Food allergy is defined as "a phenomenon in which adverse reactions (symptoms in skin, mucosal, digestive, respiratory systems, and anaphylactic reactions) are caused in living body through immunological mechanisms after intake of causative food." Various symptoms of food allergy occur in many organs. Food allergy falls into four general clinical types; 1) neonatal and infantile gastrointestinal allergy, 2) infantile atopic dermatitis associated with food allergy, 3) immediate symptoms (urticaria, anaphylaxis, etc.), and 4) food-dependent exercise-induced anaphylaxis and oral allergy syndrome (i.e., specific forms of immediate-type food allergy). Therapy for food allergy includes treatments of and prophylactic measures against hypersensitivity like anaphylaxis. A fundamental prophylactic measure is the elimination diet. However, elimination diets should be conducted only if they are inevitable because they places a burden on patients. For this purpose, it is highly important that causative foods are accurately identified. Many means to determine the causative foods are available, including history taking, skin prick test, antigen specific IgE antibodies in blood, basophil histamine release test, elimination diet test, oral food challenge test, etc. Of these, the oral food challenge test is the most reliable. However, it should be conducted under the supervision of experienced physicians because it may cause adverse reactions such as anaphylaxis.
In Japan, the prevalence of food allergy has been increasing and a variety of problems have emerged regarding what should be considered a food allergy. A treatment regimen consists of avoiding the offending food (elimination diet therapy) and receiving nourishment from alternative foods (substitutional diet therapy). There is a growing concern that confusion has resulted from the lack of a consensus on the procedures for diagnosing and treating food allergies. The Food Allergy Committee of the Japanese Society of Pediatric Allergy and Clinical Immunology established the "Guidelines for Diagnosis and Management of Pediatric Food Allergy." Definition, classification, pathophysiology, clinical disorders and management of food allergy are discussed and determined.
The present questionnaire survey, designed to interview Japanese internists and pediatricians who were specialists or nonspecialists in allergy or asthma, was conducted to determine the acceptance of "Asthma Prevention and Management Guidelines 1998" 1 year after release. The surveyor visited each physician and used the questionnaire form at the interview. Replies were obtained from a total of 5,963 physicians. The percentage of physicians who were aware of the guidelines was 96% among specialists and 68% among nonspecialists. Among the internists who were aware of the guidelines, the percentage of physicians giving a reply of "I refer to them often" or "I refer to them" in the actual diagnosis and management of asthma was 95% among specialists and 92% among nonspecialists. Therefore, reference was very high. Except for nonspecialists among pediatricians, not less than 60% of physicians expected that propagation of the present guidelines would allow a further decrease in asthma death and further improvement of patient's quality of life. The present survey revealed an increase in guideline awareness over the last several years, which was especially marked in nonspecialists. Furthermore, high reference and high expectancy also verified that physicians recognize the contents of the present guidelines as appropriate.
Skin tests of the nondialyzable fraction of lactose were performed on patients with a clinical diagnosis of cow's milk allergy. The yields of brownishtolored residue, allergens (ALG), were 0.006% from reagent grade lactose (ALG 1) and 0.011% from lactose used in a commercial infant food formula (ALG 2). The ALG was separated into four fractions by chromatography on Sephadex G-75. The highest incidences of positive skin reaction among the four ALG 1 and ALG 2 fractions were 8/9 and 8/12 respectively. The ALG fractions were identified as a sugar protein complex and the protein moiety of ALG contained high amounts of glutamic acid (or glutam-me), threonin, asparagic acid (or asparagine) and proline.
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