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Background: Immediate-type wheat allergy due to hydrolyzed wheat protein (HWP-IWA) supplemented soap has been a serious social issue. We investigated the significance of challenge test and other tests not only to diagnose HWP-IWA but to know the symptoms of each patients., Methods: From January 2010 to June 2012, we performed challenge test in 41 cases with positive prick test of Glupearl 19S®, a major allergic HWP found in Cha no Shizuku®., Results: Thirty nine of 41 cases were challenge test positive. In two patients who showed positive skin prick test but negative for challenge test, titer of specific IgE antibody and/or basophil histamine release test against Glupearl 19S® revealed positive reaction., Conclusion: Challenge test is not included in indispensable examinations for the diagnosis of HWP-IWA in the recommended guidelines. However, challenge test is still a useful tool for assessing actual severity of each patient's symptoms and determining the timing of cessation of wheat avoidance. In addition, combined check-up with several laboratory examination and challenge test may help appropriate diagnosis of HWP-IWA.

Background: Recently, it has become a social problem that hydrolyzed wheat protein in facial soap can induce wheat allergy including wheat-dependent exercise-induced anaphylaxis (WDEIA). We described the clinical characteristics of the patients related., Methods: We collected 12 cases who had had a medical examination from January to October in 2010., Result: All the patients were female and mean age was 36.0± 9.9 years. All of them had had no prior symptoms history of wheat allergy, they gradually developed wheat anaphylaxis or WDEIA in an average of 2 years after they started to use a soap product in question which contains hydrolyzed wheat proteins. Most patients suffered immediate contact allergic reactions after or at the time of washing their face with the soap product. 10 of 12 patients showed a low level of IgE to CAP-recombinant ω-5-gliadin. Episodes of anaphylaxis were prevented by avoiding both intake of wheat-containing foods and usage of the soap product., Conclusion: We concluded that their wheat anaphylaxis is likely to be caused by epicutaneous sensitization of the hydrolyzed wheat proteins in the soap product. It was important that physicians should know the possibility of sensitization from non-dietary antigen.

Objective: This study evaluated the efficacy and safety of Budesonide Inhalation Suspension (BIS) nebulazation by mesh nebulizer in children ages 6 months to 4 years with moderate to severe persistent asthma., Method: This 12-week, randomized, open study involved 30 asthmatic children. They were randomized 3 different nebulizer groups, Pari TurboBoy +LC Plus nebulizer, Pari eMotion and Omron MicroAir NE-22U. BIS administered 0.25 mg once daily (qd). Efficacy was assessed by daily card. Safety was assessed by adverse event, plasma cortisol and growth., Result: Baseline concentrations of plasma cortisol were significantly high in the group of Omron MicroAir NE-22U compared to other group. Plasma cortisol were decreased significantly at 4 weeks in Omron MicroAir NE-22U compared with baseline, but those in no subjects decreased under normal range. Asthma symptoms were improved significantly from baseline to 12-week., Conclusion: This study demonstrate that usage of mesh nebulizer in BIS 0.25 mg qd is effective and safe in young asthmatic children.

Background: A cross-sectional survey, Asthma Insights and Reality in Japan (AIRJ) conducted in 2000 demonstrated that the level of asthma control and inhaled corticosteroid (ICS) use in Japanese asthmatics were low compared to the average in European countries. The purpose of the AIRJ survey in 2005 was to assess changes in the burden of asthma and asthma management in Japan since 2000 AIRJ survey., Methods: We used identical methods to AIRJ 2000, including random-digit dialing to identify current asthmatics throughout Japan in 2005. A detailed telephone survey which included items on the burden of asthma and clinical management was conducted in 800 households (400 adults, 400 children) from the identified asthmatics. We compared AIRJ 2005 results with those of AIRJ 2000 separately for adults and children with statistical adjustment for differences in population characteristics between AIRJ 2000 and AIRJ 2005., Results: Participants in 2005 reported significantly lower prevalence of symptoms, including a decrease in daytime symptoms in adults (52% to 46%, p=0.046) and a decrease in night-time awaking in children (40% to 33%, p=0.039). The number of patients who experienced one or more asthma episodes in the past year (ER visits, hospitalization, or unscheduled doctor visits) decreased significantly from 2000 in adults (41% to 31%, p<0.01) and children (62% to 49%, p<0.001). ICS use rate increased significantly in adults (12% to 18%, p=0.019) and had a tendency to increase in children (5% to 8%, p=0.059)., Conclusions: There have been improvements in the burden of asthma patients and clinical disease management as well as more use of ICS in Japan since 2000. Nevertheless, in most patients, ICS use still remained low, and asthma management fell short of the goals of treatment outlined in the Japanese guidelines. There is a need to increase awareness of and compliance with the asthma guidelines and to popularize standardized therapy in Japan.

Purpose: This study was designed to clarify the definition of sick house syndrome (SHS)., Methods: SHS was defined based on the disease related to habitation as follows. 1. The cause of the onset of a disease relates to house. 2. Symptoms appear within house. 3. Symptoms will be less serious or disappear if patient away from house. 4. If patient goes into house, symptoms will appear repeatedly. When it corresponded to all above, it was defined to SHS, and it classified as MCS (multiple chemical sensitivities) without above conditions. Even if SHS is isolated from similar disease completely, characteristic symptoms of MCS are hard to be detected because MCS are combination of two or more diseases. Based on this working hypothesis, the logistic regression by setting MCS as reference was performed so that characteristic symptoms of SHS show odds ratios with exceeding one., Results: The odds ratios with more than two of characteristic symptoms in SHS were "nausea or vomiting" "Troublesome in everything" and the causative substances to which symptoms get worse was "The smell of a perfume and cosmetics". Characteristic symptoms of an allergy disease were detected by comparison with the allergic conjunctivitis, allergic rhinitis, and bronchial asthma, respectively., Conclusion: These results showed that the classification method was appropriate. This definition is not fundamentally differed from the definition of the sick-building syndrome of WHO.

Background: This Asthma Insights & Reality in Japan survey was conducted to access the achievement of asthma control by patients and current status of asthma treatment in 2005., Methods: This was cross-sectional, randomized-digit-dial household telephone survey, conducted between September and December 2005., Results: A total 400 adults (mean 52.2 years) and 400 parents of children (mean 8.2 years) with asthma were interviewed by telephone. More than 40% of these patients reported having daytime asthma symptoms and over 30% in nighttime symptoms with awakening. Asthma episodes, i.e. hospitalization, emergency room visit, unscheduled visit, work/school absence were observed in 7, 4, 33, 29% of total patients during the past year, respectively. Eighteen percent of adult and 8% of children used inhaled corticosteroid. Awareness of peak-flow meter and experience of lung function test were low., Conclusion: The rate of patients who experienced asthma symptoms or episodes tended to decrease, and use of inhaled corticosteroids seemed to be increased since 2002 when a similar survey took place. However, asthma remains poorly controlled and the current level is still far from achieving the goal of asthma management objected by the Japanese guidelines. Further dissemination of standardize therapy in compliance with the guideline is required.

The patient was a 65-year-old man with chief complaints of flare, swelling, itching and loss of consciousness. He had a history of diabetes diagnosed at the age of 34 years and was receiving medication from a local doctor. He had experienced systemic flare, swelling and loss of consciousness 20 minutes after drinking beer at a party at the age of 34 years. Since that time, he had frequently experienced urticaria and loss of consciousness while taking a walk after eating various foods (all of which contained flour). In February 2001, he experienced systemic flare, swelling and loss of consciousness when he returned home from a walk after eating a meal that included meat dumplings. Laboratory tests on admission showed a serum IgE level of 253 IU/ml, and the IgE level for flour in a RAST was 2.13 UA/ml (class 2). The results of exercise tolerance tests were normal during fasting, after ingestion of food that did not include allergens (wheat, shrimps and crab) and after ingestion of half of a thick slice of white bread, but systemic wheal and flare reactions appeared during an exercise tolerance test after ingestion of one thick slice of white bread. A diagnosis of food-dependent exercise-induced anaphylaxis caused by flour was made on the basis of the results.

We have monitored Juniper pollen which caused winter allergy symptoms by Burkard sampler in Galveston, Texas. We identified and counted Juniper pollen grains by PAAA protocol which was a comprehensive guideline for the operation of Hirst-Type suction bioaerosol sampler, (original of Burkard sampler) in the USA. In Galveston we were able to detect the Mountain Cedar (Juniperus ashei) pollen from December to of January, and Eastern Red Cedar (Juniperus virginiana) which has cross reactivity to MC from almost middle of January to February. There is no MC vegetation in Galveston. We found the pollen grains were transported from west at Edward Plateau in West Texas where it was thickly wooded. Then, we tried to monitor Japanese Cedar (JC) pollen grains in Fukuoka, Japan according with the same method. We found the significant positive correlation between the pollen counts using one single longitudinal traverse counting technique in the PAAA protocol and the JC pollen counting on the whole of Melinex tape per 24 hours (R2=0.9212, p=0.0001), and the gravitational method that is Durham sampler's pollen counting in 2002 (R2=0.489, p=0.0001), and in 2003 (R2=0.948, p=0.0001) respectively. We suggested that we can use the PAAA protocol for airborne pollen investigation in Japan by Burkard sampler.