Shiro Sugiura

Sun exposure inversely related to food sensitization during infancy

Autumn and winter birth (AWB) has been reported to be a risk factor for the development of food allergies. However, the association between seasonal factors and allergic sensitization during early infancy remains unclear.

A workshop with practical training for anaphylaxis management improves the self-efficacy of school personnel

BACKGROUND School personnel are required to guarantee a secure school environment for children suffering from severe food allergies. We organized a workshop for school personnel to learn the appropriate management of anaphylaxis that included practical training with an adrenaline auto-injector (AAI). The objective of this study was to evaluate the workshop in terms of the improvement of self-efficacy (SE) of participants to deal with anaphylaxis. METHODS All 93 school nurses, 73 schoolteachers and 110 childcare workers participating in the study completed a questionnaire before and after the workshop. The SE of the participants was evaluated using an original 15-item questionnaire. RESULTS Before the workshop, the SE of school nurses was the highest among the profession groups, and being involved with children prescribed an AAI was a common factor associated with a high SE. After the workshop, the SE increased in all groups, but most apparently in school nurses and those involved with children prescribed an AAI. The presence of an emergency plan was positively associated with the SE of schoolteachers only after the workshop, even though no such association existed beforehand. CONCLUSIONS Practical instruction of school nurses and school personnel involved with children prescribed an AAI resulted in dramatic improvement of the SE. These people are expected to play a central role in the development of an anaphylaxis management plan in their schools.

The ingestion of cow's milk formula in the first 3 months of life prevents the development of cow's milk allergy

Background IgE-mediated cows milk allergy (CMA) is one of the most common food allergies in infants. It is still controversial whether the early introduction of cows milk formula (CMF) prevents the development of CMA. Objective We aimed to evaluate the duration and frequency of CMF ingestion as compere with exclusive breast-fed for preventing CMA in high-risk infants. Methods We enrolled the patients diagnosed with hens egg allergy by an oral food challenge. A questionnaire was completed by the caregivers of the patients regarding the timing of introduction and discontinuation of CMF, and the frequency of CMF ingestion. Based on the information, we analyzed the relationship between the duration and frequency of CMF ingestion and the development of CMA at 3–24 months of age. Results Three hundred seventy-four patients were analyzed; 171 were diagnosed with CMA (45.7%). The analyzed patients (n = 374) were categorized into the following subgroups: exclusively breast-fed (breast-fed group, n = 75); discontinued ingestion of CMF before 3 months of age (temporary group, n = 177); continuous ingestion of CMF, but not daily, up to 3 months of age (nondaily group, n = 47); continuous ingestion of CMF at least once daily (daily group, n = 75). The incidence of developing CMA between the breast-fed group and temporary group did not show any statistical difference. Nondaily group and daily group had significantly lower incidence of developing CMA in comparison to the breast-fed group (nondaily group odds ratio 0.43; p = 0.02, daily group odds ratio 0.11; p < 0.001). Conclusion Ingestion of CMF during the first 3 months of life might prevent the development of CMA in high-risk infants.

The relationship between the season of birth and early-onset food allergies in children.

This study examined the relationship between the season of birth (SoB) and other factors with the development of FA.

Food sensitization in Japanese infants is associated with a common Filaggrin variant

1 51 F 320 Y 35 20 9 1 10 5 4 2 0.43 0.29 2 78 M 300 N 37 21 13 5 12 11 4 4 2.29 0.14 3 67 M 560 Y 56 47 11 12 8 6 4 2 1.86 0.86 4 55 F 102 N 10 3 6 2 24 20 8 8 1.14 0.43 5 51 F 120 N 38 30 11 5 7 2 4 2 0.57 0.29 6 55 M 590 N 42 18 9 5 19 12 8 5 3.14 0.86 Mean (SD) 60 (11) e 332 (209) e 36 (15) 23 (15) 10 (2) 5 (4) 13.3 (6.7) 9.3 (6.4) 5.3 (2.1) 3.8 (2.4) 1.6 (1.1) 0.5 (0.3) P value e e e e .005 .017 .007 .030 .034

Pediatric hospitalizations with influenza A infection during the 2009–2010 pandemic in five hospitals in Japan

Background:  The aim of this study was to identify the clinical characteristics of hospitalized children with the 2009 pandemic influenza virus infection in Japan.

Development of a prediction model for a severe reaction in cow's milk challenges

In addition to their conventional purposes, which is for the definitive diagnosis of a food allergy or for the discernment of tolerance to the allergen,1 oral food challenges (OFCs) are performed to determine the threshold dose of food allergens for risk-assessment or minimal avoidance. More severe reactions tend to be provoked in these OFC settings. We have already reported a model for predicting severe allergic reactions provoked in boiled egg challenges.2 In the present study, we developed a model for predicting a severe reaction to a milk OFC. This newmodel was developed via a similar method to that used for the egg challenge.2 An open OFC of milk was performed in accordance with the Japanese Guideline for Food Allergy 20143 throughout the study period. Raw cows milk was administered in a gradient dose (typically 4 to 5 doses from 0.2-0.5-1-2-5-10-20 ml) every 30e40 min. The challenge was stopped if the patient exhibited an objective allergic reaction corresponding to 5 points of the total score (TS) of Anaphylaxis Scoring Aichi (ASCA).2,4 To quantify the overall severity of the result of OFCs, the TS/Pro2 was applied, which was calculated by dividing the TS by the cumulative protein dose (Pro) of milk (3.3% of whole milk) administered before the appearance of symptoms. We divided patients in the development dataset into two groups (severe cases and non-severe cases) based on the median value of the TS/Pro of the development dataset. The development dataset was obtained from OFCs to cows milk from April 2012 to May 2013. During this period, 220 OFCs to milk were conducted, and 144 (65.5%) of thosewere positive. The appropriate laboratory data (specific IgE to milk and total IgE) collected within 180 days from OFC were missing in 37 cases, and 10 OFCs performed during the OIT were also excluded. As a result, 97 cases were analyzed. To validate this model in an independent clinical setting (validation dataset), 95 consecutive OFCs to milk (70 positive and 25 negative) with appropriate data and conditions from June 2013 to March 2014 were analyzed in a prospective manner. This study was approved by the institutional review board of Aichi Childrens Health and Medical Center. All analyses were performed with the STATA software program (version 12.1 for Mac; STATA Inc., College Station, TX, USA). For all analyses, a 2-sided probability value below 0.05 was considered to indicate statistical significance. The characteristics of the datasets are shown in Supplementary Table 1. Based on the median value of TS/Pro in the development dataset, we defined severe cases as TS/Pro 80 (n 1⁄4 49) and non-

Development of a prediction model for severe wheat allergy

9. Song W-J, Sintobin I, Sohn K-H, et al. Staphylococcal enterotoxin IgE sensitization in lateonset severe eosinophilic asthma in the elderly. Clin Exp Allergy. 2016;46:411-421. 10. Beeh KM, Ksoll M, Buhl R. Elevation of total serum immunoglobulin E is associated with asthma in nonallergic individuals. Eur Respir J. 2000;16:609-614. 11. Kalesnikoff J, Huber M, Lam V, et al. Monomeric IgE stimulates signaling pathways in mast cells that lead to cytokine production and cell survival. Immunity. 2001;14:801-811. 12. Foroughi S, Foster B, Kim N, et al. AntiIgE treatment of eosinophilassociated gastrointestinal disorders. J Allergy Clin Immunol. 2007;120:594-601.

Probability curves for predicting symptom severity during an oral food challenge with wheat

Wheat allergy is the third most common food allergy among young children in Japan.1 The most reliable examination for the definitive diagnosis of a food allergy is an oral food challenge (OFC); however, consuming wheat appears to be an independent risk factor for anaphylaxis during OFC.2 As predictive factors for severe wheat OFC outcomes have not yet been identified, simple and easy indicators to predict induced symptom severity during wheat OFCs are needed. Omega-5 gliadin is a major allergen in young children with an immediate allergic reaction to wheat,3 and the serum u-5 gliadin-specific IgE level was reported to be a useful parameter for predicting positive OFC outcomes.4,5 Conversely, we previously reported probability curves for predicting symptom severity during egg and milk OFCs based on allergen-specific IgE levels6,7 to add clinical usefulness to these that only predict positive outcomes.1 Here we report probability curves for predicting symptom severity during a wheat OFC. In this study, unified OFC protocols with a single database system were used to conduct a total of 1679 OFCs at 14 institutions between October 2012 and May 2014. The indication for OFC was decided according to the Japanese guidelines for food allergy with their clinical history of food allergy and related specific IgE levels.1,8 Of 173 wheat OFC cases, 117 OFCs with sufficient data for patients aged 6 years were included in the final analysis. We excluded 56 cases including 4 older patients, 16 cases of insufficient dosing, 3 inconclusive cases, and 33 cases without appropriate specific IgE data. Udon noodles were used for wheat exposure; children ingested 1, 2, 5, 10, and 20 (or 30) g of udon noodles in increasing order at intervals of 15e30 min. Considering that udon noodles contain 3.1% wheat protein,8 the maximal total consumed wheat proteins was 1488 mg during OFCs. An OFC was terminated once a distinct allergic symptom was induced following ingestion. Severity of induced allergic symptoms was graded from 1 to 5 using the grading system of the guideline,1 which is based on Sampsons anaphylaxis severity score.9 In this study, a negative outcome was defined as the consumption of at least 38 g of udon noodles without any induced symptoms.8 Serum u-5 gliadinand wheat-specific IgE levels were monitored for 3 months prior to OFCs using the ImmunoCap test (Thermo Fisher Scientific, Uppsala, Sweden). The present study was approved by a local research ethics committee. In statistical analyses, allergen-specific IgE levels, which were out of detection limits, were considered as 0.17 kUA/L for levels

Evaluation of the results of oral food challenges conducted in specialized and general hospitals

Background Oral food challenge (OFC) tests are conducted in both specialized institutions and general hospitals. We aimed to compare the severity of the conditions of the patients between these 2 types of institutions in order to consider the role of such institutions in society. Objective We evaluated the results of OFC tests for hens egg, cows milk, and wheat that were conducted in a specialized institution (Aichi Childrens Health and Medical Center [ACHMC], n = 835) and in 4 general hospitals (n = 327) in Aichi prefecture, Japan. Methods The symptoms provoked were scored using the total score (TS) of the Anaphylaxis Scoring Aichi scoring system in combination with the total ingested protein dose (Pro) before the appearance of allergic symptoms. Results The total ingested dose of the challenge-positive patients in ACHMC was significantly less than that in the general hospitals (p < 0.01). The median TS of the provoked symptoms in ACHMC and the general hospitals did not differ to a statistically significant extent in the hens egg or cows milk challenges; however, the median TS in ACHMC was significantly lower than that in the general hospitals for the wheat challenge (p = 0.02). The median TS/Pro values in ACHMC were almost identical to the upper 25% of the TS/Pro values in the general hospitals, suggesting that the specialized institution usually managed more severe patients. Conclusion The specialized institution performed OFC tests at a lower threshold dose, but provoked similar TSs to the general hospitals. This evaluation may help in optimizing the distribution of patients to general hospitals and specialized institutions.