Yoshie Okabe

Association between the Results of the Childhood Asthma Control Test and Objective Parameters in Asthmatic Children

Objective. The Childhood Asthma Control Test (C-ACT), a seven-item, self-administered questionnaire, has been used as a tool to assess the control level in children with asthma. The aim of this study was to determine whether the C-ACT reflects airflow limitation and airway inflammation in addition to clinical manifestations. Methods. Asthmatic children aged 5–11 years who were able to perform the lung function test and fractional exhaled nitric oxide (FeNO) evaluation correctly were recruited during their regular visits. Children and their parents were asked to answer the officially developed Japanese version of the C-ACT. Results. Among 258 children (176 boys, median age 9 years), there was a significant positive correlation between the C-ACT score and the percent predicted forced expiratory volume in 1 s (%FEV1) (r = 0.317, p < .001). The accuracy of the C-ACT for identifying asthmatic subjects with normal lung function (%FEV1 >80%) described as the area under the receiver operating characteristic curve was 71.5% (95% CI = 62.8–80.2%, p < .001), and based on the Youden index the optimal cutoff score was 23 (sensitivity of 78% and specificity of 54%). In contrast, there was no relationship between the C-ACT score and the FeNO value. Conclusions. These results suggest that a cutoff score of 23 for the C-ACT could be useful for identifying children with well-controlled asthma and normal lung function. Further studies are warranted to develop an easy-to-use questionnaire to assess the extent of airway inflammation in children.

Association of overweight with asthma symptoms in Japanese school children.

Background:  Most studies regarding the association of obesity with asthma have been performed in the Western countries. This study is a nationwide survey conducted in Japan.

Association between obesity and asthma in Japanese preschool children.

To cite this article: Okabe Y, Adachi Y, Itazawa T, Yoshida K, Ohya Y, Odajima H, Akasawa A, Miyawaki T. Association between obesity and asthma in Japanese preschool children. Pediatric Allergy Immunology 2012: 23: 550–555.

MxA-based recognition of viral illness in Febrile children by a whole blood assay

Febrile children are often given antibiotics empirically and unnecessarily. MxA is a protein induced in peripheral lymphoid cells by type 1 interferons during active viral infection. The ability of a whole blood ELISA assay for MxA to identify children with viral illness was studied in 122 children who presented with acute onset fever and 52 age-matched healthy controls. The febrile children were divided into three groups according to their final diagnoses: etiologically diagnosed viral infection, clinically diagnosed viral infection, and bacterial infection. MxA levels in the bacterial infection group and controls were similar and low (90.9 ± 69.7 and 76.9 ± 63.2 ng/mL, respectively). In contrast, mean MxA levels in the two viral infection groups were higher than in both the bacterial and control groups (719.2 ± 386.4 and 827.0 ± 651.1, respectively). A receiver operating characteristic analysis showed that the area under the curve of the MxA level was greater than under the curves of both the white blood cell count and the C-reactive protein concentration. Whole blood assay of MxA is a clinically useful tool for diagnosing viral illness in febrile children and should help reduce use of unnecessary antibiotics.

Comparison of exhalation time methods (6 sec vs. 10 sec) of a hand-held exhaled nitric oxide analyzer.

Standard exhalation time for measuring fractional exhaled nitric oxide (FeNO) is 10 sec, but this is not easy for younger children. We aimed to investigate the agreement between FeNO values during 10‐sec (FeNO‐10) and 6‐sec (FeNO‐6) exhalation and the feasibility of measuring FeNO‐6, using a hand‐held analyzer, NIOX‐MINO®. FeNO values measured during 10‐ and 6‐sec (random order) were compared. Success rates of the two different time modes were also evaluated. In 119 asthmatic children (median age 8 years [range 4–15]) who had been already accustomed to NIOX‐MINO®, median FeNO‐10 (29 ppb [IQR 15.2–42.0]) and FeNO‐6 (27 ppb [IQR 16.0–43.5]) did not differ significantly (P = 0.90), and there was a good correlation between both values (r = 0.984, P < 0.001). Mean difference (FeNO‐10–FeNO‐6) was −0.151 ppb (95% CI: −0.95 to 0.65, limits of agreement: −8.8 to 8.5). In 46 asthmatic children (median age 7 years [range 4–15]) who had never used any FeNO analyzers, all the children aged 8 years and more (n = 21) succeeded in measuring FeNO on both time modes, whereas for children aged younger than 8 years (n = 25) success rates of the 10‐ and 6‐sec mode were 60.0% and 92.0%, respectively. In conclusion, we showed good agreement between FeNO‐10 and FeNO‐6, and the 6‐sec mode of NIOX‐MINO® is more feasible than 10‐sec mode for measuring FeNO in younger children. Pediatr Pulmonol. 2010; 45:1005–1008.

New sandwich-type enzyme-linked immunosorbent assay for human MxA protein in a whole blood using monoclonal antibodies against GTP-binding domain for recognition of viral infection.

To develop a clinically significant and practical enzyme‐linked immunosorbent assay (ELISA) for the detection of MxA protein in human whole blood, a biological marker of viral infection.

A case of mite-ingestion-associated exercise- induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis.

We present a case of mite-ingestion-associated exercise-induced anaphylaxis mimicking wheat-dependent exercise-induced anaphylaxis (WDEIA). A 17-year-old boy was referred for an episode of anaphylaxis while jogging, 1.5 h after having eaten okonomiyaki (a Japanese pancake). Laboratory measures revealed a slightly elevated specific immunoglobulin E (IgE) antibody against omega-5 gliadin (0.41 kUA/l) and a marked elevation of specific IgE antibody against house-dust mite, Dermatophagoides farinae (142 kUA/l). A detailed interview revealed that, in spite of the referring doctors advice to discontinue postprandial exercises, he continued his jogging routine after consuming foods containing wheat and also that his younger brother, who had mild intermittent asthma, had suffered a mild asthma attack 2 h after eating the same food. We therefore examined the okonimiyaki mix, which had been stored for several months after opening the package until this episode, under a microscope, and we found an abundant number of live mites, D. farinae. Finally, a diagnosis of mite-ingestion-associated exercise-induced anaphylaxis was made. This clinical entity should be excluded when making a diagnosis of WDEIA.

Molecular characterization of two novel VEGFR3 mutations in Japanese families with Milroy’s disease

© 2008 Japan Pediatric Society Milroy’s disease is an autosomal dominant inheritance disease characterized by non-progressive congenital edema of the lower extremities existing from birth. Recently, the gene encoding vascular endothelial growth factor receptor 3 ( VEGFR3 ) has been identifi ed as a causative gene for this disease. 1,2 To date, 14 unique mutations from 17 independent families have been reported. All the mutations are located in either one of the two tyrosine kinase (TK) domains, TK1 or TK2. 1 – 3 Interestingly, neither nonsense mutations nor splice site mutations resulting in premature termination of the transcript have been reported. In the present study we report two novel VEGFR3 mutations in Japanese families with Milroy’s disease. One family had a missense mutation in conservative alanine residue in the TK1 domain. The other family had one nucleotide deletion at the invariant sequence of a splice donor site. This is the fi rst case of Milroy’s disease caused by a mutation resulting in premature termination of the VEGFR3 transcript.

Safety and usefulness of a novel eMotion electric mesh nebulizer in children with asthma.

BACKGROUND A new electronic mesh nebulizer, eMotion® is known to have higher performance compared to conventional nebulizers. However, there are some concerns about whether too much delivered dose might cause side effects with higher frequency. METHODS To evaluate the safety and usefulness of the nebulizer, we measured changes in heart rates and lung functions of 73 asthmatic children when they inhaled 1μg/kg of procaterol with eMotion® or a conventional nebulizer, Junior BOY®. RESULTS In 34 children with mild asthma exacerbation, physical findings, lung function and transcutaneous oxygen saturation levels were improved after inhalation using both nebulizers. No adverse effects including significant increase of heart rate were found. Improvements in the rates of the parameters were comparable. When response to beta2-agonist inhalation was checked in 39 children in stable condition, similar degrees of improvement in lung function were observed, and heart rates did not change after inhalation with either nebulizers. CONCLUSIONS Safety and efficacy was comparable between eMotion® and a conventional nebulizer when it was used to administer beta2-agonists in asthmatic children. However, from the fact that eMotion® needs only 3-4 minutes to inhale 2mL solution, eMotion® could be more useful for most children who usually do not prefer longer inhalation time with conventional compressor nebulizers.