Background : The number of patients with pollen-food allergy syndrome (PFAS) has increased globally. Apples are a major causative food for PFAS. Varied reports have demonstrated the usefulness of skin prick test (SPT) for the diagnosis of PFAS, besides differences in symptom expression among apple cultivars, thus the diagnosis of PFAS remains unclear.
Purpose : To investigate the clinical features of apple-induced PFAS by performing a double-blind placebocontrolled food challenge (DBPCFC) using different apple cultivars on patients with apple-induced PFAS.
Method : DBPCFC was performed for six patients with apple-induced PFAS using 10 apple cultivars. We measured the degree of symptoms using the Visual Analog Scale (VAS). Further, we assessed the correlations of Mal d 1 and Bet v 1-specific IgE levels and SPT findings to the VAS.
Results : Three of six patients (50％) were VAS-positive for two apple cultivars, one patient each (17％) was positive for three, four, and five apple cultivars. The correlation between SPT findings and VAS was insignificant (p＝0.103). The VAS displayed a positive relationship with Mal d 1 and Bet v 1 (r＝0.5 and r＝0.84, respectively).
Conclusion : It is necessary to perform DBPCFC with multiple apple cultivars to diagnose PFAS. The SPT was not useful in diagnosing PFAS ; however, Bet v 1-specific IgE levels may be advantageous. This novel clinical study of PFAS assessed multiple Japanese apple varieties, therefore, our findings can serve as a baseline for future studies.

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Malignant mesothelioma is rare, and its prognosis is markedly poor. It is often difficult to distinguish malignant mesothelioma from carcinomatous peritonitis of other solid tumors. We report a case of malignant peritoneal mesothelioma diagnosed by a laparoscopy with the consent of her and her family. A 68-year-old Japanese woman, who indicated ascites, multiple abdominal masses, and a high level of CA125, was referred to our hospital. The ascites cytology by conventional smear and cell block technique were all negative. We evaluated the abdominal wall adhesion around the umbilicus using abdominal ultrasonography and considered we could safely perform a looking laparoscopy. The laparoscopy revealed peritoneal thickening and multiple white nodules on the greater omentum, liver, diaphragm, and uterus. The biopsy was performed from the greater omentum and peritoneum. In histopathological examination, atypical eosinophilic cells were observed and calretinin and D2-40, both known as mesothelial markers, were positive. She was diagnosed with malignant peritoneal mesothelioma and treated with six cycles of carboplatin, pemetrexed, and bevacizumab therapy followed 30 cycles of pemetrexed and bevacizumab as maintenance therapy, of which therapeutic efficacy was the complete response. A looking laparoscopy is effective for the diagnosis of malignant peritoneal mesothelioma.

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