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The incidence of eosinophilic esophagitis (EoE) and pollen-food allergy syndrome (PFAS) is increasing worldwide, and coexistence of these 2 diseases has been reported in adults. In children, however, these conditions have not been reported as comorbidities probably because sensitization to aeroallergens occurs at an older age. We report the case of a boy with EoE and PFAS. He had had intermittent vomiting since 2 years of age. At 7 years of age, he experienced an episode of itchiness of the lips and throat for the first time, followed by vomiting, immediately after ingesting some raw fruits. We diagnosed PFAS based on the skin prick test at 8 years of age and diagnosed EoE by esophagogastroduodenoscopy 11 months after the diagnose of PFAS. His digestive symptoms did not disappear despite eliminating the fruits responsible for PFAS, but esomeprazole improved his symptoms. The incidence of EoE and PFAS as comorbidities in children might increase in the future.

The number of patients with food allergy in Japan is increasing year by year, although the precise prevalence of them is not clear. We aimed to determine the estimated number of people with food allergies in Japan and produce new methods of the investigation of them.We determined the number of people with food allergies using government data and statistics such as demographic statistic and the number of students.In infants, the number of patients with a food allergy was 800000 as per the self-reported prevalence; however, as per the physician's diagnoses, 300000-500000 of them had a food allergy. In students, the selfreported number was 600000, while 350000 cases were diagnosed by physicians. In adults, the consumer agency investigated the patients who visited the hospital with the immediate hypersensitivity. In this study, the participants were limited to patients who visited the hospital. This made the estimation of the overall prevalence of food allergy in Japan.For children, if we add the questionnaire to the existing study, which questions them regarding the symptoms of food allergy, the diagnosis by the physician, and the blood test, we can better investigate the prevalence of food allergies and changing pattern by the year. In adults, we propose that future investigations consisting of the National Health and Nutrition Survey and a comprehensive survey of living conditions should be conducted, because few studies have reported on food allergies.

Lipid transfer protein (LTP) is a major fruit allergen. It has, however, recently been revealed that the systemic reaction in peach-allergic patients is related not only to LTP (Pru p 3) but also to gibberellin-regulated protein (Pru p 7). We investigated recombinant Pru p 7 (rPru p 7) for its potential use in worldwide standardization for the diagnosis of peach allergy.Natural Pru p 7 (nPru p 7) was purified from peach crude extract using a monoclonal antibody affinity column. Complementary DNA for Pru p 7 was cloned and expressed in Escherichia coli and Pichia pastoris. Serum immunoglobulin (Ig) E in peach-allergic patients was examined by enzyme-linked immunosorbent assay (ELISA) using nPru p 7 and rPru p 7 (E. coli product: erPru p 7 and P. pastoris product: prPru p 7).Peach-allergic patients (n=27) were diagnosed and categorized into oral reaction (n=10) or systemic reaction (n=17). The nPru p 7 positivity based on serum IgE levels was 52% in the systemic-reaction group and 0% in the oral-reaction group (P0.05). In the systemic-reaction group, there was no significant difference in reactivity between nPru p 7 and prPru p 7, but the reactivity of erPru p 7 was significantly lower than those of nPru p 7 and prPru p 7 (P0.05).We found that prPru p 7 exhibited reactivity in ELISA comparable to that of nPru p 7 for the diagnosis of peach allergy with systemic reaction.

Proactive therapy for atopic dermatitis (AD) effectively prevents exacerbation. However, its role in preventing subsequent sensitization to allergens has not been prospectively studied. We investigated whether proactive therapy for AD can effectively impact immunological parameters in a randomized, investigator-blinded, parallel group study. Thirty patients aged 3 months to 7 years with moderate to severe AD who had undergone an AD educational program were allocated to a proactive treatment group or a reactive treatment group. During the disease control period, patients in the proactive group performed intermittent preventive application of topical corticosteroid for 1 year. Changes in the severity scoring, quality of life measures and immunological parameters (serum thymus and activation regulated chemokine [TARC], total immunoglobulin E [IgE] and house dust mite-specific IgE levels) were evaluated and compared between the proactive and reactive treatment groups. Although the average topical corticosteroid ointment use per day in both groups was not significantly different, the severity and quality of life scores were significantly lower in the proactive group than in the reactive group at the final visit. In addition, compared with baseline levels, serum TARC levels remained significantly lower during proactive therapy, while house dust mite-specific IgE levels were significantly increased only in the reactive group. The results suggest that in addition to controlling the severity of AD, intermittent preventive administration of topical corticosteroids may prevent an increase in aeroallergen-specific IgE levels in patients with childhood AD. The use of TARC levels as a biomarker for AD remission is also supported.

We report the case of a 5-month-old female infant who had allergic enterocolitis with protein-losing enteropathy and had low birth weight. Until the age of 4 months, she was fed only breast milk and did not experience any related problems. When she was 5-months-old, she was admitted to our hospital with the chief complaints of vomiting and diarrhea. She had whole body edema, thoracic and abdominal ascites, and bloody stools. Laboratory examinations showed the presence of hypoalbuminemia, hypogammaglobulinemia, and an elevated CRP level. Subsequently, she was fed an elemental diet with enteral tube feeding, and her condition gradually improved. However, 2 weeks later, her symptoms reappeared, and therefore, she was admitted to the National Center for Child Health and Development. She underwent upper and colon endoscopies and was found out to have multiple inflammatory lesions in the area extending from the cecum to the rectum. The biopsy findings showed features of eosinophilic enterocolitis and she was diagnosed with allergic eosinophilic enterocolitis. Subsequently, an elemental formula that does not include soybean was used for feeding the infant. The symptoms resolved and her condition improved; currently, she is well and is showing normal development. We have reported this case because allergic enterocolitis is becoming a topic of concern.

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.

S U N D A Y 366 Allergen Specific Immunotherapy in Cases of Severe Atopic Dermatitis Inmaculada S anchez-Mach in, MD, Paloma Poza, Ruperto Gonz alez, Victor Matheu, MD; Hospital Ofra-T orax, Tenerife, Spain, Hospital Ofra-T orax, santa cruz de tenerife, Spain, Hospital Ofra-T orax, S/C de Tenerife, Spain, Hospital Ofra, Tenerife, Spain. RATIONALE: Allergen sensitization appears to be part of the etiology of Atopic Dermatitis (AD). The effectiveness of allergen specific immunotherapy (SIT) in AD remains controversial, even contraindicated in severe cases. METHODS: Total IgE (T-IgE) and Specific IgE (S-IgE) by CAPFarmacia. Patient 1 (P1): 43-year-old male. Patient 2 (P2): 31-year old woman. Patient 3 (P3): 9-year-old woman. All of them were nonresponders to usual therapeutics including corticosteroids oral (Last year daily for P1, P2, and 6 cycles for P3), cyclosporin (P1, P2) or methotrexate (P1with bloody diarrhea). They hadmild persistent rhinitis and intermitent asthma and positive S-IgE to Dermatophagoidesand storage mites, and P1 also to grass, ragweed pollen and foods without clinical relevance. RESULTS: In a first visit SCORAD and T-IgEwere: P1, 81 and 31,090UI/ ml. P2, 75 and 19,038UI/ml. P3, 36 and 14.897UI/ml.We started treatment with SIT, with cluster administration schedule of 4weeks in Hospital Immunotherapy Unit and subsequent monthly maintenance. The early months P1 and P2 showed improvement. The T-IgE was descending in improved patients to be in the 4 year of SIT: 5,560UI/ml for P1 and 2,500UI/ml for P2 with SCORAD of 11 and 5 respectively. However, since there was no clinical improvement for P3 over the first year and her T-IgE increase to 19,239UI/ml and SCORAD to 40, the SIT was stopped. CONCLUSIONS:Wehave observed a rapid onset of action after initiation of SIT in some cases of Severe AD. Clinical improvement was correlated with the decrease in T-IgE. The SIT may be a therapeutic alternative.

S A T U R D A Y 129 Safety of Proactive Topical Corticosteroid Therapy About Adrenal Function and Growth Velocity of Childhood Severe Atopic Dermatitis T. Fukuie, I. Nomura, M. Futamura, M. Narita, Y. Nakagawa, T. Ohzeki, K. Matsumoto, H. Saito, Y. Ohya; National Center for Child health and Development, Tokyo, JAPAN, Hamamatsu University School of Medicine, Shizuoka, JAPAN, National Research Institute for Child Health and Development, Tokyo, JAPAN. RATIONALE:We have reported about decline of serum IgE titer by proactive treatment of atopic dermatitis (AAAAI 2009, BJD 2010 in press). But safety of long-term proactive treatment with using topical corticosteroid about adrenal and growth suppression in children with atopic dermatitis (AD) has not been enough described. METHODS: Growth measurement of the patients with severe AD who admitted to National Center for Child Health and Development (Tokyo, Japan) from April 2006 to March 2008 and continued the proactive administration of topical corticosteroid over 2 years were studied retrospectively and compared with the normal value of Japanese children. Height and annual height velocity were converted to standard deviation scores (SDS). Hypothalamic-Pituitary-Adrenal (HPA) axis function was assessed by serum cortisol and 24-hour urinary free cortisol excretion before and after receiving continuous therapy with proactive management. RESULTS: Eleven girls and 15 boys who could have continued the proactive therapy between the study periods were eligible for this study. The mean (range) agewas 4.4 yrs (0-10) and the mean baseline height SD score was -0.54. Mean baseline serum and urinary cortisol levels were once reduced significantly with everyday use of topical corticosteroids (remission-induction phase), however improved at intermittent proactive treatment phase.Mean height SD scores after 1 and 2 years were not aggravated (-0.54 and -0.47, respectively), and mean annual height velocity SD scores (height-adjusted) after 1 and 2 years were -0.23 and 0.50. CONCLUSIONS:We found that proactive intermittent application of topical corticosteroid does not have negative effects on HPA axis function and height velocity.