We reported that post-emetic serum thymus and activation-regulated chemokine (TARC) levels may be a potential biomarker to diagnose solid food protein-induced enterocolitis syndrome (FPIES). However, there are no reports on the relationship between FPIES severity and serum TARC levels. The subjects were 13 cases of FPIES (hen's egg=10, Wheat=1, rice=1, short-neck clam=1) for a total of 22 events (7 emergency outpatient visits, 9 positive and 6 negative results of oral food challenge test). Serum TARC levels at 6 and 24 h after antigen ingestion were compared between the symptomatic and asymptomatic events and the mild-moderate and severe events. We also evaluated the correlation between vomiting duration and serum TARC levels. The median serum TARC (pg/ml) in the asymptomatic, mild-moderate, and severe events were 546, 1093, and 3127 at 6 h after ingestion, and 910, 2053, and 6496 at 24 h after ingestion, respectively. The serum TARC level was significantly higher in the symptomatic events than the asymptomatic events, and it was significantly higher in the severe events than the mild-moderate events (p < 0.01). There was a moderate correlation between serum TARC levels and vomiting duration. Post-emetic serum TARC correlates with the severity of FPIES. It is expected that this information will lead to an objective evaluation of the severity of FPIES.

We experienced a case of vocal cord dysfunction (VCD) in a child to whom an adrenaline autoinjector (Epipen®) had been prescribed and frequently used following a diagnosis of exercise-induced anaphylaxis. An exercise test was performed to investigate her frequent episodes of anaphylaxis-like symptoms. A few minutes after starting the test, signs of dyspnea, such as throat tightness and stridor, appeared, although hypoxia was not present and her respiratory sounds were normal. Medications were not effective for treating her respiratory symptoms. Laryngoscopy performed at the test revealed bizarre vocal cord movement, which was diagnosed as VCD. The symptoms gradually diminished after the initiation of biofeedback therapy, including pursed lips breathing and abdominal breathing. Thereafter, she did not use an adrenaline autoinjector when symptoms appeared; instead, she would perform biofeedback therapy before using the adrenaline autoinjector. Thus, VCD should be included in the differential diagnosis of patients who show anaphylactic symptoms that are resistant to preventive therapy.

The case subject was a 19-year-old exchange student from Thailand who had undergone tuberculosis (TB) treatment twice. Upon observing a shadow in the right upper lung, the patient was referred for examination; however, acid-fast bacteria test results were negative. Furthermore, high levels of total IgE and anti-aspergillus IgE and IgG antibodies were found. Bronchoscopy revealed inflammation with stenosis in the right superior lobar bronchus, and there was an outflow of yellow viscous sputum upon suctioning. After applying a localized steroid spray, the patient expectorated a large amount of sputum containing Aspergillus fumigatus. Upon administration of steroids and itraconazole, the conglomerate mass shadow's inner portion disappeared, and dilated bronchi appeared. Even though the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) of Rosenberg and Patterson were not strictly satisfied, ABPA was diagnosed in conjunction with the course of treatment. It was determined that prior tubercle bacilli test results were negative, and thus the patient must have had ABPA from the onset. The symptoms eased, and the patient returned to Thailand. Although pulmonary tuberculosis and ABPA are different illnesses, they share similarities in symptoms and clinical findings. Therefore, past medical history should not be believed blindly, and it is imperative to diagnosis the condition accurately by performing appropriate tests. Furthermore, we had the opportunity to view the computed tomography images of the chest 18 years after the initial examination. In the entire lung region, findings of significant bronchiectasis were presented.

There are few prospective observational studies on the prevalence of atopic dermatitis (AD) in children. We aimed to prospectively investigate the dynamics of change in the prevalence of AD from early childhood to adolescence. We conducted a survey with a modified questionnaire to diagnose AD based on The International Study of Asthma and Allergies in Childhood questionnaire with 1230 13-year-old children who were born in the Minami ward, Yokohama City between May 2004 and June 2005 and had undergone physical examinations by dermatologists at 3 years of age. Among the 422 children who answered the questionnaire, 210 had undergone periodic physical examinations by dermatologists from 4 months to 3 years of age (Cohort 1), whereas 212 had undergone physical examinations only at 3 years of age (Cohort 2). The prevalence of AD was 16.9% in 422 children at 13 years of age, with 22.9%, 16.6%, 20.0% and 18.3% prevalence at 4 months, 18 months, 3 years and 13 years of age, respectively, in children who were followed up long-term. The frequency of AD occurrence per year decreased after the age of 3 years; a history of AD at this age was significantly related to AD at 13 years of age (Fisher's exact test, p<0.001). In conclusion, it was suggested that AD in 3-year-old children is one of the risk factors for the development of AD in 13-year-old children.

We studied clinical efficacy and safety after 1 year of mite sublingual immunotherapy (SLIT) for perennial allergic rhinitis in children, compared with adults. We compared 121 children under 15 yeas old (81 male, aged 5-14 years, a median of 12 years) and 77 adults (36 male, aged 15-65 years, a median of 26 years) treated with mite SLIT tablet (10000 Japanese Allergy Unit). The clinical efficacy before and 1 year after SLIT was evaluated by assessing symptom scores by Japanese rhino-conjunctivitis quality of life questionnaire (JRQLQ No1) and visual analog scale (VAS). Combined medication was also compared. Adverse events of SLIT were checked at every visit. All items of JRQLQ No1 scores and VAS after 1 year of mite SLIT, except eye symptoms in adults by JRQLQ No1, were significantly improved in both children and adults. Comparing children and adults, there were no differences in symptoms before and after 1 year. Combined medication score showed a similar result. Adverse events were observed in 57.9% of children and 58.4% of adults, but there were no serious adverse reactions. There was no difference between children and adults in efficacy and safety of mite SLIT, and both group showed significant improvement of symptoms.

To clarify the status of admission to facilities for food allergy (FA) children. Guardians of FA children who underwent oral food challenges at Sagamihara National Hospital from September to December 2018 were enrolled. We surveyed the experience of refusal to enter facilities, the reason for refusal and so on using a self-administered questionnaire. We distributed a questionnaire to 205 guardians, of which 168 responded (response rate 82%). The median age (range) at the time of the survey was 4.5 (0 to 12) years old, 2 (1 to 11) food items had been removed at the time of admission, and 56 (33%) had a history of anaphylaxis before admission. Twenty-nine patients (17%) were prescribed an adrenaline auto injector. Twenty patients (12%) had been denied entry, the median number of refusals (range) was 1.5 (1 to 30). History of anaphylaxis before admission (odds ratio 2.80 [1.08-7.22]) and having 5 or more causative foods (odds ratio 3.44 [1.27-9.32]) were associated with admission refusal. 〔' Factors related to children with FA〕, 〔Factors related to facilities〕, and 〔Factors related to facility staff〕 were extracted as the reasons for refusal. In addition to the factors related to children with FA, the factors related to facilities and facility staff were related to admission refusal. Therefore, cooperation between medical care, local governments, and facility that comprehensively supports the living environment of children with FA is needed.

In a method evaluating conjunctival hyperemia using rabbits, it is common to visually grade the degree of vasodilation. However, this method is limited in evaluating consecutive value and in reproducibility. We quantified the degree of conjunctival hyperemia in rabbits as the area ratio of blood vessels by image analysis, and compared the vascular area percentage calculated by image analysis with the hyperemia score. The conjunctiva was photographed before and after the instillation of 0.1% arachidonic acid using a digital medical scope VersaCam® (Nidek Co., Ltd.). Next, the area of the conjunctival blood vessels occupying the area of interest was calculated using hyperemia analysis software. The hyperemia score was visually graded for the degree of conjunctiva vasodilation. Furthermore, the hyperemia score and the vascular area ratio were compared. Fifteen minutes after the instillation of arachidonic acid, the area ratio of the blood vessels in the conjunctiva increased significantly and gradually decreased over time. This trend correlated with the hyperemia score. We found that the degree of conjunctival hyperemia in rabbits can be evaluated numerically and quantitatively. This method is considered to be useful for evaluating conjunctival hyperemia in allergic conjunctival diseases.

To determine the frequency and effects of accidental ingestion of packaged processed foods, eating out, and over-the-counter sales in individuals with food allergies. The participants were guardians of children hospitalized for an oral food challenge test during January and February 2016 at the Department of Pediatrics, Sagamihara National Hospital. We conducted a questionnaire survey on food allergies, accidental ingestion via packaged processed foods, eating out, and over-the-counter sales in the past 1 year, and the degree of understanding of the display of allergen-related information. A total of 442 participants were given questionnaires, and 226 provided valid responses. Among these respondents, 31% had experienced accidental ingestion (packaged processed food: 24%, food service: 12%), and approximately one quarter of the subjects with allergic symptoms had repeated accidental ingestion. About 70% of the causes were due to overlooking or misunderstanding of allergen information. Of the participants, 85% were aware that processed foods must display allergen information, and 39% were aware that there was no requirement to label food sold in food service and over-the-counter sales. Patients with food allergies are familiar with and repeatedly experience accidental ingestion of packaged processed foods, eating out, and over-the-counter sales. In order to prevent accidental ingestion, it is important to thoroughly check allergy labeling and to instruct patients on precautions to take when eating out or over-the-counter sales.

Although an important cause of vocal cord dysfunction (VCD) is psychogenic reaction, VCD may be associated with severe asthma and must be distinguished from the disease. A 30-years-old woman was admitted to our hospital with dyspnea despite treatment for asthma. Inspiratory stridor and expiratory wheezes were noted, and neck and chest computed tomography showed normal airways and lungs. Fractional exhaled nitric oxide levels were also normal. Pulmonary function test with a flow-volume loop curve showed normal expiratory loop with flattening of the inspiratory loop after methacholine inhalation. During the attack, bronchoscopy revealed the vocal cord closing with stridor during the inspiratory phase. Therefore, the patient was diagnosed with VCD. The dyspnea improved with respiratory rehabilitation and pursed-lip breathing. VCD should be considered in the differential diagnosis of intractable severe asthma. In this case, bronchoscopy and bronchial inhalation challenge with methacholine helped in the diagnosis.

A 12-year-old boy visited our hospital with complaints of chronic cough and dyspnea. Chest X-ray and CT revealed diffuse granular shadow in the bilateral lung fields and "Tree-in-bud appearance" in the peripheral airways, respectively. Sinusitis was present, and restrictive disorder was predominantly found in pulmonary function. The patient was diagnosed with DPB, and long-term therapy was started with low-dose clarithromycin (CAM), The patient showed a dramatic response to CAM, with improvements of both the clinical symptoms and pulmonary function within 1-2 months. According to the relevant literature, in adult patients with this disease, pulmonary dysfunction starts from an obstructive pattern; however, this is not the case in pediatric patients. It was therefore suggested that the mechanisms underlying the development of pulmonary dysfunction in cases of childhood onset differs from those with an adult onset.