中島 陽一

【背景・目的】学校では教職員が複数児童の対応を同時に行うため、食物アレルギーに関するインシデントが起きやすい。2014年度に文部科学省から「学校給食における食物アレルギー対応指針」(以下、対応指針)が発表されたが、対応指針発表の前後におけるインシデント発生の背景因子を検証した報告はないため、今回我々は検討した。【方法】2015年度から2019年度に食物アレルギー講習会に参加した教員や保護者へ手渡し、あるいはアレルギー支援ネットワークのホームページのインシデント事例入力サイトや患者会への郵送などを通して、インシデント事例のアンケートを実施した。その中から教育施設に関する事例について対応指針発表前(15件)と発表後(28件)の2群に分けて、原因食品、誘発症状、発症状況、給食の対応レベル、生活管理指導表の提出状況、発症原因を調査した。【結果】インシデント事例の原因食品については鶏卵の割合が減り、発症状況については給食中が最多で変化はなかった。給食の対応レベルで「完全除去」よりも「一部弁当」や「普通食」の報告が増えていた。発症の原因として「完全除去」での「調理中のアレルゲン混入」の報告は減っていたが「配膳ミス」の報告は継続していた。運動誘発による事例が対応指針発表後、新たに報告され、昼食後の体育や遊び時間での発症が多く、重篤な症状も多く報告されていた。【結論】対応指針発表後もインシデントの背景因子として「配膳ミス」が報告されていることから、「配膳ミス」を防ぐ取り組みの推進と、新たな課題として食物依存性運動誘発アナフィラキシーの認知度を教育関係者に高める啓発活動が必要であると考えた。(著者抄録)

BACKGROUND: Allergen-specific immunotherapy (AIT), an established treatment for allergic diseases, prevents the development of other allergic manifestations. Although the mechanisms remain unclear, AIT has been shown to reduce basophil activation (BA) against nontarget allergens. OBJECTIVES: The aim of this study was to assess immunological changes in Dermatophagoides farinae (Der f) after Japanese cedar pollen (JCP)-based subcutaneous immunotherapy (SCIT) monotherapy. METHOD: The data of 16 patients (age: 6-37 years) with JCP-induced allergic rhinitis who were sensitive to Der f (serum Der f-specific immunoglobulin E [IgE] level >0.34 kUA/L) and received JCP-based SCIT for 5 years were reviewed retrospectively. BA by Der f and JCP extracts and serum-specific IgE and immunoglobulin G4 (IgG4) levels against these allergens were evaluated before and after completing 5 years of JCP-based SCIT monotherapy. RESULTS: The areas under the dose-response curves of BA by Der f and JCP extracts were significantly reduced (p = 0.02 and p = 0.002, respectively). JCP-specific IgE levels decreased and JCP-specific IgG4 levels increased significantly (p < 0.001 for both), whereas Der f-specific IgE and IgG4 levels did not change significantly. CONCLUSIONS: JCP-based SCIT monotherapy reduced Der f-specific BA. These findings suggest that JCP-based SCIT has the potential to modulate immune response toward nontarget allergens.

即時型食物アレルギーの原因食物のうち、魚卵は5%で第6番目で、その95%はイクラである。アレルゲンとなる蛋白の種類そのものが異なる魚卵と鶏卵との間に交差抗原性はないが、魚卵間にはある。摂取状況を確認した検討では、イクラアレルギー患者においてタラコにも症状があるのは25%、子持ちシシャモに症状があるのは11%であった。イクラの主要アレルゲンはβ'-componentで、タラコとの交差抗原性に関与すると考えられた。

Eczema herpeticum (EH) is a disseminated cutaneous infection with herpes simplex virus (HSV) that develops in patients with atopic dermatitis. The kinetics and clinical significance of HSV viremia in EH are poorly understood. Herein, we report HSV DNAemia in a child with EH 12 months after the completion of chemotherapy for Hodgkin lymphoma.

Objectives: Fish roe is a common allergen in Japan. We have previously reported that although immunoglobulin (IgE) from patients with salmon roe (SR) or pollock roe (PR) allergies cross-react, 70% of patients with SR allergy can consume PR without developing any symptoms. However, a correlation between clinical cross-reactivity and serological cross-reactivity remains to be demonstrated. Methods: Serum samples were collected from 15 patients with SR allergy who had consumed cooked PR previously. Among these volunteers, four had experienced immediate symptoms after consuming cooked PR, while the others had exhibited no symptoms of PR allergy. A competitive enzyme-linked immunosorbent assay (ELISA) was performed to analyze the serological cross-reactivity with SR and PR. Immunoblotting inhibition assays were performed using serum samples that had been pre-incubated with SR or PR extracts. Results: In ELISAs, binding to SR was inhibited by >50% when the serum samples from patients with both SR and PR allergies were pre-incubated with PR extract (p=0.0256). In immunoblots, pre-incubation of serum samples with PR extract inhibited detection of the 16-kDa protein, which likely corresponds to the major SR allergen beta' component, significantly more for samples from patients with both SR and PR allergies (100%) than for samples from those with only an SR allergy (18.2%) (p=0.011). Conclusions: The superior competitive binding of the sera from patients with both SR and PR allergies to PR compared with that to SR may induce clinical cross-reactivity between SR and PR.

Maturity-onset diabetes of the young (MODY) is a form of diabetes mellitus characterized by autosomal dominant inheritance, early onset, and the absence of pancreatic autoimmune markers. MODY-causing mutations have been identified in 14 genes, and carboxyl ester lipase (CEL) has been implicated in MODY8. We report a Japanese patient with MODY who harbored a heterogeneous mutation in CEL exon 2 (NM_001807.4:c.146_147delCT; NP_001798.2:p.Ser49CysfsTer52). A 13-year-old girl experienced her first episode of diabetic ketoacidosis, during which her endogenous insulin secretion was poor. However, her insulin secretion had apparently recovered 2 months after the commencement of insulin treatment, and no further treatment was required for the following 2 years. Diabetic ketoacidosis recurred when the patient was 15 years old, when her insulin secretion was again poor. Since that time, the patient, who is now 18 years old, has been undergoing continuous insulin treatment. The large fluctuations in her insulin secretory capacity led us to suspect MODY. MODY8 patients that carry a mutation in the variable number of tandem repeats in the last exon of the CEL gene typically show pancreatic exocrine dysfunction. However, in the present case, which features premature termination, there is no involvement of exocrine dysfunction, potentially demonstrating a genotype-phenotype correlation.

Oral allergy syndrome(OAS)は花粉症患者が新鮮な果物や生野菜を食べた際にみられるIgE抗体の関与する即時型アレルギーである。通常、症状は口腔や喉に限局し、原因食品であっても加熱すれば食べられる。こういった現象は、花粉アレルゲンに対するIgE抗体が、花粉抗原と共通の構造を有する食物抗原に対して交差反応を起こすことによって生じる。このことから花粉-食物アレルギー症候群(Pollen-associated Food Allergy Syndrome:PFAS)とも呼ばれる。また、PFASのアレルゲンコンポーネントの特徴として、熱に弱く、消化されやすい特徴を有する。しかし、豆乳など大豆製品では例外的に全身症状を伴うことがある。本稿では、PFASに係るコンポーネントの特徴をわかりやすく解説し、シラカンバ花粉症でみられる豆乳アレルギーが重症化する機序に関して仮説も加えて記述する。また最近ヒノキ科の花粉とモモGibberellin-regulated protein(GRP)との関連が海外で報告されており、これについても若干の検証を加える。(著者抄録)

OBJECTIVES: We conducted a multicenter study using the same questionnaire in 1999 and 2014 to investigate changes in the characteristics of patients with latex allergy. METHODS: We mailed questionnaires on latex allergy to hospitals in Japan that were members of the Japanese Latex Allergy Society. RESULTS: We compared the 25 responses received in 2014 and the 81 responses received in 1999. With regard to the age distribution, the number of patients with latex allergy in their 20s declined significantly from 1999 to 2014 (P=0.004). The largest proportion of latex allergy cases was observed among those aged <10 years. The incidence of cases caused by medical rubber gloves decreased significantly (P=0.004). Moreover, latex-fruit syndrome increased from 15% to 40% (P=0.006). CONCLUSIONS: Our findings indicate that the frequency of occurrence of latex allergy in people in their 20s decreased from 1999 to 2014. The largest proportion of latex allergy cases was observed among those aged <10 years. Future measures to protect children are required.

Rotavirus gastroenteritis causes substantial morbidity and mortality worldwide in children. We report three infants with rotavirus gastroenteritis complicated by various severity of gastrointestinal bleeding. Two patients (cases 1 and 2) recovered completely without any specific treatments. One patient (case 3) died despite extensive treatments including a red blood cell transfusion and endoscopic hemostatic therapy. Rotavirus genotypes G1P[8] and G9P[8] were detected in cases 2 and 3, respectively. Rotavirus antigenemia levels were not high at the onset of melena, suggesting that systemic rotaviral infection does not play an important role in causing melena. J. Med. Virol. 88:171-174, 2016. (c) 2015 Wiley Periodicals, Inc.

Objectives: Oral allergy syndrome (OAS) associated with citrus fruits has been previously reported. However, in Japan, although rare, citrus allergy is also associated with food-dependent exercise-induced anaphylaxis (FDEIA). This study was done to determine whether different allergens may be involved in these two responses, and to examine cross-reactivity between popular citrus fruits and local pollen allergens.Methods:Twelve patients were studied who had a history of OAS (8 cases) or FDEIA (4 cases), and had positive IgE antibody titers or tested positive with a skin prick test to citrus antigens. Serum immunodetection assays and immunoblot inhibition assays were performed with extracted Valencia orange (rCit s 2), selected antigens in white birch pollen (WBP) and orchard grass pollen (OGP).Results: Immunodetection assays demonstrated an allergen associated with OAS as the 14-kDa protein, Cit s 2. An as yet unidentified 54-kDa protein was demonstrated in FDEIA patients. Cross-reactivity between orange and pollen antigens was confirmed by the following results: 1) Significant correlations between serum specific IgE levels for orange and OGP, 2) Immunoblot inhibition with WBP and OGP pollen antigens against rCit s 2. In Immunoblot inhibition, WBP and OGP both pollen antigens inhibited against rCit s 2.Conclusion: The main allergen of OAS induced by orange was Cit s 2, which has cross-reactivity with WBP and/or OGP in Japanese patients with orange allergy. IgE-binding protein pattern in patients with FDEIA induced by orange were different from that in OAS. A 54-kDa protein was assumed to be a candidate for clinically relevant allergens in the development of the FDEIA.

Background: Sea urchin roe can cause anaphylactic reactions the first time they are consumed; therefore, careful clinical attention should be paid to their effects. However, no previous study has examined the allergens in sea urchin roe using sera from more than one patient. We attempted to identify sea urchin allergens using sera from 5 patients with sea urchin allergies. Methods: We enrolled 5 patients with relevant medical histories, positive results on a skin prick test and/or a food challenge test, and high levels of sea urchin-specific IgE in an enzyme-linked immunosorbent assay. We performed SDS-PAGE, immunoblotting, immunoblot inhibition, and N-terminal amino acid sequence detection. Results: Ten protein bands ranging from 18 to 170 kDa were detected in more than 2 patients' sera. In immunoblotting, the protein band for the 170-kDa major yolk protein was recognized by 4 of the 5 sera. Furthermore, the reaction between IgE and the protein band for egg cortical vesicle protein (18 kDa) was inhibited by the addition of salmon roe extract. Conclusion: Major yolk protein was confirmed to be one of the main allergens in sea urchin roe. In addition, egg cortical vesicle protein (18 kDa) was demonstrated to be an important protein for cross-reactivity with salmon roe. (C) 2014 S. Karger AG, Basel

Background: Salmon roe (SR) anaphylaxis has often been reported and SR-containing foods are designated as 'recommended for allergic labeling'; however, there have been no reports about its allergenicity, including its cross-reactivity. Because its cross-reactivity is controversial, clinicians are often confused concerning education regarding its dietary elimination. The purpose of this study was to examine the cross-reactivity between SR and other kinds of fish roe, salmon, or chicken egg (CE).<br> Methods: We measured the specific-IgE to SR, herring roe (HR), pollock roe (PR), salmon and CE using RAST in 27 patients with a fish allergy and 26 control subjects. Then, using the sera of 2 patients with SR anaphylaxis, an ELISA inhibition study was performed to examine the cross-reactivity between SR and HR, PR, salmon or CE. We then compared the IgE binding patterns to SR between the anaphylaxis patients and fish allergy patients with immunoblotting.<br> Results: There were positive correlations between SR and HR or PR, but none between SR and salmon or CE. In the ELISA study using sera from two patients with SR anaphylaxis, IgE-binding to SR was inhibited more than 50% only when the sera were pre-incubated with HR, inhibited almost 50% by PR in a dose-dependent manner, but not inhibited by CE or anisakis. Salmon inhibited the IgE binding to SR more than 50% in a SR-anaphylaxis patient. The IgE binding patterns to SR from anaphylaxis patients were almost identical and unlike those of patients with fish allergy.<br> Conclusions: There was a cross-reactivity between SR and HR, but no relationship between SR and CE.<br>