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스티렌(Styrene)과 Toluene Diisocyanate (TDI)에 의한 직업성 천식
예영민 ( Young Min Ye ),최길순 ( Gil Soon Choi ),박한정 ( Han Jung Park ),김현아 ( Hyoun Ah Kim ),허규영 ( Gyu Young Hur ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.1
Styrene, a common solvent and volatile organic compound (VOC), is widely used in the factories of plastics, resins, insulators, coatings, and paints. While toluene diisocyanate (TDI) is a well-known causative agent of asthma, styrene has been rarely reported to cause occupational asthma (OA). We report a 50-year-old repairman with OA due to both styrene and TDI in whose job was filling cracks and flattening the surface of vehicles with styrene-containing plaster`s putty, followed by spray painting. He suffered from cough, dyspnea durings the work with putty. He presented with a 2-year history of asthma and allergic rhinitis. The level of serum total IgE and sputum eosinophils were 2,878 IU/L and 63%, respectively. The methacholine challenge test was positive (PC20 0.59 mg/mL). The bronchoprovacation tests with TDI and styrene showed early and dual responses, respectively. Currently, he is in well-controlled state with the use of a combination of inhaled corticosteroid and long acting β2-agonist after the avoidance of the causative agents. (Korean J Asthma Allergy Clin Immunol 2007;27:70-73)
예영민 ( Young-min Ye ) 대한내과학회 2019 대한내과학회지 Vol.94 No.4
Urticaria is a common cutaneous disease characterized by recurrent and transient wheals and pruritus, sometimes accompanied angioedema. The classification of urticaria is based on the duration of the disease and whether extrinsic triggers are identified or not. Acute urticaria is usually occurred by specific causes, such as drug, food, and infection, etc. Therefore, acute urticaria can be remitted within 6 weeks just by avoiding the exposure to the causes. However, chronic urticaria defined as repeatedly occurred itchy wheals and/or angioedema for at least 6 weeks, has a significant effect on patients’ quality of life. Chronic inducible urticaria can be triggered by various physical stimuli including dermographism, delayed pressure, cold, heat, cholinergic stimuli, sunlight, and exercise. Chronic spontaneous urticaria (CSU) is diagnosed when no specific extrinsic cause is identified in the patients. CSU due to autoimmune mechanism accounts for 30-50%, autologous serum skin test and anti-thyroid autoantibody can be evaluated. However, various physical stimuli, emotional or physical stress, drugs, particularly aspirin and non-steroidal anti-inflammatory drugs can exacerbate urticaria in 30-75% of patients with CSU. Allergic diseases and autoimmune diseases are more common in CSU patients than in general populations. To assess the severity of urticaria and to adjust treatment step, urticaria activity score over 7 days, calculated by the number of wheals and the severity of pruritus, is recommended by recent international guidelines. (Korean J Med 2019;94:353-357)
예영민 ( Young Min Ye ),장광천 ( Gwang Cheon Jang ),최선희 ( Sun Hee Choi ),이정민 ( Jeong Min Lee ),유혜수 ( Hye Soo Yoo ),박경희 ( Kyung Hee Park ),신미용 ( Mee Yong Shin ),김지현 ( Ji Hyun Kim ),이서영 ( Suh Young Lee ),최정희 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1
Chronic urticaria (CU) is defined by the presence of urticaria that has been continuously or intermittently for a period of 6 weeks or longer. The prevalence of CU in the general population has been estimated to range from 0.5% to 5%. Correct diagnosis and proper management for CU is essential to improve the quality of care. To date, several practical guidelines have been available for practitioners. In this article, we reviewed and summarized the epidemiology, pathogenesis, diagnosis, and management based on case reports and studies of CU from Korea and the other part of world, and recently published guidelines. Although there are many controversies, this report for CU would provide a clinical guidance for healthcare professionals in Korea.
김정은 ( Jeong Eun Kim ),견진옥 ( Jin Ok Kyun ),진선민 ( Sun Min Jin ),이영희 ( Young Hee Lee ),김주희 ( Joo Hee Kim ),이현영 ( Hyun Young Lee ),박해심 ( Hae Sim Park ),최영화 ( Young Wha Choi ),예영민 ( Young Min Ye ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.3
Background: There have been few reports on the characteristics of adverse drug reactions (ADRs) in elderly patients among the Korean population. Objective: To investigate the characteristics of ADRs in elderly patients compared with those in younger ones. Method: ADRs were collected from a spontaneous reporting system at our university hospital in 2008. Characteristics including underlying diseases, duration of hospitalization, clinical manifestations, culprit drugs and number of concomitant medications were compared between the young (<65 years) and elderly (≥65 years) groups. Result: A total of 528 ADRs occurred in 513 patients, and 120 ADRs (22.7%) occurred in 116 elderly patients. Their mean age was 71.6 years. Antibiotics (45.8%) were the most common culprit drugs. The prevalence of ADRs due to cardiovascular drugs was significantly higher in the elderly group (9.2%) than in the young group (2.9%, P=0.003). The most prevalent clinical types were skin manifestations (40.5%), gastrointestinal abnormalities (28.4%) and systemic reactions (23.5%) in both groups. Renal function abnormalities were significantly more prevalent in the elderly group (4.2%) than in the young group (0.5%, P=0.008). The mean number of concomitant medications was significantly higher in the elderly group (6.5±4.6) than in the young group (1.9±3.9). Conclusion: For the early detection of ADRs in elderly patients, close monitoring of cardiovascular drug use and renal function are recommended. (Korean J Asthma Allergy Clin Immunol 2010;30:216-221)
Cefaclor 즉시형 과민반응을 나타낸 환자들의 임상적 및 면역학적 특징
남영희 ( Young Hee Nam ),김정은 ( Jeong Eun Kim ),황의경 ( Eui Kyung Hwang ),진현정 ( Hyun Jung Jin ),신유섭 ( Yoo Seob Shin ),예영민 ( Young Min Ye ),남동호 ( Dong Ho Nahm ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.3
Background: Cefaclor is commonly prescribed for various infectious diseases. It is known as a major causative antibiotic that induces drug hypersensitivity reactions. The aim of this study is to evaluate clinical and immunologic features of cefaclor immediate hypersensitivity. Methods: We conducted a retrospective study on the patients with histories of immediate hypersensitivity to cefaclor at Ajou University Hospital between January 2002 and February 2011. Serum specific IgE to cefaclor was measured using the ImmunoCAP system. Results: Fifty patients were enrolled in this study. The most common immediate hypersensitivity reaction was anaphylaxis (38/50, 76%), followed by urticaria/angioedema (12/50, 24%). High serum specific IgE to cefaclor was noted in 40 patients (80%). There were no significant differences in clinical parameters whether the patients had serum specific IgE or not, except that serum total IgE level was higher in patients with high serum specific IgE to cefaclor (P=0.042). Serum specific IgE to penicillin was detected in 26.1% of the patients with high serum specific IgE to cefaclor, while serum specific IgE to aminopenicillin was not found in any of the study subjects. Conclusion: Immediate hypersensitivity to cefaclor occurred mostly through the IgE-mediated mechanism, and anaphylaxis was the most common manifestation. Cross reactivity with penicillin was noted in 26% of the patients, but no cross reactivity with aminopenicillin was noted. (Korean J Asthma Allergy Clin Immunol 2011;31:192-198)
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.
성인 천식 환자들에서 Cytokeratin 18 단백에 대한 IgG 자가항체와 천식의 임상적 중증도 간의 연관성
신지영 ( Jee Young Shin ),권별 ( Byul Kwon ),신호수 ( Ho Su Sin ),예영민 ( Young Min Ye ),박해심 ( Hae Sim Park ),남동호 ( Dong Ho Nahm ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.3
Background: Cytokeratin 18 (CK18) protein was identified as an airway epithelial cell antigen associated with nonallergic asthma. Objective: We evaluated an association between IgG autoantibodies to CK18 protein and clinical severity of asthma in this study. Method: Severe asthma was defined as when patients had experienced at least one severe asthmatic exacerbation requiring an emergency room visit or admission in the last year despite continuous typical therapies. Moderate asthma was defined as when patients had been controlled by typical therapies without severe asthmatic exacerbation in the last year. Mild asthma was defined as when patients experienced intermittent asthmatic symptoms and did not need continuous anti-asthmatic treatments in the last year. IgG autoantibodies to CK18 protein were detected in serum samples by immunoblot analysis Result: IgG autoantibodies to CK18 protein were detected in 48 of 161 asthmatic patients (29.8%) and 5 of 58 healthy controls (8.6%) (P=0.002). IgG autoantibodies to CK18 protein were detected in 1 of 20 patients with mild asthma (5.0%), 22 of 63 patients with moderate asthma (34.9%), and 25 of 78 patients with severe asthma (32.1%)(P<0.001). Conclusion: These findings suggest that IgG autoantibodies to CK18 protein could be a biological marker for moderate-to-severe asthma requiring continuous medical treatment. (Korean J Asthma Allergy Clin Immunol 2006;26:219-224)
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)