The allergen immunotherapy (hypo-sensitization therapy) for the type I allergy is started by Dr Noon L as subcutaneous immunotherapy: SCIT in 1911. There is a treatment experience for 100 years after his report. However there are some serious side effects to our regret, so it doesn't become standard treatment in Japan. Sublingual immunotherapy: SLIT is a method it is the safest and is near in the current state practical use because it improves these side effects. We have done the clinical trial of SLIT to Japanese cedar pollinosis. There are no side effects other than the sense of incompatibility of the limited part, effectiveness also decreases the symptom score, the amount of the medication use is decreased, and the treatment method that reduces the deterioration of QOL is confirmed. There is no evidence though the effect is verified to children's Japanese cedar pollinosis. The evidence construction is necessary also in children's SLIT in near future.

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Foods allergy management basics are elimination of the minimum food items that should be based on correct diagnosis. Oral food challenge tests are essential for achieving correct diagnosis. However, facilities that currently perform oral food challenge tests are not enough throughout Japan. In this review paper, we address histories and theories of oral food challenge tests, and open our detail methods, which may help other facilities to perform food challenge tests easily.

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【Purpose】The Anaphylaxis Exploratory Working Group of Japanese Society of Pediatric Allergy and Clinical Immunology lately released a decision entitled "A Popular Guide on Indication for Intramuscular Injection of adrenalin by EPIPEN^®". The purpose of this study was to examine and evaluate validity of an intramuscular injection of adrenalin (adrenalin injection) to treat the symptoms described in that decision (WG symptoms) based on the result of the oral food challenge test (OFC). 【Method】OFCs by double blind method were performed for older than 5 years children to asses indication for treatment of oral immunotherapy. We examined retrospectively the result of 391 OFC positive cases in the OFC: 151 cases about chicken egg, 163 cases about cow's milk, 50 cases about wheat, 27 cases about peanuts. 【Result】In 106 of total 391 cases, some sorts of WG symptoms were present. Regarding those 106 cases, adrenalin injections were used in 90 (84.9%) cases. On the other hand, in 287 cases in which WG symptoms were not present, adrenalin injections did not be used. Although there were much respiratory symptom (p<0.001), neurological symptoms (p<0.001), and circulatory organ symptoms (p<0.001) intentionally in 90 children with adrenaline compared with 301 children without adrenalin intramuscular injection, a difference was not seen in skin symptom. 【Conclusion】According to the consideration on the result of OFC in severe cases, WG symptoms was thought to be useful criteria for figuring out indication for adrenalin injection.

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To examine the effect of asthmatic patient-oriented class held in August 2011 for adherence and self-care ability on which doctors and co-medical staffs collaborated jointly. Subjects: Eighteen asthmatic children participated in "asthma class for children" on August 4, 2011, and seventeen patients regularly came to our hospital after the lessons. We evaluated 17 patients' respiratory function, adherence and self-care ability of asthma diary, PEF and treatment before, 1 month and 3 months after the lessons. Results: One month after the class, their adherence, self-care ability and respiratory function were significantly improved compared to those before the class (P<0.05), so "asthma class for children" was effective. Three months after the class, maneuver of inhalation and the PEF were better than before class. Though we recognized that some participants couldn' t maintain adherence and self-care ability, the number of children who could maintain more than 50% of adherence increased before the class. Conclusions: We found that the asthmatic patient-oriented class was effective to improve their adherence and self-care ability. Through the class, children understood the pathogenesis of asthma and need of treatment, and it became an opportunity to do self-care independently.

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<Background>Recently, the close alliance between physicians and pharmacists, has been reported necessary and effective for the good management of adult asthma, as inhaled corticosteroids (ICS) therapy is spreading in Japan. So far, there has been no report about the alliance between them for the management of pediatric asthma. Since we would like to consider and achieve a good alliance between them for pediatric asthma, we took a questionnaire to pharmacies in Miyagi Prefecture. <Methods>We administered a mail-back survey by questionnaire sheets to pharmacies in Miyagi prefecture. Among 454 answers (collection rate: 43.4%), we analyzed 334 answers from pharmacies which prescribed to children. <Results>44.7% of the pharmacists answered that they were asked about the side effects of ICS by the patients or their parents, and 44.8% of them answered that they felt the doctors' explanation of the use of ICS were not adequate. On the other hand, direct instruction to the patients and its frequency of the use of ICS by pharmacists were not also adequate. For the good management of pediatric asthma, the majority of pharmacists wished to have a good alliance between themselves and physicians, and an opportunity such as an educational seminar about asthma with physicians, and a standardized instruction of ICS. <Conclusion>Most of the pharmacists have high motivation to achieve an effective alliance between themselves and physicians.

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A questionnaire survey was conducted among 376 members of the West Japan Research Society of Pediatric Clinical Allergy and Shikoku Research Society of Pediatric Clinical Allergy. A response was requested from each of the 324 facilities in order to assess the state of implementation and safety, etc. of oral challenge testing for food allergies. The response rate was 50% (163 hospitals and clinics) including 72% (63) of hospitals and 42% (100) of clinics and 63/100 responses from allergy specialists/general pediatricians. A total of 74% of the specialists implemented challenge testing compared to 38% of the generalists. Regarding the average number of times administered, 57% of the specialists reposted a rate of 1-5 tests, while 28% reported a rate of 11 tests or more among outpatients. In contrast, 85% of the general pediatricians reported a rate of 1-5 tests. Only 40% of the specialists and 23% of the generalists implemented testing among inpatients. Medical service fees were charged by 85% of the specialists, compared to only 38% of the generalists. The reasons given for the lack of testing included "difficulties in ensuring the staff, venue and time necessary to implement the tests", and "the risk of an immediate reaction" from the generalists, and "limits by health insurance regulations in the number of challenge tests and the age of patients who able to receive the tests" from the specialists. In order to ensure that a greater number of children safety receive challenge testing, both the establishment of a training system for specialists and the simultaneous expansion of the adaptive criteria for challenge testing implemented by specialists are required.

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Wheezing and other respiratory symptoms are frequently seen in infants and young children. It has been suggested that there exist some phenotypes of recurrent wheezing in infants and children. Pathophysiology, prognosis and long-term management may differ for each phenotype. Objective assessments of lung function and bronchial hyperresponsiveness help to distinguish between these phenotypes and to diagnose asthma. Spirometry is probably the most frequently performed lung function test. Measuring maximal forced expiratory flow-volume is important for determining the clinical utility of spirometry. Calculation of the parameters; FVC, FEV₁, MMF, V'₅₀ and V'₂₅ is recommended to evaluate pulmonary function. Evaluating the shape of the effort-independent portion of the flow-volume curve is especially important because the shape sensitively reflects the condition of small airways. Although most infants and young children are not able to voluntarily perform the physiological maneuvers, commercial devices using impulse oscillation system (IOS) suitable for young children have become available. Using these methods, objective lung function should be evaluated for diagnosis and management of asthma in children.

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Both of fractional exhaled nitric oxide (FeNO) and Exhaled breath condensate (EBC) analysis are non-invasive and effective biomarker for the evaluation of asthma. FeNO can be applied for asthma diagnosis and treatment monitoring. Oxidative stress markers, eicosanoids, and cytokines are measurable in EBC samples. In addition to symptoms and lung function measurements, FeNO and/or EBC analysis reflects airway inflammation, and allows correct assessment of the disease.

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Exercise provocative test is often performed in the diagnosis of allergic diseases. Because the frequency of EIA is thought to be high in the daily life of children, the evaluation of the EIA should be important. The method of EIA was described.

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24h-gastroesophageal pH monitoring is the most useful method for diagnosis of gastroesophageal reflux desiase (GERD) in children with asthma. But, it is important that association of respiratory symptoms and GER is checked. In recently, Combined Multiple Intraluminal Impedance and pH monitoring can be used in children. So, we hope that many data are reported in the future. Esophagogastroduodenoscopy and upper gastrointestinal series are performed when gastroesophageal symptoms are appeared in addition to respiratory symptoms.

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