[INVESTIGATION OF THE IMPACT OF ALLERGIC DISEASE ON CHILDREN'S SARS-CoV-2 VACCINATION DECISIONS].

Background, Objectives: The factors associated with parents' decisions to vaccinate their children with SARS-CoV-2 vaccine and the impact of the coexistence of allergic diseases in their children are unclear. METHODS: A cross-sectional survey was conducted among parents of patients aged 15 years or younger who visited our pediatric allergy outpatient clinic and three partner pediatric clinics between April and May 2021. Survey items included presence or absence of other allergic diseases, and SARS-CoV-2 vaccination preferences and reasons. RESULTS: 646 responses were received, with 568 valid responses (88%). Thirty-eight respondents (6.7%) did not want their children to receive SARS-CoV-2 vaccine. Factors that led parents to reject the SARS-CoV-2 vaccine for their children were the coexistence of food allergies and a low evaluation of the expectations of the safety and preventive effect of the SARS-CoV-2 vaccine. The top reasons for not wanting to vaccinate were related to concerns about side effects to the vaccine. CONCLUSION: In order for parents to make correct decisions regarding SARS-CoV-2 vaccination of their children, it is necessary to create an environment in which up-to-date and correct information is available to avoid excessive anxiety. More care is needed, especially if the child has food allergies.

Effect of oral immunotherapy in children with milk allergy: The ORIMA study.

BACKGROUND: This study was aimed at evaluating the efficacy and safety of oral immunotherapy (OIT) in children with severe cow's milk allergy. METHODS: The subjects comprised 28 children (aged 3-12 years) with allergic symptoms that were induced by ≤ 10 mL of cow's milk in an oral food challenge test (OFC). The subjects were randomly allocated to the treatment group (n = 14) and control group (n = 14); the former received rush immunotherapy for 2 weeks, followed by a gradual increase of cow's milk volume to 100 mL for 1 year, and the latter completely eliminated cow's milk for 1 year. Both groups underwent an OFC with 100 mL of cow's milk after 1 year. RESULTS: The treatment group had significantly higher rates of a negative OFC [7/14 (50%) vs. 0/14 (0%), p < 0.01] compared with the control group. The cow's milk-specific IgE level significantly decreased in the treatment group (p < 0.01) but not in the control group (p = 0.63). During the study period, adrenaline was required in 6/14 patients (43%) of the treatment group and in 0/14 patients (0%) of the control group. Long follow-up data were available at the 2-year point after the study for 8 in the treatment group and 7 (87.5%) of these continued to ingest milk (>100 mL). CONCLUSIONS: The effect of immunotherapy was 50%, but the incidence of adverse events was not low. Further studies focusing on safety is necessary to standardize OIT for cow's milk allergy.

Utility of therapeutic strategy based on the modified Pulmonary Index Score for childhood asthma exacerbation.

Background: There are no validated quantitative tools for assessing asthma exacerbation, which may cause significant variation in determining the severity of exacerbation across caregivers. A modified Pulmonary Index Score (mPIS) has been proposed as a quantitative indicator of the severity of childhood asthma exacerbation. However, the utility of mPIS as a treatment decision-making tool has not been investigated. Objective: The aim of the present study was to clarify the utility of therapeutic strategies based on mPIS in children hospitalized for asthma exacerbation. Methods: This was a case-control study of patients admitted to our hospital between 2010 and 2015. In addition to the conventional therapy based on Japanese guidelines, treatment adaptation by using mPIS began in 2013. Children admitted after 2013 were regarded as being in the case group and those before 2012 were the control group. The length of the hospital stay and the duration of continuous isoproterenol inhalation therapy (CIT) were compared as clinical outcomes. Results: The targeted number of patients was 346 (182 cases and 164 controls). The mean ± standard error age was 3.5 ± 0.2 years in the case group and 3.4 ± 0.2 years in the control group. Male patients constituted 64.3% of the case group and 60.4% of the control group. The mean ± standard error length of hospital stay was significantly shortened in the case group (8.1 ± 0.2 days versus 9.6 ± 0.2 days, p < 0.001). The mean ± standard error duration of CIT was also shortened in the case group (2.3 ± 0.1 days versus 3.9 ± 0.3 days, p < 0.001). Conclusion: An mPIS-based therapeutic strategy may have reduced the length of hospital stay by enabling timely adjustments to clinical interventions and enabling caregivers to perform a more-accurate assessment of asthma exacerbation.

[SAFETY OF INFLUENZA VACCINATION IN CHILDREN WITH SEVERE ALLERGY TO HEN'S EGGS: A PROSPECTIVE CASE SERIES STUDY].

BACKGROUND: Influenza vaccination guidelines have recommended that pediatricians should consult with allergists in the case of for children with histories of anaphylaxis to hen's eggs. On the other hand, whether such children can be safely vaccinated is unclear. OBJECTIVE: To evaluate the safety of influenza vaccination for children severely allergic to eggs. METHODS: The study population consisted severe egg-allergic children that had never been immunized with influenza vaccine. The inclusion criteria of severe egg-allergic children included evidence of serum specific IgE antibodies to egg white or an ovomucoid level of class4 or more and complete elimination of dietary intake of eggs, or occurrence of Sampson Grade 3 to 5 anaphylactic reactions upon egg ingestion. Patients underwent skin prick tests, and received 0.1ml of influenza vaccine, followed in 30 minutes if no reaction with the remainder of an age-appropriate dose. We observed the subjects for 30 minutes afterwards, and they were observed by their patients during the subsequent 24 hours. RESULTS: A total of 17 patients were enrolled. All patients received influenza vaccination without an allergic reaction. CONCLUSIONS: Influenza vaccination is safe even in children with histories of severe egg allergy. influenza vaccination without an allergic reaction.

[Effects of measurement position on the forced oscillation technique values].

BACKGROUND: Cheek support and subject's arm position can influence on lung function values measured with forced oscillation technique. We examined resistance and reactance by different methods using a new forced oscillation technique machine called MostGraph (Chest Co. Ltd., Tokyo, Japan). METHODS: We evaluated nineteen adults. Four methods are measured. 1: the subjects support their cheeks with their hands. 2: the tester support the subject's cheeks with their hands. 3: the subjects stiffen their cheeks without any cheek support. 4: subject relax their cheeks without any cheek support. R5, R20, R5-R20, X5, Fres and ALX were compared between four methods. RESULTS: In resistance values, R20 was the lowest in the fourth method, and it was significantly different from the first (p<0.01) and the second (p<0.01) method. R5-R20 was the lowest in the second method, and it was significantly different from the third (p<0.01) and forth (p<0.01) methods. In reactance values, X5 was the highest in the second method. All ractance values in the second method were significantly different from the first and the fourth method. CONCLUSION: Measurement values using Mostgraph was influenced by methods of supporting cheeks and subject's arm position. Measurement method should be unify and the first method is ideal and practical.

[The evaluation of lung function by using forced oscillation technique for children with asthma].

BACKGROUND: Lung function measurements are useful objective indices to monitor asthma control in children. Recently, a new forced oscillation technique machine called MostGraph (Chest Co. Ltd., Tokyo, Japan) has been developed to diagnose and monitor asthma. We assessed the utility of MostGraph in asthmatic children. METHODS: We evaluated 66 well controlled asthmatic children (11±3 yrs). For each subject, we measured respiratory function using MostGraph and spirometry and assessed the relationship between the two indices. RESULTS: MostGraph measurements were significantly correlated with age and body height. R5 was remarkably associated with FEV1% by analyzing partial correlation that excluded the factor of height. In addition, R5-R20 and Fres were significantly related to FEV1% and MMF. Furthermore, R5-R20 and Fres were significantly associated with MMF through multiple regression analyses for MostGraph parameters, the height and spirometory parameters. We classified asthmatic children into two groups with 70% of V25 cut point. Group with V25 below 70% had higher scores for R5-R20, Fres and ALX, compared to group with V25 above 70%. CONCLUSION: MostGraph could be effectively used for the R5-R20 and Fres lung function measurements to assess asthma control in children. The results also suggested that R5-R20 and Fres might be parameters of small airway dysfunction.

[Three cases with high TARC levels of gastrointestinal food allergies in neonates and infants].

We measured serum TARC (Thymus and activation-regulated chemokine, CCL-17) levels in three patients of gastrointestinal food allergies in neonates and infants. Patient 1: 14-day-old girl. The chief complaints were poor feeding and weight loss. She tested peripheral eosinophilia (5820 /µL), high serum TARC levels (4730 pg/mL) and positive milk-specific IgE (1.53 UA/mL) at the time of onset. After change from cow' milk formula to hydrolyzed infant formulas and breast milk ahead of dairy products intake, the symptoms resolved. One month and a half later, she re-tested negative milk-specific IgE and normal serum TARC levels (198 pg/mL). Patient 2: 3-month-old girl. The chief complaint was vomiting after intake of cow' milk formula. She tested negative milk-specific IgE and very high serum TARC levels (25200 pg/mL) at the time of onset. After changing to hydrolyzed infant formulas and breast milk ahead of dairy products intake, the symptom resolved. Three months later, she re-tested positive milk-specific IgE (0.42 UA/mL) and normal serum TARC levels (1250 pg/mL). Patient 3: 21-day-old boy. The chief complaint was vomiting after intake of cow' milk formula. He tested peripheral eosinophilia (2923 /µL), very high serum TARC levels (49100 pg/mL) and positive milk-specific IgE (0.47 UA/mL) at the time of onset. After changing to hydrolyzed infant formulas and breast milk ahead of dairy products intake, the symptom resolved. Two weeks later, he re-tested negative milk-specific IgE and serum TARC levels (2210 pg/mL). Serum TARC may be related to the part of gastrointestinal food allergies in neonates and infants.