A model for recovery-from-extinction effects in Pavlovian conditioning and exposure therapy.

Exposure therapy is an effective intervention for anxiety-related problems. The mechanism of this intervention has been the extinction procedure in Pavlovian conditioning, and this application has provided many successful instances for the prevention of relapse. However, traditional associative theories cannot comprehensively explain many findings. In particular, it is difficult to explain the recovery-from-extinction effects, which is the reappearance of the conditioned response following extinction. In this paper, we propose an associative model that is a mathematical extension of Bouton's (1993, Psychological Bulletin, 114, 80-99) model for the extinction procedure. The core of our model is that the asymptotic strength of the inhibitory association depends on the degree of excitatory association retrieved in a context in which a conditioned stimulus (CS) is presented and that the retrieval is determined by the similarity between contexts during both reinforcement and non-reinforcement and the retrieval context. Our model provides an explanation of the recovery-from-extinction effects, and implications for exposure therapy.

[CLINICAL MANIFESTATIONS AND SAFETY OF AN ORAL FOOD CHALLENGE USING BOILED EGG YOLK].

BACKGROUND: Allergenicity to heated egg yolks is known to be low in hen's egg allergy. However, there are few reports concerning the safety of an oral food challenge (OFC) with boiled egg yolks. This study aimed to determine the safety of a boiled egg yolk OFC and the clinical characteristics of patients who were OFC-positive. METHODS: We retrospectively examined the data of patients who underwent an OFC with one boiled egg yolk at Miyagi Children's Hospital between January 2013 and December 2020. Patients were included if they had a history of immediate symptoms due to hen's egg or positive specific IgE levels to egg yolk or egg white. RESULTS: Among 600 patients, 15.0% were positive for OFC, only one patient required an intramuscular adrenaline injection, and 70% of OFC-positive patients had gastrointestinal symptoms. CONCLUSION: Boiled egg yolk OFC had a low symptom induction rate; however, when symptoms were induced, gastrointestinal symptoms were most commonly observed. Given the low risk of developing severe symptoms, we conclude that the likelihood of safely performing an OFC is high.

Home-based, slow up-dosing oral immunotherapy for hen's egg allergy in an adult patient.

Standard therapy for food allergies involves avoiding causative foods until a patient has outgrown their allergies. Oral immunotherapy (OIT) is an optional treatment for children unlikely to outgrow their food allergy. However, information about OIT in adult patients with food allergies is very limited. We present a case of severe hen's egg allergy (HEA) in an adult who tried home-based, slow up-dosing OIT, reported to have been tolerable and effective in children. A 20-year-old woman with HEA experienced repeated anaphylaxis since childhood when she consumed a small quantity of hen's egg, so she completely avoided hen's eggs. She underwent inpatient oral food challenge (OFC) with 10-g boiled egg yolk and presented lip swelling and abdominal pain. OFC with 1-g boiled egg yolk the following day induced no adverse reaction. OIT was initiated using a home-based, slow up-dosing protocol. She consumed 1 g of boiled egg yolk at home every day, increasing this by 5%-10% every 2 weeks. She started 0.5-g boiled egg white after reaching a whole egg yolk. If adverse reactions occurred, the daily dose was decreased. After 59 months, she was able to eat an entire boiled egg. Anaphylaxis occurred 3 times during OIT due to accidental consumptions of egg products or insufficient heating of egg. Home-based, slow up-dosing OIT might be applicable for adults with severe HEA. It should be performed with appropriate equipment and education for patients, in case of emergency.

Neuropsychological Comparison Between Patients with Social Anxiety and Healthy Controls: Weak Central Coherence and Visual Scanning Deficit.

INTRODUCTION: Although deficits in neuropsychological functioning have been reported in social anxiety disorder (SAD), studies focusing on neuropsychological dysfunction in SAD are limited, and the evidence is still lacking. The purpose of this study was to examine the deficits in neuropsychological functioning in patients with SAD by comparing SAD patients and a healthy control (HC) group. MATERIALS AND METHODS: A total of 72 participants (20 in the SAD group and 52 in the HC group) were assessed with neuropsychological tests, consisting of the Rey Complex Figure Test (RCFT) to measure central coherence and the Trail Making Test A and B (TMT-A; TMT-B) to measure visual scanning and executive functioning. RESULTS: Analysis of covariance with depressive symptoms as a covariate revealed that central coherence (RCFT) and visual scanning (TMT-A) were significantly lower in the SAD group than in the HC group. No difference was found in executive functioning (TMT-B) when the effect of visual scanning was considered. DISCUSSION: Our findings suggest that SAD patients have weak central coherence and deficits in visual scanning compared to healthy controls. The clinical implications of these neuropsychological functioning deficits in SAD patients are discussed.

Predictors of response to exposure and response prevention-based cognitive behavioral therapy for obsessive-compulsive disorder.

BACKGROUND: Cognitive behavioral therapy (CBT), which includes exposure and response prevention (ERP), is effective in improving symptoms of obsessive-compulsive disorder (OCD). However, whether poor cognitive functions and autism spectrum disorder (ASD) traits affect the therapeutic response of patients with OCD to ERP-based CBT remains unclear. This study aimed to identify factors predictive of the therapeutic response of Japanese patients with OCD to ERP-based CBT. METHODS: Forty-two Japanese outpatients with OCD were assessed using the Wechsler Adult Intelligence Scale-III (WAIS-III), Yale-Brown Obsessive-Compulsive Scale, Patient Health Questionnaire 9-item scale, and Autism Spectrum Quotient (AQ) at pre- and post-treatment. We used multiple regression analyses to estimate the effect on therapeutic response change. The treatment response change was set as a dependent variable in multiple regression analyses. RESULTS: Multiple regression analyses showed that among independent variables, communication as an AQ sub-scale and Letter Number Sequencing as a WAIS-III sub-test predict the therapeutic response to ERP-based CBT . CONCLUSIONS: Our results suggest that diminished working memory (Letter Number Sequencing), poor communication skill (AQ sub-scale) may undermine responsiveness to ERP-based CBT among patients with OCD. TRIAL REGISTRATION: UMIN, UMIN00024087 . Registered 20 September 2016 - Retrospectively registered (including retrospective data).

[CHARACTERISTICS OF THE SYMPTOMS DURING FOOD AND EXERCISE PROVOCATION TESTS IN PATIENTS AFTER ORAL IMMUNOTHERAPY: COMPARISON WITH FOOD-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS].

OBJECTIVE: We aim to examine the characteristics of the symptoms induced by exercise provocation tests following allergen consumption in patients who have undergone oral immunotherapy (OIT). METHOD: Patients who were positive for exercise provocation tests in Miyagi Children's Hospital from April 2012 to January 2019 were retrospectively analyzed. Patients were classified into food-dependent exerciseinduced anaphylaxis (FDEIA) group and post-OIT-FDEIA group. RESULT: Six patients in the FDEIA group and 19 patients in the post-OIT-FDEIA group were analyzed. There were no significant differences in age, sex, and number of complications between the FDEIA and post-OIT-FDEIA groups, except for level of total serum immunoglobulin E. The median time from the start of exercise to onset of symptoms was 20 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. The rate of adrenaline administration in post-OIT-FDEIA group was significantly lower. The median time from exercise to onset of severe symptoms requiring adrenaline was 32.5 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. CONCLUSION: These data suggest that FDEIA and post-OIT-FDEIA patients can exhibit similar clinical symptoms, and all symptoms occurred in 60 minutes after exercise.

[PROVOCATION TESTS OF FOOD AND EXERCISE AFTER ORAL IMMUNOTHERAPY].

BACKGROUND: Oral immunotherapy (OIT) for food allergy requires exercise restrictions following the regular consumption of allergens to prevent immediate symptoms. We investigated the efficacy and the safety of exercise provocation tests to assess exercise tolerance after consumption of allergens following OIT. METHODS: This study was based on data from patients who underwent exercise provocation tests with consumption of their allergen after OIT in Miyagi Children's Hospital between April 2012 and March 2019. The results of exercise provocation tests and patients' characteristics were retrospectively analyzed. RESULTS: Fifteen out of 91 patients were positive for exercise provocation tests. The positive rates were 12% (4/33) with egg, 15% (5/34) with cow's milk, and 25% (6/24) with wheat. Intramuscular adrenaline injections were administered to two patients with allergies to egg, one with cow's milk, and one with wheat. CONCLUSION: Following OIT, the assessment using exercise provocation tests should be performed prior to termination of exercise restriction because some patients remain intolerant to exercise.

[SAFETY OF A THREE-LEVEL STEPWISE ORAL FOOD CHALLENGE FOR PEANUT ALLERGY].

BACKGROUND: The present study aimed to assess the safety of a three-level stepwise oral food challenge (OFC) in patients with peanut allergy. METHODS: This retrospective analysis reviewed laboratory test results and food allergy histories (obtained from medical records) of participants who underwent OFC using peanut butter for the first time at Miyagi Children's Hospital between January 2015 and December 2017. Total food dose was classified as follows: step 1, 0.1 g peanut butter; step 2, 0.5g peanut butter; and step 3, 3g peanut butter. RESULTS: A total of 114 participants were included. OFC-positive rates were 52% (step 1), 35% (step 2), and 20% (step 3). Of the 41 OFC-positive participants, 1 required an intramuscular adrenaline injection during step 3. Peanut allergy history rates and peanut- and Ara h 2-specific immunoglobulin E (sIgE) titers were significantly higher during the low-dose step. CONCLUSION: The three-level stepwise OFC with peanut butter is safe for patients with peanut allergy, as indicated by peanut- and Ara h 2-sIgE titers.