Bathing is one of the factors involved in the development of food-dependent exercise-induced anaphylaxis (FDEIA). Here, we report a case of FDEIA induced by bathing after peach ingestion in an 8-year-old girl. The patient had taken a bath 10 minutes after eating a raw peach. Thirty minutes later, she experienced anaphylaxis. She underwent prick-to-prick testing for peaches, and the results were positive. Her peach-specific IgE levels were 5.35 UA/mL. Peach-induced anaphylaxis was suspected, and an oral food challenge test for raw peaches was conducted; however, the findings were negative. Later, anaphylaxis was induced by an exercise challenge test, performed after the patient received aspirin and ingested a raw peach. Based on the above findings, she was diagnosed with FDEIA induced by a peach. Upon performing allergen component analysis, Prup 3 was negative and Prup 7 was positive. The mechanism by which bathing induces FDEIA is not well understood. There have been few reports of FDEIA induced by bathing after meals. Our case shows that bathing should be recognized as a factor involved in FDEIA onset.

Background: The implications of sensitization in utero have not been elucidated to date.

Objective: To investigate the association between neonatal allergen-specific IgE, measured by a highly sensitive method, and sensitization or occurrence of food allergy (FA) during infancy.

Method: This birth cohort study included 125 unselected infants. Allergen-specific IgE in neonatal blood was measured by a highly sensitive densely carboxylated protein chip. The infants underwent a physical examination and skin prick test (SPT) at 6 and 12 months of age. Their parents completed a questionnaire at 0, 1, 6, and 12 months.

Results: Among 125 neonatal blood samples, 105 (84%) showed allergen-specific IgE against at least one of the tested antigens. Approximately 50% of our samples contained elevated egg white-specific IgE levels. Neonatal allergen-specific IgE was not associated with SPT or occurrence of FA during infancy. No association was observed between maternal egg consumption and neonatal egg-specific IgE levels. Dermatitis during early infancy was positively associated with SPT and FA on univariate analysis, and with SPT on multiple logistic regression analysis.

Conclusion: No association was found between neonatal allergen-specific IgE and sensitization or FA during infancy. Our results suggest that FA-related sensitization develops after birth.

A 9-year-old girl presented with a chief complaint of dyspnea. Her mother had asthma, and her father had allergies to some types of seafood. She was diagnosed with severe asthma and referred to our hospital. Her lifestyle was irregular, and her home environment was poor. She was treated with high-dose inhaled steroids and a leukotriene receptor antagonist. However, it was difficult to perform an environmental intervention because her father and grandfather resisted throwing away their garbage. She was discharged on the 100th day after the room where she spent most of her time was cleaned. Unfortunately, she had an exacerbation four months later. After admission, her symptoms improved rapidly, but her home environment was very poor again, and her parents did not accept any intervention. With the assistance and cooperation of the community and her elementary school teachers, an excellent improvement in her home environment was achieved. Through this case, we recognized the vital importance of environmental intervention.

Objective: To clarify the risk factors for systemic reactions (SRs) during rapid induction phase in rush subcutaneous immunotherapy with standardized house dust mite extract (HDM-SCIT).

Methods: In 68 cases who were introduced with the rush subcutaneous immunotherapy with standardized house dust mite antigen (HDM-rSCIT), we examined the risk factors for SRs such as age, threshold and starting antigen dose of HDM, target antigen dose of HDM in rapid induction phase, season of introduction, coexistence of allergic disease, and the severity of bronchial asthma and allergic rhinitis.

Results: The SRs of HDM-rSCIT appeared in 44 of 68 cases (65%), and the risk factors for the SRs were 500JAU of target HDM antigen dose in rapid induction phase, introduction other than summer, and high allergic rhinitis symptom medication score.

Conclusion: It was suggested that the SRs may be decreased by strictly managing the symptoms of allergic rhinitis before introduction, reducing the target HDM antigen dose in rapid induction phase, and introducing SCIT in summer.

Background: Children with food allergies would be released from food elimination programs at school when they can tolerate more than the maximum amounts of the food included in school meals.

Purpose: The present study aimed to determine the maximum amount of egg and cow's milk protein in 198 meals served at elementary schools in Toyota city in 1 year and to evaluate the nutritional value of school meals including substitutes for eggs or milk. Based on this, we considered the decision criteria for children with food allergies to start standard school meals.

Method: We analyzed the amount of egg and cow's milk protein in meals from school lunch menus using ingredient tables for processed foods. Furthermore, we calculated and compared the nutritional values of standard school meals with those of school meals including substitutes for eggs or milk.

Results: The highest amount of egg and cow's milk protein included in a meal was 45 and 5.93 g respectively. The calcium content of meals including substitutes for milk was 21.9±9.2% of the standard value.

Conclusion: Analysis of school meals of a municipal district determined the decision criteria for food elimination programs at school. As the milk elimination causes significant shortage of calcium, this will help improve nutrient intake in such children.

Common adverse effects of beta2 stimulants include tremors, tachycardia, hypokalemia, hyperglycemia, and lactic acidosis. Here we report a case of a 10-year-old girl who showed adverse effects after ingestion of beta2 stimulants. Two days before admission, she was prescribed one 50-μg tablet of procaterol and one 200-mg tablet of clarithromycin twice a day for her frequent cough. She took one tablet of each; 2 hours later, she developed tachycardia, nausea, and vomiting. At 4.5 hours after ingestion, she visited our hospital. At the time of admission she had tachycardia, abdominal pain, tremor, lactic acidosis, and hyperglycemia, and we treated her for hypokalemia and lactic acidosis. The serum procaterol level was 79.4 pg/mL at 7 hours after ingestion. Many reports have detailed hypokalemia and lactic acidosis as a consequence of long-term oral administration of beta2 stimulants; however, to date, there are few reports that describe the development of side effects after short-term use. Therefore, when prescribing procaterol to children, the possibility of adverse effects should be considered.

We present a case of a 10-year-old girl who was diagnosed by a physician with bronchial asthma five years earlier. She was treated with an inhaled corticosteroid and oral administration of a leukotriene receptor antagonist. She was referred to our department after five years of treatment as her wheezing did not improve.

Chest auscultation detected expiratory wheezing, and computed tomography (CT) revealed fluid retention in the paranasal sinuses. Chest radiograph and CT showed nodular shadowing.

Hematological examination revealed an increase in the cold aggregation rating. Based on these findings, the patient was diagnosed with diffuse panbronchiolitis (DPB) and oral administration of clarithromycin was initiated. After five months of treatment initiation, there was improvement in her respiratory symptoms and respiratory function. Currently, the patient is being followed up without treatment and is free of respiratory symptoms or function deterioration.

If symptoms of cough or wheezing do not respond to prolonged treatment for asthma, DPB should be considered in the differential diagnosis list.

Background/Objective: Japanese guidelines for food allergy published in 2016 recommend repetitive ingestion of a food allergen at home after mild symptoms during a supervised oral food challenge (OFC). This study aimed to evaluate the safety of repetitive ingestion of a food allergen at home in patients who experienced mild symptoms at OFC.

Methods: In this retrospective study, we included children who showed mild symptoms in response to a chicken egg, milk, wheat, or peanut OFCs at Miyagi Children's Hospital from January 2013 to April 2018. We examined the nature of the symptoms experienced at home and treatment received.

Results: Our study included 161 children with a median age of 3.9 years. The median level of serum nonspecific immunoglobulin E was 418.5 IU/mL; 159 children (98.8%) were complicated with atopic dermatitis and 69 (42.9%) with bronchial asthma. Of these, 144 children (89.4%) reported no further symptoms at home, while 17 (10.6%) experienced few symptoms after OFC. Among those who reported symptoms, 16 were documented as mild, and 1 was reported with moderate symptoms; no severe symptoms were reported.

Conclusion: The study results suggest that repetitive ingestion of food allergen at home after OFC is generally safe in patients who experienced mild symptoms during OFC. However, patients and their families will require guidance on how to treat to allergic symptoms.

The prevalence of childhood food allergy is increasing, affecting the quality of life of food-allergic patients. Cow milk, a major allergen, accounts for about 20% of all food allergies in Japan. Particularly, it is common in infants, who usually experience the first episode before one year of age. We hereby report a case where the patient instantly developed a contact urticaria after wearing underwear made of milk-containing rayon fiber. The diagnosis was confirmed after carrying out a patch test of the underwear concerned, which showed a positive result for immediate allergic reaction, and an elution test of milk-containing fibers, which revealed casein elutes. Recently, various food proteins have been added to other products, including clothing and cosmetics, which may cause allergic symptoms. Thus, caution is required.

Atopic dermatitis (AD) is a disease that affects approximately 10% of the total population in Japan and is frequently encountered in pediatric daily medical care. Uncontrolled refractory AD is not uncommon, even with basic treatment. From the viewpoint of the clinician, this scenario is thought to be caused by problems that can be attributed to both the patient and the healthcare worker. Problems on the patient's side include poor treatment adherence and severe AD itself. Poor treatment adherence by the subject may occur owing to the transition of the treatment from the caregiver to the patient himself/herself. Steroid phobia is a major issue and may be caused by a caregiver's misunderstanding of the side effects of topical steroids. Such a situation would require the intervention of a medical staff with accurate knowledge to provide care or training. Problems on the healthcare worker's side include differential diagnosis, existence of complications, inappropriate topical therapy, and inadequate patient education. Furthermore, it is possible that topical steroids are not properly selected, which necessitates the reconsideration of the treatment choice and the method. In addition, approaches other than topical therapy may need to be introduced.

Atopic dermatitis (AD) is a chronic skin disorder characterized by pruritus and recurrent eczematous lesions that are accompanied by T-helper (Th) 2-dominated inflammation. Etiology of AD is not yet completely understood, but it is multifactorial. The pathogenesis of AD is driven by three major pathological factors, namely, disruption of the skin barrier, an altered Th2 cell response and pruritus (itching).

To improve skin barrier functions, daily use of moisturizer products are required to increase moisture content in the stratum corneum, which further leads to the prevention of allergen invasion and relapse of dermatitis, as well as suppression of itching by recovering and maintaining skin barrier functions. Topical anti-inflammatory ointment such as topical corticosteroid and tacrolimus is essential to improve the dermatitis in AD. Dupilumab, which is a monoclonal antibody against interleukin (IL) -4 receptor α and inhibits down-stream signaling induced by IL-4 and IL-13, shows tremendous effectiveness on moderate to severe AD.

While the intake of fruits and vegetables has been recommended for maintaining good health and preventing lifestyle-related diseases, in recent years, an increase in the prevalence of allergies to fruits and vegetables, e.g., pollen-associated food allergy syndrome (PFAS), has been reported. Meanwhile, fruit allergens causing severe anaphylaxis have been reported; new allergens have been discovered and their pathological mechanisms have been clarified. Most of the symptoms induced by fruits or vegetables are localized around the mouth and are self-limiting; however, systemic allergic symptoms such as anaphylactic shock, which are mainly caused by the specific characteristics of allergens such as resistance to heat and digestive enzymes, may develop in some cases. Recently, especially in Italy and Japan, gibberellin-regulated protein (GRP) has been identified as an allergen causing severe systemic peach allergy. Understanding allergens that are highly conserved across species (i.e., pan-allergens) is becoming increasingly important for diagnostics and research in food allergy.

Tree nuts and seeds are one of the main causative agents of IgE-mediated food allergies, with peanuts, walnuts and cashews being the most frequent inducers of severe symptoms. They are classified into four major superfamilies (prolamine, cupin, Bet v1 homologue, and profilin) and exhibit different heat and digestion tolerances due to their structural characteristics. They show amino acid identity in a certain percentage of cases. As a result, multiple antigen sensitization is often observed, but it is often only sensitization without clinical symptoms. Recent advances in allergen analysis techniques have improved clinical diagnostic accuracy. Storage proteins belong to prolamine and cupin, and are associated with allergic reactions. The diagnostic utility of Ara h 2 in peanuts, Gly m 8 in soybeans, Jug r1 in walnuts, Ana o 3 in cashews, Cor a 9 and Cor a 14 in hazelnuts, and Ses I 1 in sesame have been reported. This paper will provide an overview of the allergens of tree nuts and seeds and their use in clinical diagnosis.