunology and Japan Society for Pediatric Otorhinolaryngology who had registered their e-mail addresses with the respective societies.

RESULTS

Responses were obtained from 803 individuals. Regarding diagnosis, pediatricians placed more emphasis on examination than on local findings, and otolaryngologists placed more emphasis on local findings than on examination. Approximately 50% of pediatricians and otolaryngologists provided nasal care instruction. Pediatricians did not utilize the practical guideline for the management of allergic rhinitis in Japan as much as otolaryngologists, and 20% of the respondents, especially pediatric non-allergists, did not have this guideline. Pediatricians spent more time seeing patients and had more difficulty in distinguishing infectious diseases in infants younger than 5 years than otolaryngologists.

CONCLUSIONS

Departmental characteristics had a significant impact on diagnostic procedures. Of the physicians in all departments, <50% provided care instructions for nasal symptoms.