아토피성 천식 환아에서 바퀴항원 감작에 관한 연구

이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김동수(Dong Soo Kim),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.1

N/A To evaluate the etiologic role of cockroach antigen in bronchial asthma in Korean children, 220 atopic asthmatic children were studied using in vitro assays for total (PRIST) and cockroach specific IgE (FAST) antibodies, and the responsiveness of skin test. Specific IgE antibodies to major German cockroach allergens, Bla Gi and Bla Gii, were also measured using avidine-biotin ELISA with monoclonal antibodies (sandwitch method) in 7 cockroach sensitive and 6 cockroach non-sensitive asthmatic children. Positive skin reactions were encountered in 28 out of 220 (12.8%) atopic asthmatics. The FAST was positive in 24 (11%) patients. Atopic asthmatics with positive skin reaction or FAST to crude cockroach antigen were 41 (18.6%) of 220. There was a relatively low degree of agreement between positive reactions by skin test and FAST (39.3%) compared with that of house dust mites antigens. On the other hand the positive rate of cockroach specific IgE was higher in patients who showed positive skin reactions to cockroach antigen (P<0.05). Among forty-one cockroach sensitive children with atopic asthma, 76.9% and 100% had positive skin reactions to D. farinae and D. pteronyssinus respectively. Specific IgE antibodies to Bla Gi and Bla Gii were detected in all patients with positive skin reaction to crude cockroach antigen and in 33.3% of those with negative skin reactions. In summary, the positive rate of cockroach allergy in Korean atopic asthmatic children was 18.6%. Cockroach seems to be one of the most common causative indoor allergen in Korean asthmatic children. The environmental assay of cockroach antigen is be needed in our country. We should further consider the possibility of cross reactivity and co-sensitization between cockroach and house dust mites allergens.

남매에서 발생한 다발성 낭성공동을 동반한 폐흡충증

이은경(Eun Kyung Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회 1994 소아알레르기 및 호흡기학회지 Vol.4 No.1

Paragonimiasis is widely distributed in the Far East, but the incidence in Korea is markedly decreased due to the change of diet habits. It is characterized by the similar progress and clinical manifestation with pulmonary tuberculosis, so it should be differentiated from pulmonary tuberculosis. We experienced 2 cases of pulmonary paragonimiasis in siblings. They were complained of chronic cough with blood-tinged sputum, treated with antituberculous medicine, and finally diagnosed as paragonimiasis by P.W. skin test and ELISA test. We report this case with brief review of literatures.

아토피성 및 비아토피성 소아천식에서 IgG anti - IgE 자가항체의 양성율과 아형

이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),김동수(Dong Soo Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.1

N/A The anti-IgE autoantibody (anti-IgE) in the IgG class was measured in children with atopic or non-atopic asthma using solid phase enzyme-linked immunosorbent assay (ELISA) in avidine-biotin system. The IgG anti-IgE was detected in 74% of children with atopic asthma, and in 83.3% of those with non-atopic asthma. In atopic asthmatics, children with the relatively high IgE antibody level (more than 100 IU/ml) showed 83.3% of positive rate of IgG anti-IgE, and those with relatively low IgE level (less than 100 IU/ml) showed 55.6% of positivity. In non-atopic asthmatics the positive rates of IgG anti-IgE were 100% and 77.7% in the children with high and low IgE levels, respectively. The IgG1 and IgG4 antibodies against IgE were also measured in all children, and there were no significant differences of positive rate and relative concentration of IgG1, IgG4 anti-IgE between atopic and non-atopic asthmatics. The concentration of IgG, IgG1 and IgG anti-IgE were well correlated with the level of total serum IgE antibody (r=0.33, r=0.39 and r=0.36 and r=0.36; p<0.05) and there was also good correlation between IgG1 or IgG4 anti-IgE and total IgG anti-IgE (r=0.84, r=0.83; p<0.0001). In summary there were no differences in positive rate and relative concentrations of IgG, IgG1 and IgG4 anti-IgE autoantibodies between atopic and non-atopic asthmatic children. And there was good correlations among IgG, IgG1 or IgG4 anti-IgE and total serum IgE antibody.

아토피 환아에서 쌀 항원에 대한 혈청 특이 IgE 및 IgG4 의 측정과 의의

이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김동수(Dong Soo Kim),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.2

N/A To evaluate the allergenicity of rice flour in Korean atopic children, we performed the ELISA for rice speci5c IgE and IgG4 using own product of partially purified crude extract of rice flour. Allergic skin test with 63 inhalant and food antigens (Torii) and rice extract was done by scratch method. Subject were divided into two groups; Group 1: subjects with positive skin reaction to buckwheat flour (n=13), Group 2: subjects with negative skin reaction to buckwheat flour (n=14). The results were as follows; 1. All subjects showed positive skin reactions to Dermatophagoides farinae (Df) and Dermatophagoides pteronyssinus (Dp), and negative to wheat and rice flour antigens. The mean age, total serum IgE and skin reactions to Df and Dp were not signi5cantly different between Group 1 and Group 2. 2. The positive rates of rice specific IgE were 38.5% and 0% in Group 1 and Group 2, respectively. The relative concentrations of rice specific IgE in Group 1 and Group 2 were 1.1±0.83 and 0.4±0.37 and there was no significant difference between Group 1 and Group 2. 3. The positive rates of rice specific IgG4 were 92.3% (12 of 13) and 85.7% (12 of 14), respectively. There was no significant difference in the relative concentration of rice speci5c IgG4 between Group 1 (2.6±0.45) and Group 2 (2.4±0.40). 4. The concentrations of specific IgE were not correlated with those of total serum IgE. In conclusion, 5 out of the 27 subjects studied are considered as rice allergic patient by demonstration of rice specific IgE in their sera. The detection of rice specific IgG4 is a less specific diagnostic method in rice allergy, and it simply represent the long-term exposure of rice antigen.

알레르기 피부검사의 일간 양성율의 차이에 관한 연구 1 . 바이오 리듬과의 상관관계

강혜영(Hye Young Kang),이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.1

N/A Allergy skin test have represented the primary diagnostic tool in allergy. Their characteristics, simplicity, rapidity of performance, low cost and high sensitivity explain the key position that skin test occupies in allergy. However, one of the main limitations of the skin test is that the cutaneous reactivity is affected by multiple factors, such as areas of body, age, circadian rhythm, seasonal variation, drug and etc. The circadian rhythm and seasonal variation of skin test is well known but day-to-day variation of cutaneous reactivity is not elucidated. The biorhythm theory suggests that there is an inherent rhythmicity to man’s performance capacity, consisting of a 23-day physical cycle, a 28-day emotional cycle, a 33-day intellectual cycle. Theoretically, the cycles begin at birth and terminate at death. We studied the correlation between day-to-day variation of skin test reactivity and biorhythm. But we cannot find a difference in skin test reactivity between critical day, positive state and negative state in biorhythm. In conclusion, There is no relationships between day-to-day variation of skin test reactivity and biorhythm.

우유 알레르기의 유발 및 제거시험을 통한 임상적 특성

류정우(Jeong Woo Ryu),염혜영(Hye Young Yeum),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1999 소아알레르기 및 호흡기학회지 Vol.9 No.3

목 적 :우유는 신생아와 영유아에서 가장 많이 섭취되고 있는 식품으로 우유 섭취가 증가됨에 따라 국내에서 우유 알레르기 환자가 증가되리라 생각된다. 우유가 알레르기의 원인인데도 모르고 먹이는 경우가 있는가 하면 원인이 아닌데도 금식시키는 경우도 있어 성장기 성장, 발육에 문제가 되고 있다. 따라서 우유 알레르기가 의심되는 환자에서 이를 확인하는 일은 중요하다고 생각되어 유발시험을 실시하였다. 방 법 : 연세대학교 의과대학 소아 알레르기 크리닉에 내원하여 병력상 우유 알레르기가 의심되거나 알레르기 피부반응검사상 우유 항원에 양성 반응을 나타냈던 환아 41례 가운데 21례를 대상으로 우유를 3-4방울 먹이는 극소량부터 시작해서 최고 250mL에 이르기까지 우유 경구 유발시험을 실시하였고, 이들의 임상 양상을 분석하였다. 결 과 : 1) 경구 유발시험을 실시하였던 환아 21례 중 우유 알레르기로 진단되었던 경우는 9례(43%)였다. 2) 대상 환자들 중에 알레르기 피부반응검사나 병력에만 양성이었던 경우는 각각 11례, 6례였는데 경구 유발시험에서는 각각 2래, 3례에서만 양성이었으며 알레르기 피부반응검사와 과거력이 모두 양성이었던 경우에는 4례 모두에서 경구 유발시험 양성을 보였다. 3) 우유 경구 유발시험시 유발된 중상은 두드러기가 7례(77.8%)에서 나타났고, 천식 및 비염 둥 호흡기 증상이 5례(55.6%), 복통, 설사 등 소화기 중상이 1례(11.1%)에서 있었다. 4) 증상을 유발하는데 필요하였던 우유의 양은 3-4방울 마시는 등 극소량으로도 증상이 유발되었던 경우가 1례(11.1%), 1-100 mL 사이가 3례(33.3%), 100 mL 이상의 우유를 마시고 증상이 유발된 경우는 5례(55.5%) 있었다. 결 론 :우유 알레르기가 의심되는 환아는 우유 제거 또는 유발시험으로 확진하는 일이 중요하며 유발시험시 두드러기 등 피부 중상이 주로 나타났으며, 다른 식품보다는 알레르기 증상이 유발되는 데 많은 양이 필요했던 것으로 보아 항원성은 높지 않음을 알았고 우유항원으로 실시한 알레르기 피부반응검사만 양성으로 나타났던 경우보다 양성 병력을 동시에 지니고 있는 환아에서 유발률이 높다는 것을 알 수 있었다. Purpose : A Cow`s milk allergy(CMA) is one of common problems during first year of life. Though milk caused allergic problems, their parents didn`t know it, and gave milk to their children. But the parents don`t give milk to their children if they know it. Therefore it may cause problems of growth and development in children. The purpose of this study is to analyze those clinical features of milk allergy confirmed by oral provocation test. Methods : We carried out the retrospective study on 21 patients who had been performed oral milk provocation test at Yonsei university children`s allergic clinic. Results : 9 out of 2lcases(43%) showed positive milk oral provocation test. The most common clinical symptom & sign was urticaria, followed by respiratory symptoms and abdominal symptoms. The rate which past history and positive skin test corresponded to oral provocation test was very high(100%). Conclusion : The most valuable diagnosis of food allergy is oral provocation test. However, predictive value of allergy skin test and past history was very high in milk allergy.

선천성 낭포성 유선종 폐기형 환아의 임상적 고찰

박석원(Seok Won Park),이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.2

N/A The congenital cystic adenomatoid malformation (CCAM) of the lung is the second most common congenital lung disease consisted of one or usually multiple interconnecting cysts in the pulmonary parenchyma lined by cuboidal and columnar epithelium. We have experienced 7 patients of congenital cystic adenomatoid malformation of the lung during last 10 years. They had various respiratory symptoms, which were fever, cough, dyspnea, tachypnea etc. They were diagnosed by chest X-ray and confirmed by chest CT scan which showed single or multiple, various sized cystic lesions on any fields of the lung. Surgical treatment was taken on 4 patients, and conservative management on 3 patients. The prognosis is better in patients who took operation than in patients who took conservative management.

선행질환을 중심으로한 무기폐의 임상적 고찰

최원규(Won Kyu Choi),강혜영(Hye Young Kang),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1994 소아알레르기 및 호흡기학회지 Vol.4 No.2

N/A Clinical data and findings of 105 cases of atelectasis in children which were confirmed by chest X-ray at Yonsei University Hospital during the period of January 1989 to December 1993 were reviewed. The result were briefly summerized as follows: 1) Atelectasis was seen most frequently below 1 year in 46 cases(43.8%) and 76 cases(72.4%) of all patients were below 5 years of age. 2) The main clinical symptom was cough in 74 cases(70.5%). The other complains were abundant expectoration in 42 cases(40%) and fever in 40 cases (38.1%). Rales were heard in 31 cases(29.5%) decreased breathing sound in 29 cases(27.6%), retraction in 20 cases(19%) and no signs in 28 cases(26.7%). 3) The involvement of the lung was usually the right upper lobe in 53 cases (50.5%) the right middle lobe in 13 cases(11.4%) and right lower lobe in 10 cases(9.5%). 4) Identifiable etiologic factors were pneumonia in 37case(35.2%) neuromuscular disease in 15 cases(14.3%), bronchiolitis in 11 cases(10.5%), asthma in 10 cases (9.5%), congenital heart disease in 10 cases(9.5%), pulmonary tuberculosis in 9 cases(8.6%), foreign body aspiration in 6 cases(5.7%), pulmonary anomaly in 5 cases(4.8%), and bronchiectasis in 2 cases(1.9%).

기관지조영술 시행 중 나타난 조영제에 대한 아나필락시양 반응 2 례

강혜영(Hye Young Kang),이수영(Soo Young Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim),이기영(Ki Young Lee) 대한소아알레르기호흡기학회 1994 소아알레르기 및 호흡기학회지 Vol.4 No.1

Anaphylactoid reactions to radiocontrast material(RCM) administration are significant clinical problem not only because the pathogenesis of such reaction has not been elucidated but also because anaphylactoid reaction to RCM occur with significant frequency in patients who have experienced previous reaction and who must be given RCM again. The pretreatement protocols and provocative challenge test have been instrumental in reducing both frequency and severity of side reaction in high risk patients. We present here 2 cases of severe anaphylacoid reaction to radiocontrast material (Hytrast) during bronchogram and review literatures briefly.

우폐중엽중후군 환자들에 대한 임상적 연구

양재호(Jae Ho Yang),박경화(Kyung Wha park),이기영(Ki Young Lee),정병주(Byeung Ju Jeoung),김규언(Kyu Earn Kim) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1998 소아알레르기 및 호흡기학회지 Vol.8 No.2

목 적 : 우패중엽증후군(Right middle lobe syndrome)은 주로 성인에서 호발하나 최근들어 소아에서 빈번하게 발생되고 있으나 이에대한 포괄적인 임상적 연구와 질병의 경과 및 예후를 예측할 수 있는 지표 및 동계는 미미한 실정이다. 이에 저자들은 과거 10년간 우페중엽증후군을 진단받고 정기적으로 추적조사가 가능하였던 환아들을 대상으로 임상소견, 검사결과, 치료방법 및 예후를 분석하여 객관적인 자료를 알아보고자 하였다. 방범 : 1988년 1월부터 1997년 6월까지 연세대학교 의과대학부속 세브란스병원 소아과에 입원하여 우폐중엽증후군을 진단 받고 치료받았던 환아 25명을 대상으로 나이, 성별, 과거력, 이학적 검사소견, 진단방법, 혈액검사소견, 치료방법 및 예후에 대하여 분석을 시행하였다. 우폐중엽증후군은 흉부 X-선 검사상 우폐중엽에 3회 이상의 폐침윤 소견을 보이고, 지속적인 무기폐증상을 동반 하지만 신경근육질환이나 만성 흡인성 폐렴에 의한 폐침윤은 배제한 경우로 진단기준을 정하였다. 결 과 : 1) 환아의 발생연령은 2개월에서 11세까지 였으며 6-10세 사이가 9례(36%)로 가장 호발하였고, 평균연령은 4년 9개월이었으며 남녀 성비는 1:1.1로 비슷하였다. 발생시기는 비교적 고르게 분포하였으나 3-6월에 13례(52%)로 호발 하였다. 2) 주중상으로는 기침이 전래에서 보였고, 객담이 20례(80%), 발열이 16례(64%)로 호흡기 감염이 주중상이었고, 호홉곤란 3례, 구토 1례 둥이 있었으며, 입원시 이학적 소견으로는 거친 호흡음 20례(80%), 수포음 11례(44%), 천명음 3례(12%), 흉부함몰 2례(8%)의 순서를 보였다. 3) 흉부 방사선상소견은 페 고형질화 17례(68%), 폐 침윤소견 14례(56%), 무기폐 12례(48%), 기관지확장증 2례(8%) 및 기관지 공기조영 2해(8%) 등 이었다. 4) 진단방법은 단순 흉부 X-선 검사 외에 전산화 단층 촬영 6례, 기관지조영술 5례였으며 최근에는 전산화 단층 촬영이 증가된 소견을 보였다. 5) 폐렴과의 연관관계는 12례(48%)에서 3회이상 폐렴으로 입원치료 받았고, mycoplasma폐렴은 6례(24%)에서 동반되었고, 알fp르기성질환은 6례(24%)에서 있었고, 2례에서 선천성 기형이 동반되었다. 6) 대상환아의 평균 입원기간은 12일 이었고 6-10일이 9례로 가장 많았다. 치료로는 극막삼출소견을 보인 6례중 2례에서 폐쇄성 흡관삽입술을 시행받았을 뿐 수술적 방법은 실시하지 않았으며, 항생제 투여 및 보존적인 치료만으로 대부분의 경우 임상적으로 호전되었다. 7) 재발은 추적 조사한 결과 1례에서 관찰되었고 외래에서 추적관찰이 가능하였던 24례에서 예후가 양호하였으며 악성으로 진행된 예는 없었다. 결 론 : 소아에서 우폐중엽증후군을 진단받았던 환아 25례에서 종양이나 결핵과 같은 외인성 압박에 의한 경우는 흔하지 않은 것으로 추정되며, 천식이나 반복성 폐렴에 의한 경우가 대부분으로 적절한 항생제 투여 및 보존적인 치료로 호전가능하며 비교적 예후가 좋은 질환으로 나타났다. Purpose : Right middle lobe syndrome is characterized by a spectrum of disease from recurrent atelectasis and pneumonitis to bronchiectasis of the Right middle lobe syndrome. It was first reported by Graham describing 12 patients with middle lobe atelectasis and bronchiectasis due to enlarged lymph nodes. The incidence of Right middle lobe syndrome seems to be increasing in children, but there have been only a few studies of right middle lobe syndrome in Korea. Methods : Twenty-five children with RMLS who had been admitted during the last 10 years were evaluated with particular attention to clinical features, laboratory results, bronchographic findings, and treatment. Results : All patients were symptomatic and complained of chronic cough(25), sputum(20), fever(16), dyspnea(3), vomiting(2), and foreign body in the bronchus(2). Most of the patients had recurrent pneumonia: 6 patients had Mycoplasma pneumonia, and 6 patients had asthma and allergic disorders. Only 5 out of the 25 patients showed sufficient obstruction on bronchography and 6 patients took computed tomography scans. Chest radiography, bronchography and computed tomography scans were evaluated for review in 25 patients showing consolidation(17), patchy infiltration( 14), atelectasis(12), hyperinflation (5) bronchiectasis(2), and air bronchogram(2). Most patients were improved by conservative medical management and only 2 patients had closed thoracostomy. Conclusion : These 25 patients who had been diagnosed as Right middle lobe syndrome were improved after 2 week` treatment of antibiotics and conservative management, and their prognosis were good during the follow-up period.