Anaphylaxis is a serious disease that can be encountered in all medical departments. Although the onset may
occur in unforeseen circumstances, it is necessary that the initial response be as efficient as possible. This article
outlines the initial response and preventive measures based on the guidelines published by the Allergy Society in
2014. In the future, with the development of new drugs such as anti-tumor drugs, monoclonal antibodies, and biologics, dealing with atypical symptoms will become an issue. In order to deepen the understanding of anaphylaxis,
it is important to understand the disease state, including the phenotype, end type, and biomarkers.
In recent years, the morbidity prevalence rate of asthma among elementary school children in Japan and the
number of hospitalized patients has been declining. In 2017, the number of asthma deaths in children was zero.
Japanese pediatric guidelines for the treatment and management of asthma (JPGL) are considered to have contributed to the success of pediatric asthma treatment in Japan.
This article explains the latest information on bronchial asthma treatment in children, such as the new findings
of pathology, transition of long-term management drugs for children, characteristics of the latest GINA (Global
Initiative for Asthma), drug therapy for long-term management, response to acute exacerbation, allergen-specific
immunotherapy, patient education, partnership with patients and their family, pediatric transitional care, pediatric
asthma and chronic obstructive pulmonary disease (COPD).
Asthma is characterized by chronic inflammation and reversibility of the airways. The disease is characterized
by inflammation of eosinophils.
Recently, a new disease related to innate immunity has been proposed, and it has been found that there are
several subtypes of refractory asthma. Biomarkers are also being explored to identify therapeutic targets during
diagnosis. New treatments for asthma include an increase in inhaled drug types and antibody therapy with biologics targeting refractory asthma. In addition, we can choose to treat asthma by respiratory intervention using bronchoscopy.
Asthma treatment, like that of other diseases, benefits from personalization.
The goal of the treatment of food allergies is to determine exactly which foods cause allergic symptoms and
remove minimal food that induce symptoms from the diet. Oral food challenge is the gold standard for definitive
diagnosis; detailed interviews are essential, and immunological tests are helpful. Nutritional guidance for food
allergy patients should be given safely after understanding the amount of the food that induces symptoms. It is
also necessary to prescribe medications for allergic symptoms and to find an emergency outpatient clinic to
consult. Control of bronchial asthma and atopic dermatitis is also very important for preventing severe allergic
symptoms and blocking the sensitization pathway
Research on the pathophysiology of airway mucosal disease has been dramatically advanced by recent progress
in immunology in the past few decades. In ARIA (Allergic Rhinitis and its Impact on Asthma), the similarity
and relevance of the mucosal pathology of the upper and lower respiratory tracts has been pointed out. Even
otolaryngologists, who often treat upper respiratory diseases, need to understand and treat lower respiratory diseases, which have a similar pathophysiology. Allergic rhinitis and eosinophilic chronic rhinosinusitis are noted
allergic diseases in the field of otorhinolaryngology, and both are associated with lower respiratory tract diseases
(particularly bronchial asthma). In this article, we describe the pathologies and treatments of allergic rhinitis and
eosinophilic chronic rhinosinusitis.
Allergic conjunctival diseases (ACDs) are inflammatory diseases of the conjunctiva caused predominantly by
the IgE-mediated immediate hypersensitivity response and accompanied by conjunctival eosinophilic inflammation. ACDs comprise five different clinical forms: seasonal allergic conjunctivitis, perennial allergic conjunctivitis,
atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), and giant papillary conjunctivitis.
In the diagnosis of ACDs, clinical scores, clinical tests for atopic diathesis (including total IgE in tears and
antigen specific-IgE antibody in serum), and ocular allergic tests are crucial diagnostic tools. In the ocular allergic
tests for ACDs, allergy-associated factors in tear samples and cytology specimens are usually investigated in the
laboratory to assess the severity of allergic inflammation in the conjunctiva. Eosinophil cationic protein and eotaxin-2 are suitable biomarkers in the ocular surface test.
Topical immunosuppressants, including cyclosporine ophthalmic solution and tacrolimus ophthalmic suspension, have been shown to be effective nonsteroidal therapies for treating VKC. It is important that the efficacy and
safety of topical immunosuppressant therapy for VKC should be evaluated objectively.
Recent findings related to ocular surface biomarkers and topical immunosuppressant therapy provide a novel
approach for allergy treatment of the ocular surface of patients with ACDs.
Systemic vasculitis is a general term for the disease that causes various organ failure with inflammatory vasculitis. At present, systemic vasculitis is classified by the size of the blood vessel as described by the Chapel Hill
Consensus Conference (CHCC) criteria. Small size vasculitis is classified as ANCA-associated vasculitis and
immune-complex associated vasculitis. Various symptoms occur with systemic vasculitis because various sizes of
vessels cause injury. The pathological etiology of systemic vasculitis is giant cell arteritis, necrotizing vasculitis
or leukocyteclastic vasculitis. Glucocorticoids were the main treatment for systemic vasculitis, but today, combination therapy with glucocorticoids and some immunosuppressive drugs is the mainstream treatment for systemic
vasculitis. Recently, some biological drugs have been used in the treatment of systemic vasculitis. Tocilizumab,
an IL-6 receptor antagonist, is used to treat rheumatoid arthritis and Castleman’s disease. In 2017, tocilizumab
was used to treat Takayasu arteritis and giant cell arteritis, which it is able to improve with glucocorticoid monotherapy. Infliximab, an anti-TNFα monoclonal antibody, is used as a treatment for rheumatoid arthritis and other
autoimmune diseases. In 2015, infliximab was used as a treatment for Kawasaki disease, which it improves, by
intravenous immunoglobulin treatment. Rituximab, an anti-CD20 monoclonal antibody, is usually used as a treatment for CD20+ B cell lymphoma. While rituximab is usually used to treat RA and SLE in the United States and
Europe, it cannot be used to treat RA and SLE in Japan. In 2017, rituximab was used as a treatment for MPA and
GPA when there is improvement caused by glucocorticoids. Mepolizumab, an IL-5 monoclonal antibody, is used
as treatment for severe bronchial asthma. Since 2017, mepolizumab has been used as a treatment for EGPA when
there is improvement caused by glucocorticoids. It is expected that more new treatments for systemic vasculitis
will be developed.