한국 성인 기관지천식 환자의 삶의 질 평가를 위한 설문의 유용성 평가를 위한 다기관 연구

박중원 ( Jung Won Park ),조유숙 ( You Sook Cho ),이순영 ( Soon Yeung Lee ),남동호 ( Dong Ho Nahm ),김윤근 ( Yoon Keun Kim ),김동기 ( Dong Ki Kim ),손지웅 ( Jee Woong Sohn ),박재경 ( Jae Kyung Park ),지영구 ( Young Koo Jee ),조영주 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.3

Background: and objective : Assessment of quality of life (QOL) of patients with chronic illness requires reasonable tools which reflect the patients' cultural and behavioral properties. We developed the quality of life questionnaire for adult Korean asthmatics (QLQAKA) on the basis of the Korean life style and evaluated its reliability and validity. Methods : The QLQAKA consisted of four domains: symptoms (six items), daily activity (five items), emotion (three items) and reaction to environmental stimuli (three items). Patients answered each item according to a five-response scale. The reproducibility and validity of the questionnaire was estimated from the responses of 244 patients who visited the clinics in 15 institutes within a 2-week interval. Results : Items with the most frequent complaints were dyspnea (87%), difficulty in sputum discharge or throat clearing (87%), limitation in strenuous activity (84%) and coughing (82.4%). The QLQAKA reflected the changes of patients' status very well. The value of minimal important differences, such as the clinically significant minimal change in the QOL score, was 0.5. The questionnaire was also highly reproducible with the value of intraclass correlation coefficiency and intraclass standard deviation as 0.940 (p<0.001) and 0.180, respectively. The changes of mean total QLQAKA score correlated weakly with the changes of FEV> and PEFR values. Conclusion: The adult version of QLQAKA was valid and may be a reproducible tool for evaluating and monitoring Korean adult asthma patients.

한국 소아와 청소년의 비염 유병률에 관한 역학적 연구

김윤근,김유영,조상헌,손지웅,이병재,김우경,이상록,박재경,민경업,하미나,안윤옥,지영구,이상일 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.3

Background: Allergic rhinitis and asthma are the most prevalent allergic diseases and a num- ber of studies have shown an increase in prevalence of both diseases all over the world in recent years. Although we reported the asthma prevalence in Korea, little is known about the prevalence of rhinitis in Korea. Objective: The purpose of this study was to elucidate the prevalence of childhood rhinitis including allergic and non-atopic rhinitis in Korea. Methods: We performed questionnaire survey and allergy skin prick test with 10 common inhalant allergens among 3,219 subjects aged 7-19 years in Seoul and Chungju. Subjects were asked whether they were troubled by sneezing, runny nose, itchy nose and/or nasal blockage in the last year, which were not related to common cold. Rhinitis was diagnosed when the subjects complained of 3 or more symptoms on questionnaire. Skin-prick test was regarded as positive when the wheal caused by allergen was same or larger than that caused by histamine. Results: The average prevalence of rhinitis was 13.0%. We could not find any significant age or sex differences in the prevalence of rhinitis. There was no regional difference between Seoul (12.7%) and Chungju (13.2%). The positive rate of skin prick test in subjects with rhinitis was 59.6%, which means the prevalence of allergic rhinitis was 7.8% and that of non-atopic rhinitis was 5.2%. The common allergens of allergic rhinitis were Dermatophagoides farinae (62.5%), Dematophagoides pteronyssinus (55.8%), cat fur (46.9%), cockroach (18.9%) and mugwort pollens (10.1%). Conclusion: The prevalence of childhood rhinitis in Korea was 13.0% and those of allergic rhinitis and non-atopic rhinitis was 7.8% and 5.2%, respectively.

Toluene diisocyanate (TDI)에 의한 직업성천식에서 TDI : 인혈청 암부민 접합체에 대한 특이 IgG 및 IgE 항체의 임상적 의의

김유영,서정희,박해심,김희연,남동호,손지웅 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.4

Background and objective : TDI is known to be the most prevalent cause of occupational asthma (OA) in Korea. However, the pathogenesis of TDI-induced occupational asthma still remains to be further clarified. So, we evaluated clinical significance of serum specific IgG and IgE antibodies to TDI-HSA conjugate in TDI-induced occupational asthma. Subjects and methods : Serum specific IgG and IgE antibodies to TDI-HSA conjugate were measured by enzyme linked immunosorbent assay. Serum was collected from 50 TDI-induced OA patients (classified as group I), and was compared with that from 13 asthmatic subjects with negative TDI-bronchoprovocation test (BPT, group II), allergic asthmatics (group III), and unexposed healthy controls (group IV). Results : The prevalence of specific IgG was significantly higher in group I than in group II (p = 0.01) or group III (p〈 0.01). No significant difference was noted between group II and group III (p $gt; 0.05). However, the prevalence of specific IgE was no different between group I and group II (p $gt; 0.05 ) or group II and group III( p $gt; 0.05 ). There was no significant difference in prevalence of specific IgG according to the asthmatic response during TDI bronchoprovocation test ( p $gt; 0.05 ). No statistical significance was noted between specific IgG and IgE antibodies in group I subjects ( p $gt; 0.05 ). Conclusion : These findings demonstrate that presence of specific IgG to TDI-HSA conjugate is closely related to TDI - BPT results and it may contribute to the development of TDI - induced asthma.

귤응애 과민성 천식에서 HLA - DRB1 유전자좌의 항원형 분포

이명현,김유영,김윤근,장윤석,지현숙,민경업,조상헌,손지웅,오흥범,정재원 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.5

Background : Specific IgE responses to allergens provide useful models for evaluating the ge- netic factors that control human immune responses. HLA class II gene products are involved in the antigen presentation of exogenous antigens. Objective : The aim of this study was to evaluate whether susceptibility or resistance to asthma induced by the citrus red mite (Panonychus citri, CRM) was associated with HLA class II gene-encoded antigens. Methods : Peripheral venous blood samples were collected from two groups of unrelated Korean adults. Ninety-one patients with citrus red mite-induced asthma and 98 exposed, healthy control subjects. The second exon of the HLA-DRB1 genes was selectively amplified by the polymerase chain reaction method. HLA typing was carried out using PCR-sequence specific oligonucleotide probes(PCR-SSOP). Results : The frequency of HLA-DR7 was significantly higher among the CRM-sensitive asthmatics than among the controls (17.6% vs 4.1%, RR=3.92, p=0.01). Conversely, the frequ- ency of HLA-DR4 was significantly lower among the CRM-sensitive asthmatics than among the controls(19.8% vs 40.8%, RR=0.36, p=0.01). No significant difference was found in the distributions of the other HLA-DRB1 gene-encoded antigens between the two groups. Conclusion : HLA-DRB1 genes may be involved in the development of citrus red mite-induced asthma. In addition, HLA-DR7 may increase, and DR4 decrease, the risk of developing asthma in exposed individuals.

카레가루에 의한 직업성 천식 및 비염 1례

박해심,정기석,이수걸,남동호,조재웅,손지웅,김익태,김선신 대한알레르기학회 2000 천식 및 알레르기 Vol.20 No.4

Curry powder is widely used in various dishes. It is a mixture of 20-50 kinds of natural spices made from the leaves and seeds of plants. Although there have been some reports of allergy caused by inhalation of spices in western countries. While there are no reports of occupational allergy caused by spices in our country, We report a patient with rhinitis and asthma induced by exposure to spice dusts in a curry industry. A 32-year-old man developed rhinorrhea, sneezing and coughing three years prior to visiting our hospital. Since 10 years ago, he has been involved in grinding and mixing spices in a curry industry. Total peripheral eosinophil count was 400/mm and serum total IgE level was 163 IU/ml. Allergy skin-prick test showed positive responses to mugwort(3+), D. farinae(3+) and celery(3+), while serum specific IgE detected by RIA(DPC, LA, CA) shawed all negative results. Skin-prick test to four kinds of spice extracts- celery seed, fennel. cumin and coriander-showed strong positive responses. Bronchoprovocation test with celery seed extract(1: 10 v/v) showed an early asthmatic response. Specific IgE and IgG₄ antibodies to celery seed and the other three spices were detectable by ELISA. IgE-ELISA inhibition test using each spice antigen showed significant inhibitions. In conclusion, IgE-mediated mechanism may be involved in the pathogenesis of curry powder-induced bronchoconstriction in an exposed worker. Further studies will be needed to investigate the role of specific IgG₄ in pathogenesis of bronchoconstriction in curry powder- induced asthma.

제주도 농촌지역 초등학생의 귤응애 항원에 대한 감작 현황과 귤응애에 대한 환경폭로가 감작에 미치는 영향

이명현,김우경,홍성철,김유영,이상록,김윤근,박해심,장윤석,이병재,김희연,민경업,지영구,조상헌,손지웅,배종면,정재원 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.6

Background : We have demonstrated recently that citrus red mite(Panonychus citri) is the most important allergen in citrus-cultivating farmers with asthma and/or rhinitis. Objective : A cross-sectional survey was performed to evaluate the sensitizat,ion to the citrus red mite and the effect of environmental exposure on the specific sensitization among primary school children living in rural areas of Cheju Island. Material and methods : A total of 4,490 children (from ages 7 to 12 years) living in rural are as were enrolled in this study. Each subject was evaluated by a questionnaire developed by International Study of Allergy and Asthma in Childhood (ISAAC), and a skin prick test with 11 common inhalant allergens including citrus red mite. Results : On skin prick tests, the most common sensitizing allergen was Dermatophagoides pteronyssinus(7-9 years : 22.7%, 10-12 years : 25.5%), followed by D. farinae(20.4%, 21.8%), cockroach(9.6%, 12.8%), and citrus red mite(8.8%, 12.6%). The sensitization rate to citrus red mite was higher in older children than in younger ones. When age factor was corrected, the positive skin response to citrus red mite was higher among childen with a history of visiting citrus farms or those living near citrus farms than among those without visiting history or those living far from citrus farms (p$gt;0.05, respectively). Conclusion : Citrus red mite is a common sensitizing allergen and evnironmental exposure may determine the risk of sensitization to citurus red mite in children living in rural areas of cheju Island.