Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Associated with Acetaminophen Use during Viral Infections

반가영,안선주,유혜수,박해심,예영민 대한면역학회 2016 Immune Network Vol.16 No.4

An association between drug treatment for viral infections and severe cutaneous adverse reactions has been noted. We investigated six patients diagnosed with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) after being prescribed acetaminophen for suspected viral illnesses. Multiplex analysis was performed to measure cytokine levels in sera before and after treatment. IL-2Ra levels significantly decreased during the convalescence phase. Although acetaminophen is relatively safe, the drug can trigger SJS/TEN in patients with suspected viral infections. T-cells and monocytes may be key components of the link between viral infection and acetaminophen-induced SJS/ TEN.

알레르기 검사의 시행과 해석

반가영 대한내과학회 2020 대한내과학회 추계학술대회 Vol.2020 No.1

Letter to the Editor Two Major Phenotypes of Sulfite Hypersensitivity: Asthma and Urticaria

반가영,박해심,김미애,유혜수,예영민 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.2

Predictors of Asthma Control by Stepwise Treatment in Elderly Asthmatic Patients

반가영,예영민,이윤환,김정은,남영희,이수걸,김주희,정기석,김상하,박해심,the Premier Researchers Aiming New Era in Asthma and Allergic Diseases 대한의학회 2015 Journal of Korean medical science Vol.30 No.8

The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged ≥ 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 ± 3.3 in the improved vs. 4.5 ± 4.4 in the control) and higher physical functioning (PF) scale (89.8 ± 14.2 in the improved vs. 82.0 ± 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of ≤ 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.

Plasma LTE4/PGF2α Ratio and Blood Eosinophil Count Are Increased in Elderly Asthmatics With Previous Asthma Exacerbation

반가영,예영민,김상하,허규영,김주희,심재정,조금선,조주연,박해심,PRANA group 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.4

The tools for asthma control assessment recommended by the current guideline are cognitive function- and effort-dependent, which is substantially impaired in the elderly. The aim of this study is to investigate objective assessment tools of asthma control status and previous asthma exacerbation (AE) in elderly subjects. Asthmatics aged >60 years who were treated with step 2 or 3 by the Global Initiative for Asthma (GINA) guideline were enrolled. During the 12-week study period, the subjects used either 400 μg of budesonide plus 10 mg of montelukast or 800 μg of inhaled budesonide. The occurrence of AE during the 4-week run-in and 12-week treatment period was monitored. After 12-week of treatment, sputum eosinophil count, peripheral eosinophil count, the plasma leukotriene E4 (LTE4), and prostaglandin F2α (PGF2α) metabolite levels were measured using the UHPLC/Q-ToF MS system. The study subjects were divided into group 1 (asthmatics who experienced AE during the study period) and group 2 (those who did not). A total of 101 patients aged 60-85 years were enrolled. Twenty-three patients (22.8%) had experienced AE. The plasma LTE4 level, LTE4/PGF2α ratio, and peripheral eosinophil count were significantly higher in group 1 than in group 2 (P=0.023, P=0.010, P=0.033, respectively). The plasma LTE4/PGF2α ratio and peripheral eosinophil count at week 12 were significantly associated with previous AE (odds ratio [OR]=1.748, P=0.013; OR=1.256, P=0.027). Receiver operating characteristic (ROC) curves to discriminate the subjects with previous AE, including these 2 parameters, showed that the area under the curve was 0.700 (P=0.004), with 73.9% sensitivity and 47.9% specificity. In conclusion, a combination of plasma LTE4/PGF2α ratio and peripheral eosinophil count can be an objective assessment tool which is significantly associated with asthma control status in elderly asthmatics.

노인 알레르기질환의 치료

반가영,박해심 대한의사협회 2015 대한의사협회지 Vol.58 No.1

The aged population is increasing worldwide, and it is therefore essential to identify the specific features of diseases in aged groups. The diagnosis of allergic diseases in the elderly is more difficult than in younger patients, because the differential diagnosis of other diseases must be excluded. The treatment of elderly allergic diseases is also challenging because most elderly patients have co-morbidities that affect the disease outcome. Co-morbidity is one of the most important factors to be considered when elderly allergic patients are treated. Co-morbidity and medications for co-morbidity affect allergic disease treatment in terms of drug-drug interaction, medication adherence, adverse drug reactions, and so on. Many studies of allergic diseases are focused on the younger population, while few studies have dealt with elderly allergic diseases. Further studies including diagnosis and treatment guidelines for elderly allergic disease are needed.

특발성 아나필락시스 환자에서 오말리주맙의 치료 효과

반가영 ( Ga Young Ban ),양은미 ( Eun Mi Yang ),김지혜 ( Ji Hye Kim ),신유섭 ( Yoo Seob Shin ),예영민 ( Young Min Ye ),남동호 ( Dong Ho Nahm ),박해심 ( Hae Sim Park ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.5

Anaphylaxis is a severe and life-threatening systemic reaction. Despite the extensive evaluation to determine the cause, 30%-60% of cases of anaphylaxis in adults remain idiopathic. Recently, omalizumab treatment has been postulated to treat refractory idiopathic anaphylaxis. We report a case of idiopathic anaphylaxis treated with omalizumab and investigated its pharmacological mechanism. A 66-year-old female presented to our clinic with recurrent anaphylaxis. She suffered from anaphylaxis 2-3 times a month for 6 months. She had past medical history of nonallergic bronchial asthma. History was carefully undertaken and anaphylaxis was not related to any specific foods, drugs, exercise, and insect bites. Serum specific IgE antibodies to common food allergens showed negative results. Oral provocation tests to food additives revealed to be negative. To screen systemic mastocytosis and mast cell activating syndrome, baseline tryptase level was checked, and it was within normal range. From comprehensive evaluation, she was diagnosed as having idiopathic anaphylaxis. She could not tolerate oral medications due to gastrointestinal discomfort, therefore, omalizumab treatment (150 mg, monthly) was started. After 6 months of treatment, anaphylaxis did not occur with complete remission status. To evaluate the pharmacological mechanism of omalizumab treatment, basophil histamine releasability test was performed. Histamine releasability induced by anti-IgE did not change after 6 months of treatment, while that induced by calcium inophore decreased. Omalizumab treatment can induce remission or favorable effects on idiopathic anaphylaxis, which may be derived from increased threshold of mast cell degranulation. Long-term studies in a larger cohort will be needed to confirm its efficacy. (Allergy Asthma Respir Dis 2015;3:380-383)

자가면역 질환을 동반한 당뇨병성 근육경색 1예

반가영 외 중앙대학교 의과대학 의과학연구소 2011 中央醫大誌 Vol.36 No.3/4

Diabetic muscle infarction (DMI) is a rare complication that usually occurs in patients with longstanding microvascular complications of diabetes. The typical clinical presentation of DMI includes a sudden onset of pain, tenderness, and swelling of the lower limbs. DMI can be diagnosed by typical clinical manifestations and magnetic resonance imaging (MRI). Treatment usually includes immobilization of the affected extremity and taking analgesics. A 44 year-old woman with type 2 diabetes mellitus and Hashimoto's thyroiditis for 10 years, presented with an abrupt and spontaneous onset of severe pain in the left thigh. In order to evaluate the etiology, angio-computed tomography, bone scan, and MRI of the lower extremities were performed. DMI was diagnosed based on the hyper-intense T2 weighted signals on the MRI. The patient was fully recovered with the conservative treatment.

메타콜린 기관지유발시험에 음성반응을 보인 천식 환자들의 임상적 특징

반가영 ( Ga Young Ban ),박혜린 ( Hae Lin Park ),황의경 ( Eui Kyung Hwang ),예영민 ( Young Min Ye ),신유섭 ( Yoo Seob Shin ),남동호 ( Dong Ho Nahm ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.3

Background: The methacholine bronchial challenge test is widely used to evaluate airway hyperresponsiveness in asthmatics; however some studies have reported a few asthmatics have negative methacholine bronchial challenge test results. We investigated the prevalence and clinical characteristics of this group of patients. Methods: We retrospectively analyzed the medical records of 118 patients diagnosed as having asthma who visited the Allergy Clinic of Ajou University Hospital between March 2010 and February 2011. Patients were divided into 2 groups according to the methacholine bronchial challenge test results: group I included those with positive results (group I, n=92) and those with negative results (group II, n=26). Results: Of the 118 subjects, 26 (22.0%) showed negative methacholine bronchial challenge test results. The rates of late-onset asthma (65.4%), non-atopy (42.1%) and overweight (47.4%) were higher in group II than in group I (37%, P=0.013; 19.6%, P=0.008; and 23.9%, P=0.008). The baseline lung function and the frequency of severe asthma exacerbation were not significantly different between the 2 groups. Conclusion: In this study, 22% of the asthmatic patients diagnosed by allergy specialists had negative methacholine bronchial challenge test results. It is suggested that late-onset asthma, non-atopy and overweight may be characteristic findings.

The Effects of NDRT Touchscreen Location on Driving and NDRT Performance in a Highly Automated Vehicle

Gayoung Ban(반가영),Philjun Moon(문필준),Woojin Park(박우진) 대한인간공학회 2021 대한인간공학회 학술대회논문집 Vol.2021 No.11

Objective: The current study aims to empirically evaluate the effects of the location of a touchscreen for a nondriving related task (NDRT) on the driver’s NDRT and take-over task performance in a highly automated vehicle. Background: There has been a bold transition in the automotive industry in which traditional static controls are being replaced by interactive displays such as touchscreens. Especially, growing prevalence of adopting touchscreens in the vehicle cockpit is evident in a highly automated vehicle where primary driving tasks are being handled by vehicle automation so that drivers are allowed to engage in different NDRTs. However, there are few empirical studies that investigate the driver’s behaviors while performing NDRT and take-over tasks with varying locations of NDRT touchscreen in the context of SAE level 3 vehicles where the driver’s primary role is performing NDRTs. Considering that performing NDRTs is one of the promises of highly automated vehicles, it is of a great necessity to empirically investigate the most desired NDRT touchscreen location. The authors of the present study are not aware of any research studies that evaluated the effects of NDRT touchscreen location on the performance of NDRT, take-over task, and the driver’s subjective experience measures in a highly automated vehicle. Method: Three different NDRT touchscreen locations were considered: Location A) left side of the steering wheel near the left air conditioning vent, Location B) the center console, and Location C) below the center console. Twentytwo participants performed the Surrogate Reference Task (SuRT, ISO TS14198) as an NDRT task and also a take-over task with each touchscreen location. The dependent measures were the following: driver’s spread of eye movement, steering wheel initiation response time, decision time for lane changes and, ratings of perceived workload, location preference, physical demand during the NDRT and the take-over task. Repeated-measures analyses of variance (ANOVA) were conducted to test the significance of NDRT touchscreen location for each dependent measure. Results: The study has found significant effects of NDRT touchscreen location on the take-over task and the NDRT performance. Location B (the center console) was found to be the best display location in terms of take-over performance. However, regarding the NDRT performance, Location B (the center console) was found to be the worst. The results indicated that the closer the NDRT touchscreen is positioned to the windscreen (e.g., the mid-console) the less detrimental the NDRT effect on the take-over performance. Despite a faster reaction to critical situations supported by Location B, the participants preferred Location C (below the center console) the most. Conclusion: When comparing the three different NDRT touchscreen locations, the location of NDRT touchscreen closer to the windscreen appears to be optimal in reacting to critical situations; however, it is also necessary to consider NDRT touchscreen location from the perspective of the drivers non-driving activities, particularly in the context of highly automated vehicles where the driver needs to and is expected to perform NDRTs. Application: The study findings may help to determine the placement of onboard NDRT touchscreen for the presentation of information related to non-driving activities in a highly automated vehicle.