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소아 천식 환자에서 전신 염증 유형에 따른 천식의 특성
설인숙 ( In Suk Sol ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),김민정 ( Min Jung Kim ),한윤기 ( Yoon Ki Han ),박영아 ( Young A Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.3
Purpose: Asthma is a chronic airway inflammation. We evaluated whether systemic inflammatory patterns could reflect the nature of airway inflammation. We assessed characteristics of asthma according to systemic inflammatory patterns. Methods: A total of 413 children with asthma were enrolled in the study. Four systemic inflammatory patterns were classified according to eosinophil and neutrophil counts in peripheral blood. Children with neutrophil count≥5,000/μL were defined as the NEUhi group, those with neutrophil count <2,720/μL as the NEUlo group. The intermediate group with neutrophil count between 2,720/μL and 5,000/uL was excluded from the study. Children with eosinophil≥650/μL were defined as the EOShi group, those with eosinophil count<240/μL as the EOSlo group. The remaining patients were excluded from the study. The characteristics of asthma include pulmonary function test results, bronchodilator response, airway hyperresponsiveness, and atopy. Results: The EOShi group had a lower PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]), a lower FEV1, and a higher immunoglobulin E level rather than the EOSlo groups, although there were no significant differences between the NEUhi and NEUlo groups. The eosinophil percentages of the induced sputum samples were higher in the EOShi group than the EOSlo group and correlated with blood eosinophil counts. Conclusion: Eosinophilic inflammation was related to characteristics of asthma and sputum eosinophils. However, neutrophilic inflammation reflected neither asthma features, sputum neutrophils, nor eosinophilic inflammation. Further studies on blood neutrophils involving asthma phenotypes in terms of more specific characteristics of asthma should be needed in children.(Respir Dis 2014;2:165-170)
소아 천식 환자에서 전신 염증 유형에 따른 천식의 특성
설인숙 ( In Suk Sol ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),김민정 ( Min Jung Kim ),한윤기 ( Yoon Ki Han ),박영아 ( Young A Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회 1992 소아알레르기 및 호흡기학회지 Vol.2 No.3
Purpose: Asthma is a chronic airway inflammation. We evaluated whether systemic inflammatory patterns could reflect the nature of airway inflammation. We assessed characteristics of asthma according to systemic inflammatory patterns. Methods: A total of 413 children with asthma were enrolled in the study. Four systemic inflammatory patterns were classified according to eosinophil and neutrophil counts in peripheral blood. Children with neutrophil count≥5,000/μL were defined as the NEUhi group, those with neutrophil count <2,720/μL as the NEUlo group. The intermediate group with neutrophil count between 2,720/μL and 5,000/uL was excluded from the study. Children with eosinophil≥650/μL were defined as the EOShi group, those with eosinophil count<240/μL as the EOSlo group. The remaining patients were excluded from the study. The characteristics of asthma include pulmonary function test results, bronchodilator response, airway hyperresponsiveness, and atopy. Results: The EOShi group had a lower PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]), a lower FEV1, and a higher immunoglobulin E level rather than the EOSlo groups, although there were no significant differences between the NEUhi and NEUlo groups. The eosinophil percentages of the induced sputum samples were higher in the EOShi group than the EOSlo group and correlated with blood eosinophil counts. Conclusion: Eosinophilic inflammation was related to characteristics of asthma and sputum eosinophils. However, neutrophilic in- flammation reflected neither asthma features, sputum neutrophils, nor eosinophilic inflammation. Further studies on blood neutrophils involving asthma phenotypes in terms of more specific characteristics of asthma should be needed in children. (Allergy Asthma Respir Dis 2014;2:165-170)
가와사키병 환아에서 아스피린 치료 후 나타난 호산구증가증 1예
설인숙 ( N Suk Sol ),최명현 ( Myung Hyun Choi ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),한윤기 ( Yoon Ki Han ),김기환 ( Ki Hwan Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu 대한천식알레르기학회(구 대한알레르기학회) 2014 Allergy Asthma & Respiratory Disease Vol.2 No.2
Drug hypersensitivity is one of drug adverse reactions that develop in susceptible patients following exposure to certain drugs and cannot be predicted from the known pharmacology of a drug. Severe hypersensitivity is associated with high morbidity and mortality. Although the issue of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) has been largely investigated in adults, data related to NSAIDs hypersensitivity is insufficient in childhood. And in spite of the recommendation to avoid use of aspirin due to Reye syndrome in children, aspirin is one of major treatment along with intravenous immunoglobulin in Kawasaki disease. We report a case of a 10-month-old boy who underwent intravenous immunoglobulin and aspirin treatment for Kawasaki disease, and subsequently revealed severe leukocytosis and eosinophilia. To our knowledge, there have been no previous reportsof aspirin-induced eosinophilia in Korea. (Allergy Asthma Respir Dis 2014;2:142-145)
합병증을 동반한 기관지 땅콩 흡인에서 체외막산소화 장치를 통한 치료 1예
정재화 ( Jae Hwa Jung ),설인숙 ( In Suk Sol ),윤서희 ( Seo Hee Yoon ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),신홍주 ( Hong Ju Shin ),박한기 ( Han Ki Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2
Foreign body aspiration commonly occurs, especially among children younger than 3 years of age. Most endobronchial foreign bodies may be easily removed by bronchoscopy and have a good prognosis. Despite advances in bronchoscopic procedures, difficulties in management of and complications from foreign body aspiration are still noted. We present a foreign body aspiration case with acute respiratory distress syndrome caused aspiration pneumonia, which was successfully treated by bronchoscopy under extracorporeal membrane oxygenation (ECMO). ECMO can be an effective and potentially life-saving method in complicated foreign body aspiration with uncompensated respiratory failure. (Allergy Asthma Respir Dis 2016;4:140-144)
계란 알레르기 환아에서 인플루엔자 백신 접종의 안정성에 대한 연구
장수진 ( Soo Jin Chang ),설인숙 ( In Suk Sol ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),한윤기 ( Yoon Ki Han ),박현빈 ( Hyun Bin Park ),김민정 ( Min Jung Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Ky 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4
Purpose: Although influenza vaccine contains some residual egg protein (ovalbumin), recent studies have been reported that the influenza vaccine is even safe for patients with egg allergy. The object of this study was to assess the safety of influenza vaccination and estimate the risk factors of allergic reactions to influenza vaccination in children with egg allergy. Methods: The medical records of 108 children were reviewed retrospectively, those were diagnosed as egg allergy at Department of Pediatrics in Severance Children’s Hospital between January 2006 and December 2011. All of them were vaccinated with very low ovalbumin concentration (≤0.12 μg/mL). Patients were vaccinated in graded doses by the international guideline. Subjects without allergic reactions to influenza vaccine among egg allergy patients were recruited as control subjects. Results: Only 12 subjects of patients had adverse reactions to influenza vaccination. There were no significant relationships between adverse reactions to influenza vaccine and their own history of other allergy, history of breast feeding or graded vaccination. The egg allergy symptoms or egg-specific IgE levels were not associated with adverse reactions to influenza vaccination. Conclusion: These results show that patients with egg allergy may have adverse reactions with influenza vaccine, but severe adverse reactions are rare as general population. Therefore, the patients with egg allergy can be safe vaccinated with influenza vaccine, regardless of severity of allergic reaction after egg ingestion or methods of vaccination. (Allergy Asthma Respir Dis 2013;1:333-338)
계란 알레르기 환아에서 인플루엔자 백신 접종의 안정성에 대한 연구
장수진 ( Soo Jin Chang ),설인숙 ( In Suk Sol ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),한윤기 ( Yoon Ki Han ),박현빈 ( Hyun Bin Park ),김민정 ( Min Jung Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Ky 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4
Purpose: Although influenza vaccine contains some residual egg protein (ovalbumin), recent studies have been reported that the influenza vaccine is even safe for patients with egg allergy. The object of this study was to assess the safety of influenza vaccination and estimate the risk factors of allergic reactions to influenza vaccination in children with egg allergy. Methods: The medical records of 108 children were reviewed retrospectively, those were diagnosed as egg allergy at Department of Pediatrics in Severance Children`s Hospital between January 2006 and December 2011. All of them were vaccinated with very low ovalbumin concentration (≤0.12 μg/mL). Patients were vaccinated in graded doses by the international guideline. Subjects without allergic reactions to influenza vaccine among egg allergy patients were recruited as control subjects. Results: Only 12 subjects of patients had adverse reactions to influenza vaccination. There were no significant relationships between adverse reactions to influenza vaccine and their own history of other allergy, history of breast feeding or graded vaccination. The egg allergy symptoms or egg-specific IgE levels were not associated with adverse reactions to influenza vaccination. Conclusion: These results show that patients with egg allergy may have adverse reactions with influenza vaccine, but severe adverse reactions are rare as general population. Therefore, the patients with egg allergy can be safe vaccinated with influenza vaccine, regardless of severity of allergic reaction after egg ingestion or methods of vaccination.
김수연 ( Soo Yeon Kim ),김윤희 ( Yoon Hee Kim ),설인숙 ( In Suk Sol ),김민정 ( Min Jung Kim ),윤서희 ( Seo Hee Yoon ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu?earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
Purpose: The revised Berlin definition (BD) showed better predictive validity for mortality in adults with acute respiratory distress syndrome (ARDS). We examined the validity of BD for pediatric ARDS as compared to the American-European Consensus Conference definition (AECCD). Methods: This single-center, retrospective study included 127 patients aged 1 month to 19 years who were admitted to the medical intensive care unit due to acute lung injury (ALI, n=31) or ARDS (n=96) using the AECCD. All patient characteristics and mortality rates were compared between the individual severity groups according to the BD and AECCD. Results: Sixty-four patients (50%) died. Mortality rates increased across the severity groups according to both definitions (26% in mild, 42% in moderate, and 75% in severe by the BD [P<0.001]; 26% in ALI non-ARDS and 58% in ARDS by the AECCD [P=0.002]). The mortality risk increased only for ‘severe ARDS’ (hazard radio for mortality, 2.56; 95% confidence intervals [CI], 1.14-5.78; P=0.023) after adjusting for confounding factors. The BD better predicted mortality, with an integrated area under the receiver operating characteristic curve (iAUC) of 0.651 (95% CI, 0.571-0.725), than the AECCD, with an iAUC of 0.584 (95% CI, 0.523-0.637). The pediatric risk of mortality (PRISM) III and pediatric index of mortality 3 scores were significantly different across BD severity groups, whereas only PRISM III scores were different according to the AECCD. Conclusion: The BD applied to children with ARDS. It could be adopted to severity classifications and predict pediatric ARDS mortality better than the AECCD. (Allergy Asthma Respir Dis 2016:4:257-263)
소아에서 human metapneumovirus 중증 폐렴으로 체외막산소화 장치를 적용한 1예
최선하 ( Sun Ha Choi ),윤서희 ( Seo Hee Yoon ),설인숙 ( In Suk Sol ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),신홍주 ( Hong Ju Shin ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6
We present the first case report of a child with human metapneumovirus (hMPV) pneumonia who survived by extracorporeal membrane oxygenation (ECMO) in Korea. A 26-month-old boy with a previous history of Lennox-Gastaut syndrome and delayed development suffered from respiratory failure after 4 days of fever, cough, and sputum. The boy underwent intubation and required ECMO application due to failure of conventional mechanical ventilation. He was on the ECMO support for 7 days. To our knowledge, this is the shortest period reported for ECMO application among successfully treated patients with hMPV infection accompanied by acute respiratory distress syndrome. This case highlights 2 clinical implications: the potentially fatal causative role of hMPV in respiratory failure in a pediatric population and the timely utilization of ECMO. (Allergy Asthma Respir Dis 2015;3:456-460)
소아 급성호흡곤란증후군에서 체외순환막장치 적용에 대한 RESP, PRESERVE, ECMOnet 점수 체계의 유용성
안원기 ( Won Kee Ahn ),한정호 ( Jung Ho Han ),김윤희 ( Yoon Hee Kim ),설인숙 ( In Suk Sol ),윤서희 ( Seo Hee Yoon ),김민정 ( Min Jung Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu-earn Kim ) 대한소아알레르기호흡기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.3
Purpose: With increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) in children, development of standardized strategies for survival prediction has become crucial; however, this has not been accomplished yet. We evaluated the adult scoring systems for survival prediction used for their applicability in pediatric ARDS and validated them. Methods: A total of 11 children with ARDS receiving ECMO from 2013 to 2014 were evaluated with adult scoring systems, including the Respiratory Extracorporeal-membrane-oxygenation Survival Prediction (RESP), the PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE), and the ECMOnet scores. We compared the scores on these scales and the clinical characteristics between survivors and nonsurvivors. Results: Eight of the 11 children died (72.7%). The PRESERVE score (survivors vs. nonsurvivors: 2 vs 5.25, P=0.048), and the ECMOnet score (4.1 vs. 5.63, P=0.048) were lower in survivors than in nonsurvivors. They correctly predicted mortality prediction. There was no significant difference in the RESP score between survivors and non-survivors (-4.33 vs -2.62, P=0.63). The parameters that showed significant differences in this study were peak inspiratory pressure, platelet, and delta neutrophil index. All children who were under immunocompromised conditions, such as those with tumors, or underwent hematopoietic stem cell transplantation died. The immunocompromised status should be considered an important factor for survival prediction in children with ARDS. Conclusion: This is the first pilot study to apply the survival prediction scoring system to pediatric ARDS with ECMO. It is necessary to establish and modify the survival prediction score system for pediatric ARDS with ECMO. (Allergy Asthma Respir Dis 2017:5:141-146)
소아 급성호흡곤란증후군에서 Pediatric Acute Lung Injury Consensus Conference 정의의 임상적 적용
김벼리 ( Byuh Ree Kim ),김수연 ( Soo Yeon Kim ),설인숙 ( In Suk Sol ),김윤희 ( Yoon Hee Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu-earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2019 Allergy Asthma & Respiratory Disease Vol.7 No.1
Purpose: Despite improved quality of intensive care, acute respiratory distress syndrome (ARDS) significantly contributes to mortality in critically ill children. As pre-existing definitions of ARDS were adult-oriented standards, the Pediatric Acute Lung Injury Consensus Conference (PALICC) group released a new definition of pediatric ARDS. In this study, we aimed to assess the performance of PALICC definition for ARDS risk stratification. Methods: Total 332 patients who admitted to the intensive care unit at Severance Hospital from January 2009 to December 2016 and diagnosed as having ARDS by either the PALICC definition or the Berlin definition were retrospectively analyzed. Patient characteristics and mortality rates were compared between the individual severity groups according to both definitions. Results: The overall mortality rate was 36.1%. The mortality rate increased across the severity classes according to both definitions (26% in mild, 37% in moderate and 68% in severe by the PALICC definition [P<0.001]; 20% in mild, 32% in moderate and 64% in severe by the Berlin definition [P<0.001]). The mortality risk increased only for severe ARDS in both definitions (hazard ratio [95% confidence interval]: 2.279 [1.414-3.672], P=0.001 by the PALICC definition; 2.674 [1.518-4.712], P=0.001 by the Berlin definition). There was no significant difference in mortality discrimination between the 2 definitions (difference in integrated area under the curve: 0.017 [-0.018 to 0.049]). Conclusion: The PALICC definition demonstrated similar discrimination power on PARDS’ severity and mortality as the Berlin definition. (Allergy Asthma Respir Dis 2019;7:44-50)