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Allopurinol에 의한 박탈성 피부염 환자에서의 탈감작 요법
홍천수,조영준,박중원,김철우,김중선,윤영연,정혜원,박정엽,허애정 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.6
Allopurinol is widely used for chronic tophaceous gout as a uric acid lowering agent. Hyperse- nsitivity to allopurinol occurrs in about 10% of patients, which limits the usage of allopurinol. The successful oral and intravenous desensitization of allopurinol has been reported worldwide since 1976. We recently experienced a 51-year-old male patient with gouty arthritis and hyperuricemia, who had previously experienced skin rash after allopurinol treatment. When allopurinol was retried, erythematous and foliative skin rash developed on entire body. Because allopurinol was essential in controlling hyperuricemia, the oral desensitization of allopurinol was tried. We report successful rapid oral allopurinol desensitization in the patient with chronic tophaceous gout, who exhibited exfoliative dermatitis as allopurinol hypersensitivity.
비전형적 천식을 동반한 알레르기성 기관지폐 아스페르길르루스증 1례
홍천수,박용범,신동환,박중원,고준상,홍용국,황영웅 대한알레르기학회 1997 천식 및 알레르기 Vol.17 No.3
Recently we experienced an allergic bronchopulmonary aspergillosis with atypical respiratory symptoms. Forty seven years old female was admitted to our hospital because of cough, sputum, right pleuritic pain for 2 weeks. She hsd experienced pneumonia several times, but had been not confirmed any causative organism. On physical examination, breathing sound was decreased over right upper lung, but wheezing and crackle were not heard over both lungs. The chest X-ray showed segmental consolidation in right upper lobe, and HRCT showed tubular bronchiectasis and obstruction of right upper lobal bronchus due to mucoid impaction. Allergic skin prick test against Aspergillus fumigatus(Af) and serum precipitin were negative, but intradermal skin test was positive for Af. Specific IgE for Af was positive with class I. Total eosinophil count was 650/mm, total IgE level was more than 3000 IU/ml, ESR was 62mm/hr, and eosinophils in induced sputum was 35%. The tests for sputum acid fast bacilli and sputum cytology for malignancy were negative. The PC20 of bronchial methacholine challenge test was 20.2 mg/ml. Transbronchial lung bi- opsy showed bronchial inflammatory change with infiltration of eosinophils and the existence of fungal hypae. Antibody index for serum IgE-Af and IgG-Af was 10.2 and 2.1 respectively, comparing with Af-sensitive asthma patients.
Pirbuterol 분무흡입제 사용에 의한 기관지 확장효과에 관한 연구
홍천수,이상용 대한천식알레르기학회 1986 천식 및 알레르기 Vol.6 No.2
Pirbuterol [2-hydroxymethyl-3-hydroxy-6-(1- hydroxy-2-tert-butyl-aminoethyl) pyridine, dihydrochloride] is a new agent (Pfizer limited) with similar structure to that of salbutamol, but the benzene ring has been replaced by a pyridine nucleus. The pharmacologic effects of pirbuterol have shown potent, long acting sympathomimetic bronchodilating effects with high selectivity for pulmonary adrenergic receptors as similar as salbutamol, but much less cardiac effects than salbutamol. We evaluated the bronchodilating effects after single inhalation (2 puffs) of pirbuterol inhaler to nonspecific and specific bronchoconstriction patients and outpatient asthmatics, and effects and adverse reactions in asthmatics with long-term usage of pirbuterol inhaler. The results were followings: l. Out of 7 asthmatics, one at 5 min., 3 at 10 min., 2 at 20 min. and 2 at 30 min. after single inhalation noted the maximum increment of peak flow rate (PFR). The bronchodilating effects were persisted in 60 minutes. There were no specific changes of pulse rates and blood pressure initial and during study after inhalation of pirbuterol inhaler in these cases. 2. In methacholine induced bronchoconstriction, the increments of FVC, FEV1 and FEF 25-75% of pirbuterol inhalation group (n=45) were statistically higher than those of saline inhalation group (n=25) (P < 0.001), but less than those of isoproterenol inhalation group (n=33) (P < 0.001). 3. Asthmatics (4 cases) in late bronchoconstriction response of house dust bronchoprovocation test revealed more than 20% increments of FVC, FEV, and FEF25-27 % after inhalation of pirbuterol inhaler than before inhalation. The increments of parameters of pulmonary function tests in pirbuterol inhalation cases were less than those of isoproterenol inhalation cases (5 cases). 4. Nineteen out of 28 asthmatics (67.9%) in outpatient clinic showed more than 10% increments of PFR after single inhalation of pirbuterol inhaler. There was. No case without increment of PFR and no case with decrement. 5. Two out of 50 asthmatics with regular medi- cines and intermittent use of pirbuterol inhaler during acute symptom exacerbation showed mild tolerable adverse reactions immediately after pirbuterol inhalation (one case; mild weakness and palpitation, one case; nervousness). All of them noted effective control of aggravated asthma symptoms after inhalation of pirbuterol inhaler. With above results, pirbuterol inhaler showed effective bronchodilating effect in nonspecific and specific bronchoconstriction states. And we can suggest it will be used safely for symptom relief in acute exacerbated asthmatics with regular medications.