Toluene diisocyanate 에 의한 천식 환자의 기도 점막내 transforming growth factor β1 의 발현 양상

이수걸(Soo Keol Lee),이선민(Sun Min Lee),함기백(Ki Baik Hahm),임현이(Hyun Ee Yim),박춘식(Choou Sik Park),김선신(Sun Sin Kim),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한천식알레르기학회 2001 천식 및 알레르기 Vol.21 No.3

Background and objective: There have been some reports on the expression of TGF β-an anti-inflammatory and fibrosing cytokine in airway mucosa of asthmatics. However, the ex- pression of TGF β1 in bronchial mucosa of TDI-induced asthma is not known. The aim of this study was to observe immunolocalization of TGF β1 in airway mucosa of TDI-induced asthma. Methods: TGF β1 expressions were compared using immunohistochemistry in bronchial muco- sa from 22 subjects with TDI-induced asthma (group I: 10 newly diagnosed, group II: 12 subjects with persistent asthma symptoms for more than 4 years after diagnosis), and 8 non- asthmatics undergoing pneumonectomy from lung tumor. The distribution and intensity of expression were analyzed by two observers in four areas of bronchial tissue-epithelium(EP), vascular endothelium(VE), smooth muscle(SM), and mucous glands(MG). Results: Positive rates of TGF β1 expression for groups Ⅰ and Ⅱ in the four areas were as follows; EP (50% vs 100%, p<0.05), VE(40% vs 100%, p<0.05), SM(33.3% vs 100%, p<0.05), and MG(66.7% vs 80%, p>0.05). Grades of TGF β1 expression of EP, VE, and SM were significantly higher in group II than in group I(p<0.05, respectively). There was no significant difference in distribution and intensity of TGF β1 expression between TDI-induced asthma and controls(p>0.05, respectively). Conclusion: TGF β1 expressions of EP, VE, SM and MG were noted in airway mucosa of TDI-induced asthma and expressions of EP, VE, and SM were more intense and frequent in patients with persistent asthma symptoms. (J Asthma Allergy Clin Immunol 21: 500-507, 2001)

증례 / 카레가루에 의한 직업성 천식 및 비염 1례

이수걸(Soo Keol Lee),조재웅(Jae Woong Cho),김선신(Sun Sin Kim),손지웅(Jee Woong Sohn),정기석(Ki Suck Jung),김익태(Ic Tae Kim),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한천식알레르기학회 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 IgG. in pathogenesis of bronchoconstriction in curry powder- induced asthma. (J Asthma Allergy Clin Immunol 20: 655-660, 2000)

여러가지 한약재에 감작된 직업성 천식 1예

이수걸(Soo Keol Lee),서정희(Jung Hee Seo),조현경(Hyeon Kyeong Cho),김선신(Sun Sin Kim),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한내과학회 2000 대한내과학회지 Vol.59 No.2

There have been a few cases of occupational allergy caused by herb materials. In this study, we report a case of occupational asthma and rhinitis sensitized by six kinds of herb materials-Ostericum (Kangwhal), Angelica (Danggui), Cnidium (Chunkung), Pinellia (Banha), Zingerber (Kunkang) and Discoreae (Sanyak) in a pharmacist working at a pharmacy. The patient had shown negative responses to 80 common inhalant and food allergens, but strong positive responses to six herb material extracts, Kangwhal, Danggui, Chunkung, Banha, Kunkang and Sanyak, were noted on skin-prick test. Bronchoprovocation test showed a dual asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha and Sanyak were detected by enzyme-linked immunosorbent assay (ELISA) with no specific IgE binding to Kangwhal, Danggui and Kunkang extracts. In order to further characterize the allergic components of these three extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. One IgE binding components (60 kDa) were detected within Chunkung extract, two (10, 25 kDa) in Banha and four (33, 34, 65, 98 kDa) in Sanyak. It is suggested that Chunkung, Banha and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker. Further studies are needed to investigate the pathogenic mechanisms induced by Kangwhal, Danggui and Kunkang. (Korean J Med 59:213-219, 2000)

증례 / 일본 삼나무 분진에 의한 작업성천식 1례

이수걸(Soo Keol Lee),서정희(Jung Hee Suh),김선신(Sun Sin Kim),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.2

Inhalation of wood dust can cause immediate and/or late onset asthma, and the number of differeut kinds of wood responsible for such reactions is increasing. We report a patient with asthma induced by exposure to the dust of Japanese cedar wood (Cryptomeria japonica). A 30- year-old man developed rhinorrhea, sneezing and coughing, 6 years prior to admission. For the past 8 years, he had been involved in interior decoration of kitchen and sauna room using wood. Total peripheral eosinophil count was 600/mm3 and serum total IgE level was 505 IU/ml. Allergy skin prick test showed negative responses to 80 common inhalant and food allergens. Skin prick test to Japanese cedar wood dust extract showed negative response. Bronchoprovocation test with Japanese cedar wood dust extract (1:10 w/v) showed dual asthmatic response. Specific IgE and IgG4 antibodies to Japanese cedar wood dust extract were not detectable by ELISA. Serum neutrophil chemotactic assay using patients serum collected during bronchoprovocation test showed increased neutrophil chemotactic activity at 4 hr. In conclusion, non-IgE mediated mechanism may be involved in pathogenesis of Japanese cedar wood dust-induced asthma. Further studies will be needed to investigate the pathogenetic mechanism.

Toluene diisocyanate (TDI ) 에 의한 천식 환자에서 transforming growth factor β1 ( TGFβ1 ) 과 TGFβ receptor II ( R II ) 의 발현 정도와 지속적인 천식 증상과의 관계

이수걸(Soo Keol Lee),이선민(Sun Min Lee),함기백(Ki Baik Hahm),임현이(Hyun Ee Yim),김선신(Sun Sin Kim),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한내과학회 2001 대한내과학회지 Vol.61 No.6

Background: The underlying mechanism to explain the poor prognosis of TDI-induced asthma is unknown. We performed this study to evaluate the role of TGFβ1 and its receptor, TFGβ receptor II (RII) in TDI-induced asthma. Methods : We applied immunohistochemistry with monoclonal antibodies to TGFβ1 and RII in bronchial mucosa from 22 subjects with TDI-induced asthma (group I: 10 newly diagnosed, group II: 12 subjects with persistent asthma symptoms for more than 4 years after diagnosis) and 8 non-asthmatics undergoing pneumonectomy from lung tumor. The expression was analyzed in 4 areas of bronchial tissue-epithelium (EP), vascular endothelium (VE), smooth muscle (SM), mucous gland (MG). The grade of intensity was presented from 0 to 3. Subepithelial basement memberane (SBM) and submucosal extracellular matrix (SECM) thickness were measured using an image analyzer. Serum specific IgE and IgG antibody levels to TDI- human serum albumin (HSA) conjugate were detected by ELISA. Results : Grade of TGFβ1 expression was significantly higher in EP, VE and SM in group II than those of group I of TDI-induced asthma (p<0.05 respectively), with significant difference in SM only inRII expression. SBM and SECM thickness of TDI-induced asthma were significantly higher than those of non-asthmatics (p<0.05, respectively), while there was no significant difference between group I and II (p>0.05). Significant correlations were noted between asthma duration after diagonsis and intensity of TGFβ1 expression in EP, VE and SM (p<0.05, respectively), with no significant correlations with RII expression (p>0.05). TGF 1 expression was significantly higher in EP, VE and SM in subjects with specific IgG antibody to TDI-HSA than those without it (p<0.05). Conclusion : These findings suggest that TGFβ1 may contribute to develop persistent asthma symptoms in TDI-induced asthma.(Korean J Med 61:623-633, 2001)

점박이응애 ( Tetranychus urticae )알레르겐 성분 규명 및 집먼지진드기와의 교차항원성 연구

이수걸(Soo Keol Lee),지영구(Young Koo Jee),김윤근(Yoon Keun Kim),서정희(Jung Hee Suh),이명현(Myung Hyun Lee),박해심(Hae Sim Park) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.6

Background: The Tetranychus urticae (TU) is commonly found on fruit trees and green house flowers. A recent investigation demonstrated that the sensitization rate to TU was as high as that of HDM in respiratory allergy patients in middle part of South Korea. Material and methods : To identify IgE binding components within TU, sera from 8 TU-sen- sitive asthmatic patients and sera from unexposed controls showing negative response to TU on skin prick test were enrolled. SD5-PAGE and immunoblot analysis were applied. To evaluate cross-allergenieity with house dust mite (HDM) two kinds of serum pool were used: one (A) showing isolated positive response to TU and the other (B) showing positive responses to both TU and HDM. ELISA inhibition tests using sera A and B were were used. Results : TU-ELISA inhibition test using serum pool A showed significant inhibition with TU and CRM and minimal inhibition with HDM, while ELISA inhibition test using serum pool B showed significant inhibition with addition of TU and CRM and partial inhibition with HDM. Immunoblot analysis using individual sera showed six IgE binding components (75, 56, 41, 37, 28, 14 kDa) and three (75, 41, 14 kDa) were bound to IgE in more than 50% of sera tested. Conclusions : Six IgE binding components were identified within TU and three (75, 41, 14 kDa) could be considered major allergens. Extensive cross-allergenicity was noted between TU and CRM TU-derived extracts contain TU-specific addition to common sharing allergens with HDM. Further investigations will be needed to identify species-specific, or common allergenic components within TU. (J Asthma Allergy Clin Immunol 20: 879-86, 2000)

의료인에서 발생한 췌장 추출물 흡입에 의한 직업성 천식

이수진(Soo Jin Lee),김희연(Hee Yeon Kim),서유진(Yu Jin Suh),김선신(Sun Sin Kim),이수걸(Soo Keol Lee),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.2

Background and objective : Porcine pancreatic extracts (PPE) are composed of a-amylase, lipase, and protease which are common components of digestives. PPE are known to cause occupational asthma in pharmaceutical workers, but there has been no report of PPE-induced occupational asthma in medical personnel. The aims of this study were to document the rate of sensitization to PPE and the prevalence of PPE-induced occupational asthma in nurses exposed to PPE and to identify possible immunological pathogenic mechanisms. Subjects and method: A clinical questionnaire on bronchial asthma and allergic rhinitis was distributed among 56 nurses working in the medical ward of Ajou University Hospital. Then, allergy skin prick tests were done with PPE and a battery of eight common inhalant allergens. The determination of specific IgE antibodies to PPE, α-amylase, and lipase was performed by ELISA. The nurses with respiratory symptoms and positive skin tests to PPE underwent methacholine inhalation test and bronchial provocation test with PPE. Results. Of the 56 nurses, five (8.9%) had symptoms suggestive of bronchial asthma, and six (10.7%) had nasal symptoms suggestive of allergic rhinitis. Of these nurses, four (7.1%) had positive results on bronchial provocation test with PPE and proved to have PPE-induced occupational asthma. The prevalences of specific IgE to PPE and a-amylase were significantly higher in patients with positive skin tests (p<0.05). The prevalence of specific IgE to lipase was not significantly different between skin test positive and negative groups (p) 0.05). The prevalences of specific IgE to PPE and a-amylase were significantly higher in patients with respiratory symptoms(p<0.05), and four subjects with PPE-induced asthma had high specific IgE antibody to a-amylase, while specific IgE to lipase values were not significantly different between patients with respiratory symptoms and those without symptoms (p>0.05). Conclusion : These results support the view that inhalation of a-amylase within PPE powder may induce occupational asthma by IgE mediated reaction in exposed medical personnel.

스티븐슨-존슨 증후군 및 독성 표피 괴사용해증 환자에서 고용량 면역글로불린 치료

이수미 ( Soo Mi Lee ),엄수정 ( Soo Jung Um ),이수걸 ( Soo Keol Lee ),김기호 ( Ki Ho Kim ),김영훈 ( Young Hoon Kim ),손춘희 ( Choon Hee Son ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.4

Background: There have been some uncontrolled studies on clinical efficacy of high-dose intravenous immunoglobulin (IVIG) in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Objective: This study was conducted to demonstrate the effectiveness of high-dose IVIG therapy in reducing mortality in Korean patients with SJS or TEN. Method: Retrospective data from 2 patients with SJS, 4 patients with SJS/TEN and 3 patients with TEN treated with high-dose IVIG were analyzed. Result: The total dose of IVIG administered was 1.0 gm/kg/day from 2 days to 1.0 gm/kg for 7 days. Of the 8 patients who showed good responses to IVIG, the mean time to objective responses was 2.0±1.4 days (range, 1 to 5 days). The length of stay in hospital was 22.8±9.2 days (range, 11 to 40 days). Two patients had poor outcomes. Based on the SCORTEN system, 3.2 patients (39.9%) were expected to die, but 2.0 patients (25.0%) died. However, there was no statistical significance (P>0.05). Conclusion: Therapy with high-dose IVIG showed a slightly improved mortality in patients with SJS, SJS/TEN overlap and TEN, but there was no statistical significance (P>0.05). Although dramatic clinical improvement was noted in most patients, further nationwide multicenter clinical trials are required to evaluate the effectiveness of high-dose IVIG in the treatment of patients with SJS or TEN. (Korean J Asthma Allergy Clin Immunol 2009;29:256-261)

알레르기 질환 환자에서 점박이응애에 대한 감작률 , 특히 IgE 항체 양성률 및 알레르겐 성분 규명

이영목(Young Mok Lee),박해심(Hae Sim Park),이명현(Myung Hyun Lee),김윤근(Yoon Keun Kim),최정희(Jeong Hee Choi),조현경(Hyeon Kyeong Cho),김현아(Hyun A Kim),이재천(Jae Chun Lee),문희범(Hee Bom Moon),이수걸(Soo Keol Lee) 대한천식알레르기학회 2002 천식 및 알레르기 Vol.22 No.1

N/A

흉막 결핵에 병발된 흉막 Mantle 세포 림프종 1 예

이현수(Hynu Su Lee),이수걸(Soo Keol Lee),장광열(Kwang Yul Chang),최익수(Ik Soo Choi),손춘희(Choon Hee Son),김재석(Jae Seok Kim),정진숙(Jin Sook Jeong),노미숙(Mee Sook Roh),한진영(Jin Yeong Han),이기남(Ki Nam Lee),최필조(Pill Jo Choi) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

Mantle cell lymphoma is relatively rare and generally difficult to differentiate from other types of lymphoma. The clinical course is very aggressive. We recently experienced a very rare patient with pleural mantle cell lymphoma associated with pleural tuberculosis. A 60-year-old female patient was admitted because of dyspnea. Chest films revealed pleural effusion. Analysis of pleural effusion was not diagnostic, but we started therapeutic trial for tuberculosis. After 2 months of anti-tuberculosis medication, the pleural effusion was not improved. We repeated pleural biopsy. Histologic finding was chronic inflammation but AFB culture was positive. After another 3 months of medications for tuberculosis, there was no improvement. We repeated pleural biopsy and thoracentesis. Repeated biopsy and the result of flow cytometry of pleural effusion were consistent with mantle cell lymphoma. We started chemotherapy for lymphoma. After three cycles of chemotherapy, pleural effusion was decreased, but she worsened and died of hepatic failure probably due to viral hepatitis.(Korean J Med 62:469-474, 2002)