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The TOPICOP scale was developed previously for atopic dermatitis patients. It comprises 12 questions to assess patients' worries and beliefs about topical corticosteroids. The aim of this study was to translate TOPICOP into Japanese and evaluate its feasibility.We developed a Japanese version of TOPICOP from the original English version, using a process of forward and backward translation. We performed an anonymous survey using the validated Japanese TOPICOP to evaluate the feasibility of its use amongst patients and parents at two hospitals.A total of 287 participants (83% female age 38±7 years) completed the Japanese TOPICOP and the average score was 41±18. More than half of the participants believed topical corticosteroids pass into bloodstream, damage the skin and affect future health. In addition, more than 60% of participants were anxious about applying topical corticosteroids to certain zones like eyelids, and about applying too much corticosteroid. Participants said that they need reassurance about topical corticosteroids. Among all participants, 68% answered within 5 minutes, 85% answered without any difficulty, and 79% could understand the meanings easily.The Japanese TOPICOP was an easy and quick scale for assessing corticosteroid phobia in Japanese atopic dermatitis patients. It can be used in clinical practice and in future clinical research on atopic dermatitis.

Many children are suffering from food allergy, however, not all of them are treated properly by pediatricians based on the latest practice guideline. The guideline does not recommend excessive elimination diet, but suggests initial appropriate skincare treatment before examining candidate allergens for food-allergy-patients with atopic dermatitis. We developed and evaluated a curriculum for continuing medical education for pediatrician about food allergy.We provided a medical educational program for pediatricians at the Division of Allergy in National Center for Child Health and Development, from January 2013 to January 2014. The program was aimed to improve their behavior in the management of food allergy, if they excessively eliminated diet from the patients and did not treat atopic dermatitis appropriately. The program was constituted of SBOs and educational strategy. Participant's self evaluation of learning and that of behavior were carried out before and after the training, and their scores were analyzed for the program evaluation.Thirty-five participants completed the program. All the scores rating 22 items for evaluation of learning were increased. Five items out of 7 about evaluation of behavior were significantly improved.We developed a medical educational program about food allergy for pediatricians. After training based on this program, the participants' knowledge and skills were improved and their behavior was desirably modified.

Some caregivers of children with food allergy may eliminate specific foods from the diet of these children without first consulting doctors. The aim of this study was to investigate the prevalence of such practice and the sensitization of the offending foods.All participants were patients aged one year or over who visited our outpatients unit with complaints of food allergy. Caregivers of the patients were asked to fill out a questionnaire to state the eliminated food items and the grounds for avoidance ("doctor's instructions", "family's judgment", and "not consumed in daily diet") of nine food items including chicken egg, cow's milk, wheat, soy bean, rice, buckwheat, peanut, sesame and shrimp. Data on food-specific IgE titers were extracted from the patients' electronic medical charts.A total of 463 subjects were included in the analyses. Prevalence of patients with specific food avoidance of each of the food item was higher in the lower age group than the higher age group. More than 83% of the patients who avoided chicken egg, cow's milk or wheat were advised by their doctors to do so, while less than 49% of patients who avoided buckwheat did so for the same reason. The percentage of the patients who showed positive sensitization to buckwheat, peanut or shrimp, and avoided it without doctor's instructions, was 46%, 48%, and 34%, respectively.While the majority of caregivers of the children who visited our outpatient unit eliminated specific foods according to doctor's instructions, a considerable proportion of them do so inappropriately without first consulting a doctor.

We developed a tailored education program using a touch-screen computer for changing management behavior with asthmatic children and their caregivers. The purpose of this study was to examine the effect of the tailored education program.Caregivers including children with asthma were recruited during visits to a national children's hospital and those whose month-long asthma condition on the JPAC (Japanese Pediatric Asthma Program) score was 14 and below were included. Caregivers were randomized to the tailored education (intervention group) or non-tailored education (control group). The intervention group underwent a patient education program using a touch-screen computer, and they received tailored messages generated by a computer program. A research nurse and clinical psychologist used a computer-based resource to tailor the education messages and provided counseling using motivational interviewing for the caregivers including children with asthma. The control group received only a booklet on asthma.Forty-seven subjects aged 1 to 6 years were enrolled. Forty-seven caregivers were randomized to the tailored education (n=22) or non-tailored education (n=25) group. The results of two-way ANOVA showed that interactions between groups were observed in the score of JPAC and asthma knowledge for preschool children whose asthma onset was within one year and a half. The main effects of time were observed in the total and subscale score of QOL (Quality of Life) and the total score of P-CASES (Parental Childhood Asthma's Self-efficacy Scale).These findings indicate the benefit of a tailored education program to control symptoms in such caregivers.

Pompholyx-like reactions may develop for aggressive atopic dermatitis treatments in the incipient phase despite of improvement of other skin symptoms.Eighty-nine patients admitted to National Center for Child Health and Development for treatment of atopic dermatitis between April 2007 and March 2009 were recruited.Pompholyx-like reactions were seen in thirteen out of eighty-nine patients between 4 and 32 (mean 16.7±10.4) days following admission. The mean age of patients with these reactions was 6.2±6.1 years (range of 3 months to 23 years). At the time of admission, practical issues of scoring atopic dermatitis: the SCORAD was assessed. The values of SCORAD index with pompholyx were ranging from 16-91 (mean 50.8±17.9), and the index except under one-year old were significantly higher than unaffected patients. These patients were evaluated into their medical record, for evidence of Pompholyx-like lesions: a bilateral vesicular eruption confined to the skin of the palms, soles, or sides of the fingers. Topical corticosteroids are used to treat Pompholyx-like reactions, all them achieved remission between 4 and 50 days (mean 18.5±12.0). In general, pompholyx is more common in summer. However, it seems that there were no significant differences in the pompholyx-like reactions incidence between in summer and in winter.The factor for the occurrence of pompholyx-like lesions remains unexplained. Although the original symptoms of eczema were improved, pompholyx-like eczema breakout, therefore, patients often feel uneasy. We should be aware of this clinical condition.

To reveal the clinical utility of an IgE test specific to ω-5 gliadin in the diagnosis of immediate-type wheat allergy.We detected ω-5 gliadin-specific IgE in sera from all patients examined for wheat-specific IgE in our allergy clinic between January and October, 2008. The diagnostic value of the test was analyzed against the true diagnosis of wheat allergy based on oral wheat challenge or convincing clinical history. Subjects comprised 233 patients (median age, 3.6 years), 59 patients were diagnosed with wheat allergy, and 174 were judged to have no wheat allergy.The prevalence of being diagnosed as wheat allergy was 68% in the patients with CAP score 2 to ω-5 gliadin IgE (n=31), and 87% in those with CAP score 3 (n=15). All of the 3 patients with CAP score 4 or more were wheat allergic. However, 24% of patients with wheat allergy showed negative results (0.35 UA/ml). According to the data, we proposed the probability curve of ω-5 gliadin-specific IgE.IgE testing specific to ω-5 gliadin can offer a useful clinical marker for the diagnosis of immediate-type wheat allergy. But the data should always be evaluated with wheat-specific IgE titers, because of the low clinical sensitivity to detect the patients with wheat allergy.

To identify the factors influencing parental medication control behaviors (inhaling corticosteroids and medication-taking) in pediatric asthma management.A specially-designed questionnaire survey was conducted on 942 parents with asthmatic children in hospitals and elementary schools.Factor analysis on inhalation behaviors resulted in five factors: understanding of benefit, mastering on inhalation skills and medication management, family support, anxiety of side effects, and explanation from a doctor (cumulative contribution ratio=51.3%). Factor analysis on medication-taking behavior resulted in five factors: understanding of medication effectiveness and benefit, family support, anxiety of side effects, skills on giving medicines, and family routine (cumulative contribution ratio=50.6%).The results indicate the importance of recognizing factors influencing parental medication control behaviors in developing education strategies to maintain and reinforce their asthma management behaviors.

We have been conducting a two-day in-hospital parental education program -"Skin Care School"- on childhood atopic dermatitis since April 2007. The program comprises three lecture- and- practical session courses on skin care, the correct skin-cleaning procedure, and the application of ointments based on the "Finger Tip Unit." The program addresses caregivers of patients less than six years old suffering from moderate to severe atopic dermatitis.To evaluate the effectiveness of this program, questionnaires were administered to 56 participants before, immediately after, one month after, and six months after completion of the program.Although the participants had received doctors' instructions on the amount of the ointments to be applied, most of them recognized on completing the program that they had been applying less amounts than prescribed. They added that the symptoms of the skin conditions, such as pruritus and sleeplessness, improved in one month after proper application and stabilized for six months. Moreover, the amounts of topical corticosteroid ointments required decreased following one month of treatment and reduced further in six months.This educational program was effective in imparting a sound understanding of skin care to the caregivers during their wards' short hospitalization. Appropriate skin care comprises cleaning the skin properly and applying adequate amounts of corticosteroid ointment and skin moisturizer, which results in improvements in conditions like eczema and a reduced requirement for corticosteroids.

We have evaluated the prognosis of milk allergy and the related factors.Patients with milk allergy (n=60) who had initially visited our hospital before 2 years old were recruited for the chart review. The ability of milk intake (30 ml) at the age of 5 years and the related clinical factors were evaluated.There were 33 patients (55%) who remained allergic to milk (allergic group) and 27 patients (45%) who could consume at least 30 ml of milk (small amount of milk intake group) by the age of 5 years. The small amount of milk intake group had a history of isolated skin symptoms after ingestion of milk more frequently than the allergic group. On the other hands, the allergic group experienced significantly higher rate of respiratory and gastrointestinal symptoms. Milk-specific IgE antibodies were examined repeatedly in each patient, and the IgE titers were significantly decreased by age in the small amount of milk intake group. In the allergic group, however, the maximum milk-specific IgE titers in each patient were significantly higher than those in the small amount of milk intake group, and after significant increase from the age of 0 to 1 years, the IgE titers did not decrease until the age of 3 years.Respiratory and gastrointestinal symptoms followed by milk intake and persistent high milk-specific IgE titers were associated with persistent milk allergy.

A kit, FASTKIT ELISA version II (Egg) (Nippon Meat Packers) is an enzyme-linked immunosorbent assay kit for detecting hen's egg proteins in foodstuffs. This kit is an enhanced version of FASTKIT ELISA (Egg) with a greater efficiency in terms of extraction of egg proteins from heated foodstuffs. However, the property of this kit remains to be fully elucidated.Using this new kit, we measured the amount of egg proteins in unheated or heated (140 degrees C or 180 degrees C, 20 min) homemade cookies containing whole egg, egg white or egg yolk.The capability for detection of unheated or heated (140 degrees C or 180 degrees C) whole egg proteins was similar. In addition, there was no significant difference in the detectability between heated (140 degrees C) whole egg and egg white proteins. However, unheated or heated (140 degrees C or 180 degrees C) egg yolk proteins were not sufficiently measured by this kit.Our data suggest that this new kit is significantly improved for detection of heated egg white proteins as compared to that of old version, but not sufficient for detection of egg yolk proteins.

A method for open food challenge test to determine food allergy has not been established in an evidence-based manner.We conducted an analysis of 438 open food challenges of raw milk (n=133, mean age 2.7+/-1.9 years), boiled egg white (n=216, 2.8+/-2.1 years) or udon noodles (n=89, 2.7+/-1.7 years) for the patients aged 1 year or more. Doses were increased (trace amounts, 1 g, 2 g, 5 g, 10 g, 20-30 g) every 20 minutes.In total, 151 (38.5%) of food challenges were positive. The positive rates of milk, egg and wheat challenges were 35.8%, 42.4% and 33.3%, respectively. Of these, 76.2%, 32.5%, 27.8% and 0.7% had, respectively, skin, respiratory, gastrointestinal and cardiovascular symptoms. Although the prevalence of positive challenge increased with level of specific IgE, it did not correlate with the threshold amount of positive food challenge or the severity of symptoms. Among the challenge positive patients, 10.6% required injection of antihistamines, corticosteroids or adrenalines for the treatment of the symptoms.This challenge protocol seemed to be appropriate and safe.