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Oral food challenges in children
Yum, Hye-Yung,Yang, Hyeon-Jong,Kim, Kyung-Won,Song, Tae-Won,Kim, Woo-Kyung,Kim, Jung-Hee,Ahn, Kang-Mo,Kim, Hyun-Hee,Lee, Soo-Young,Pyun, Bok-Yang The Korean Pediatric Society 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.1
Many patients assume that allergic reactions against foods are responsible for triggering or worsening their allergic symptoms. Therefore, it is important to identify patients who would benefit from an elimination diet, while avoiding unnecessary dietary restrictions. The diagnosis of food allergy depends on the thorough review of the patients's medical history, results of supplemented trials of dietary elimination, and in vivo and in vitro tests for measuring specific IgE levels. However, in some cases the reliability of such procedures is suboptimal. Oral food challenges are procedures employed for making an accurate diagnosis of immediate and occasionally delayed adverse reactions to foods. The timing and type of the challenge, preparation of patients, foods to be tested, and dosing schedule should be determined on the basis of the patient's history, age, and experience. Although double-blind, placebo-controlled food challenges(DBPCFC) are used to establish definitively if a food is the cause of adverse reactions, they are time-consuming, expensive and troublesome for physician and patients. In practice, An open challenge controlled by trained personnel is sufficient especially in infants and young children. The interpretation of the results and follow-up after a challenge are also important. Since theses challenges are relatively safe and informative, controlled oral food challenges could become the measure of choice in children.
Yum, Hye Yung,Ha, Eun Kyo,Shin, Yoon Ho,Han, Man Yong The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.8
Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%-89% of the chronic rhinitis cases, affecting 1%-50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%-67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.
천식의 만성기도개형에서 섬유아세포성장인자와 그 수용체의 역할
염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회 2006 소아알레르기 및 호흡기학회지 Vol.16 No.4
A number of structural changes occur in the airway wall in asthma. The most characteristic is thickening of the subepithelial lamina reticularis which is observed in bronchial tissue even in patients with mild disease. This pathophysiological change which was the result of deposition of interstitial collagens by increased numbers of myofibroblasts is likely to be directed by growth factors having fibropoliferative and profibrotic effect. The acivation of the epithelial-mesenchymal unit involves reciprocal activities of growth factors belonging to the fibroblast growth (FGF), epidermal growth factor (EGF), and transforming growth factor-β families. Among them FGF is a member of family of heparin binding growth factors that affect the growth and differentiation of a large number of cell types. Especially basic FGF involved in morphogenesis, wound repair, inflammation, angiogenesis, and tumor growth and invasion, and require the glycosaminoglycan side chains of heparan sulphate, proteoglycans for high affinity binding to their specific receptors. Few studies suggested bFGF would be an important regulator of airway remodeling by means of paracrine control of bronchial myofibroblasts in response to cell damage and repair. [Pediatr Allergy Respir Dis(Korea) 2006;16:267-273]
염혜영 ( Hye Yung Yum ),한기옥 ( Ki Ok Han ),박지애 ( Ji Ae Park ),강미연 ( Mi Youn Kang ),장석일 ( Suk Il Chang ),조상헌 ( Sang Heon Cho ),편복양 ( Bok Yang Pyun ),나영호 ( Yeong Ho Rha ),김규한 ( Kyu Han Kim ),윤호주 ( Ho Joo Yo 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.1
Background: Education programs are essential in improving disease management and quality of life in patients with atopic dermatitis and their families by promoting disease knowledge. In these perspectives, the Seoul Atopy Asthma Education and Information Center has been established under the project ``Atopy-free Seoul`` by Seoul City since 2008. Our goal is an improvement in public health through development of education programs and counseling activities based on scientifically proven medicine. However, implementation and evaluation of effectiveness of education programs are needed to redeem configuration. The aim of this study was to determine the necessity of an education program of atopic dermatitis for optimal disease management. Methods: An education program for citizens was designed by the advisory organization of Korean Asthma Allergy Foundation. To evaluate the efficacy of the education program, 9 questionnaires about disease knowledge were developed. Participants were asked to answer the questionnaires and differences in the percentage of correct answers were compared before and after the program education. Results: In 5 sessions, 359 participants responded to the survey on disease knowledge before and after the education program. There was significant increase in the percentage of correct answers to 5 out of the 9 questions. This result proved that the education program was effective in improving the disease knowledge of atopic dermatitis. Conclusion: Significant improvement in disease knowledge after education of atopic dermatitis supports the need and feasibility of education programs for citizens. (Korean J Asthma Allergy Clin Immunol 2012;32:21-25)
염혜영 ( Hye Yung Yum ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, with a prevalence of up to 15%-20% in children and 2%-10% in adults. Patients with AD have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Recently, there has been increasing awareness of the importance of vitamin D, a potential factor, in the development and progression of atopic diseases including AD. Furthermore, some reports suggested that vi¬tamin D deficiency impairs epithelial integrity, leading to increased and inappropriate mucosal exposure to antigens promoting sensitization. Even though numerous studies favor strong associations of vitamin D deficiency during pregnancy and infancy with allergies, high vitamin D intake might be harmful according to conflicting results of other trials. The growing body of the literature indicates an inverse relationship between the severity of AD and vitamin D levels. Animal studies, case reports, randomized clinical trials, and birth cohort studies have suggested that vitamin D may alleviate the symptoms of AD through immune-modulation of the innate and adaptive immune system. Moreover, some studies have shown that in individuals with AD with low vitamin D level, repletion of vitamin D results in decreased severity of diseases. However, all these results have prompted the question of which time, dose, duration, or mode of application of vitamin D might be appropriate in children with AD. Further large cohort studies and clinical trials are warranted to assess the role of vitamin D in the prevention and treatment of AD in children.(Allergy Asthma Respir Dis 2015;3:95-98)
쌀과 저항원성 쌀 및 유전자 재조합 쌀의 알레르기 항원성의 비교
염혜영 ( Hye Yung Yum ),이경은 ( Kyung Eun Lee ),최성연 ( Sung Youn Choi ),양혜선 ( Hea Sun Yang ),손명현 ( Myung Hyun Sohn ),이상일 ( Sang Il Lee ),박혜경 ( Hye Kyung Park ),박선희 ( Sun Hee Park ),이순호 ( Soon Ho Lee ),이우영 ( 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2005 소아알레르기 및 호흡기학회지 Vol.15 No.2
염혜영(Hye Yung Yum),김영래(Young Rae Kim),차병호(Byung Ho Cha),이준수(Joon Soo Lee),고창준(Chang Jun Coe) 대한소아신경학회 1995 대한소아신경학회지 Vol.3 No.1
연구 배경 : 기존의 항경련제로 치료되지 않았던 난치성 간질 소아 간질에 있어서 lamotrigine의 치료 효과를 알아보고자 본 연구를 시행하였다. 방법 : 연세 의대 세브란스 병원 소아과에서 난치성 간질로 진단받은 환아 90명(남 59명, 여31명)에게 그동안 복용하던 항경련제는 그대로 복용하면서 lamotrigine을 추가로 복용하게 하고, 1개월 간격으로 발작의 빈도 및 부작용의 발현 여부를 추적 관찰하였다. 용량은 sodium valproate를 투약받고 있지않은 환아는 2주동안 1일 1회 1mg/kg를 투여 후 2-4주동안 2mg/kg를 하루 2회 투여한 후 점차 증량하였다. Sodium valproate를 투약받고 있는 환아는 2주동안 1일 1회 0.5mg/kg를 투여 후, 점차 증량하였다. 결과 : 전체 대상 환아 중 lamotrigine 추가 투여 후 발작 감소를 보인 환아는 65명(72.2%)이었고 그중 23명(25.6%)에서는 전혀 발작이 없었으며, 25명(27.8%)에서는 50%이상의 발작 감소를,17명(18.9%)에서는 50%미만의 발작 감소를 보였다. 발작의 유형에 따른 치료 결과는 50%이상의 발작 감소를 기준으로 할때 복잡 부분성 발작이 75%(3/4), 전신성 발작이 54.1%(33/61), Lennox-Gastaut 증후군이 54.5%(12/22), 미분류성 발작이 0%(0/3)로 나타났다. 투약 기간중 부작용이 관찰된 환아는 모두 4명(4.4%)이었다. 결론 : 소아 난치성 간질에 lamotrigine을 추가로 투여하여 좋은 효과를 관찰하였으며, 부작용은 매우 적었다. Background : This study was performed to observe the efficacy of lamotrigine in children with intractable epilepsy. Method : 90 patients who have been treated with known antiepileptic drugs Yonsei University College of Medicine Severance Hospital were reviewed. Lamotrigine was added on other antiepileptic drugs. The frequency of seizure attacks, and occurrence of adverse effects were monitored monthly at outpatient unit. Results : Approximately 70% of patients experienced reduction in seizure frequencies after medication of lamotrigine. The percentage of children who experivenced 50% or greater reduction in seizure frequency according to seizure types were 75% in complex partial seizure, 54.1% in generalized seizure, and 54.5% in Lennox-Castaut syndrome. Among them. 4 children had adverse effect. and stopped the medication. Conclusion : Lamotrigine add-on therapy seems to be effective in children with intractable epilepsy and adverse effects were trivial.
염혜영(Hye Yung Yum),김규언(Kyu Earn Kim),강혜영(Hay Young Kang),정병주(Byung Ju Jeoung),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1996 소아알레르기 및 호흡기학회지 Vol.6 No.1
N/A To counsel parents about the future prospects of EIA in their children, it is very important to know the prognosis of EIA, As there is no report concerning the natural history of EJA, we performed this study. Forty-seven children (male 37, female 10) were included in this longitudinal evaluation, all of whom were diagnosed as having EIA through the exercise loading test at least two years ago (mean 35/12 years). We performed a follow-up exercise loading test and compared the results. The children were tested with the up and down stairs method for 6 minutes. The changes in pulmonary function were measured by a peak flow meter. The results are as follows: 1. Twenty-eight cases of 47 children(59.6%) didn't reveal EIA when we performed the follow-up exercise loading test. There was no difference between boys and girls. 2. When we analyzed the data according to the severity of EIA, we had the following results: 70.8% of mild EIA, 53.8% of moderate EIA, and 40.0% of severe EIA were shown to not have EIA. 3. The remission of EIA was not correlated with total eosinophil count, total IgE level and the number of positive allergen in skin test at initial diagnosis. In conclusion, the 59.6% of children with EIA demonstrated to have remission of their EIA after 2 or more years. The remission rate was the highest (70.8%) in mild EIA.