Food allergies and food-induced anaphylaxis: role of cofactors

Shin, Meeyong The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.8

Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14%-18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This review aims to educate clinicians on recent developments in the role of cofactors and highlight the importance of recognizing cofactors in food allergies and food-induced anaphylaxis.

Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years

Lee, Jihyun,Shin, Meeyong,Lee, Bora The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.8

Background: Complementary food in infancy is necessary for human growth, neurodevelopment, and health. However, the role of allergen consumption in early infancy and its effects on the development of food allergy or tolerance remain unclear. Purpose: To investigate the influence of age at the time of complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. Methods: We combined data from the Korea National Health and Nutrition Examination Survey collected from 2010 to 2014 and analyzed 1619 children aged 1-3 years who were included in the survey. Multivariate regression analysis was used to identify associations among type of feeding, age at the time of complementary food introduction, and doctor-diagnosed atopic dermatitis and asthma. Results: Age at the time of complementary food introduction was not significantly associated with doctor-diagnosed atopic dermatitis and asthma in children aged 1-3 years. In the univariate analysis, children with asthma showed higher water and sodium intake levels than nonasthmatic children. However, this relationship was not significant in the multivariate regression analysis. Conclusion: The present study revealed no statistically significant relationship between age at the time of complementary food introduction and the risk of atopic dermatitis and asthma in young Korean children. A national prospective study is needed to clarify the influence of age at the time of complementary food introduction on the development of allergic diseases.

Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

You Hoon Jeon,Kangmo Ahn,김지현,Meeyong Shin,Soo-Jong Hong,So-Yeon Lee,Bok-Yang Pyun,Taek Ki Min,Minyoung Jung,Jeongmin Lee,송태원,Hye-Young Kim,Sooyoung Lee,Kyunguk Jeong,Yoon-Ha Hwang,Minji Kim,Yong Ju Le 대한의학회 2022 Journal of Korean medical science Vol.37 No.4

Background: Atopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea. Methods: AD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschoolonset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups. Results: A total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancyonset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group. Conclusion: This study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

소아에서 human metapneumovirus 감염의 최근 역학 및 임상 양상: 2011-2014

장명선 ( Myeong Sun Jang ),신미용 ( Meeyong Shin ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.5

Purpose: This study was performed to investigate the epidemiologic and clinical features of human metapneumovirus (hMPV). Methods: We performed real-time reverse transcription polymerase chain reaction with nasopharyngeal samples from 2,403 chil-dren who were hospitalized with acute respiratory infection. Then medical records of 120 children, who were diagnosed with hMPV respiratory infection between 2011 and 2014, were retrospectively analyzed retrospectively and compared to epidemiologic data on respiratory virus infection reported by Korea Centers for Disease Control and Prevention. Results: We detected 120 hMPV-positive cases out of 1,723 virus-positive specimens (7.0%), which prevailed mostly in spring be-tween March and May. Respiratory infection with hMPV was more common in female patients (55.0%) and hPMV infection was prevalent among children aged <5 years (80.8%). Coinfections with other respiratory viruses were observed in 34 patients of 120 hMPV-positive cases (28.3%), mostly with rhinovirus (52.9%). In addition, hPMV infection mostly presented with pneumonia (71.7%). Among 120 hMPV-positive patients during the recent 4 years, most (68.3%) were diagnosed in 2014. During 2011-2014, influenza virus infection was prevalent mainly from January to March, and hMPV infection started to appear just after the end of influenza vi-rus outbreak. Conclusion: In Korean children, hMPV was a common causative organism of viral pneumonia during the spring season. The hMPV infection pandemic was observed in 2014 and the clinical importance of hMPV has recently been increasing. Therefore, additional studies are required to define the epidemiology, disease characteristics caused by hMPV, and the cause of recent outbreak. (Allergy Asthma Respir Dis 2017;5:269-273)

Maternal Posttraumatic Stress Symptoms and Psychological Burden in Mothers of Korean Children With Anaphylaxis

Jeong Kyunguk,김지현,Chang Hyoung Yoon,Song Tae Won,Kim Jeong Hee,Shin Meeyong,Min Taek Ki,최선희,Lee Yong Ju,김경원,Kim Woo Kyung,Jeon You Hoon,Yum Hye Yung,Ahn Kangmo,Lee Sooyoung,Ahn Youngmin,Jang Gwang Che 대한천식알레르기학회 2022 Allergy, Asthma & Immunology Research Vol.14 No.6

Purpose: Anaphylaxis is a severe allergic reaction that is potentially life-threatening, but post-traumatic stress symptoms (PTSS) in the caregivers of children with anaphylaxis have not been evaluated. This study aimed to investigate the psychological burden on mothers of children with recent anaphylaxis. Methods: A total of 188 children with recent anaphylaxis was recruited from 13 hospitals in Korea. Validated questionnaires, including the Korean versions of the Beck Anxiety Inventory (K-BAI), the Beck Depression Inventory (K-BDI), and the Impact of Event Scale Revised-Korean version (IES-R-K), were used to evaluate maternal anxiety, depression, and PTSS. Results: The median ages of children and their mothers were 4 and 36 years, respectively. PTSS (IES-R-K ≥ 25) were identified in 56.9% of mothers, and 57.9% of them showed severe PTSS. The proportions of mothers who had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17) were 18.6% and 33.0%, respectively. Multivariable logistic regression analysis indicated that the patient’s history of asthma (adjusted odds ratio [aOR], 5.46; 95% CI, 1.17–25.59) and the presence of central nervous symptoms (aOR, 3.27; 95% CI, 1.07–9.96) were associated with PTSS. Age of 2 or older (aOR, 2.87; 95% CI, 1.10–7.52) and eggs, milk, or wheat as the cause of anaphylaxis (aOR, 2.87; 95% CI, 1.10–7.52) increased the risk of severe PTSS. Conclusions: The rate of PTSS among mothers of children with recent anaphylaxis was high at 56.9%. Clinicians who care for pediatric anaphylaxis patients should be aware of the psychological burden on their caregivers.

Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study

Eun Lee,Dae Jin Song,Woo Kyung Kim,Dong In Suh,백혜성,Meeyong Shin,Young Yoo,Jin Tack Kim,Ji-Won Kwon,Gwang Cheon Jang,Dae Hyun Lim,Hyeon-Jong Yang,Hwan Soo Kim,Ju-Hee Seo,Sung-Il Woo,Hyung Young Kim,You 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.1

Purpose: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. Methods: This study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. Results: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. Conclusions: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.