Prognostic Factors for Chronic Spontaneous Urticaria: A 6-Month Prospective Observational Study

Ye, Young-Min,Park, Jung-Won,Kim, Sang-Ha,Ban, Ga-Young,Kim, Ji-Hye,Shin, Yoo-Seob,Lee, Hyun-Young,Park, Hae-Sim The Korean Academy of Asthma, Allergy and Clinical 2016 Allergy, Asthma & Immunology Research Vol.8 No.2

<P><B>Purpose</B></P><P>Chronic urticaria (CU) has a substantial impact on the quality of life. Little clinical data on the prognosis of CU has been reported. This study aimed to investigate the control status and remission rate of CU and to explore potential predictors of good responses to the treatment during a 6-month treatment period.</P><P><B>Methods</B></P><P>A total of 75 patients with chronic spontaneous urticaria (CSU) were enrolled from 3 university hospitals in Korea. Urticaria control state was classified into 2 groups: group I (remission and well-controlled) and group II (partly and uncontrolled). CU-specific quality of life (CU-QoL) and the urticaria activity score (UAS) were measured before and after the treatment. Autologous serum skin test (ASST), and anti-nuclear and anti-thyroid antibodies were measured at the enrollment into the study. Aspirin intolerance was confirmed by an oral provocation test.</P><P><B>Results</B></P><P>Of 59 patients completing the study, 21 (35.6%) arrived at well-controlled status and only 2 (3.4%) achieved remission, whereas 26 (44.1%) remained at partly controlled status and 10 (16.9%) were at uncontrolled status. Mean changes in CU-QoL (36.5±2.7 vs 20.6±4.3, <I>P</I>=0.017) and UAS (-7.9±0.8 vs -3.0±1.0, <I>P</I>=0.001) were significantly different between groups I and II. The presence of serum autoantibodies and aspirin intolerance had no influence on the control of urticaria in this study. However, ASST positivity was identified as a significant predictor of CU control in multivariate analysis (OR=6.106, <I>P</I>=0.017).</P><P><B>Conclusions</B></P><P>The proportion of CSU patients that achieved remission or a well-controlled state was 39% for the 6 months of stepwise treatment. Longer observations are necessary to assess the exact prognosis of CSU. ASST results may be a useful parameter for predicting a better response to treatment and both UAS and CU-QoL are helpful to monitor therapeutic response.</P>

Bovine Lactoferricin Induces Intestinal Epithelial Cell Activation through Phosphorylation of FAK and Paxillin and Prevents Rotavirus Infection

( Ye Young Jeong ),( Ga Young Lee ),( Yung Choon Yoo ) 한국미생물 · 생명공학회 2021 Journal of microbiology and biotechnology Vol.31 No.8

We investigated the effect of bovine lactoferricin (Lfcin-B), a peptide derived from bovine lactoferrin, on activation of intestinal epithelial cells in IEC-6 intestinal cell, and protection against in vivo rotavirus (RV) infection. Treatment with Lfcin-B significantly enhanced the growth of IEC-6 cells and increased their capacity for attachment and spreading in culture plates. Also, Lfcin-B synergistically augmented the binding of IEC-6 cells to laminin, a component of the extracellular matrix (ECM). In the analysis of the intracellular mechanism related to Lfcin-B-induced activation of IEC-6 cells, this peptide upregulated tyrosine-dependent phosphorylation of focal adhesion kinase (FAK) and paxillin, which are intracellular proteins associated with cell adhesion, spreading, and signal transduction during cell activation. An experiment using synthetic peptides with various sequences of amino acids revealed that a sequence of 9 amino acids (FKCRRWQWR) corresponding to 17-25 of the N-terminus of Lfcin-B is responsible for the epithelial cell activation. In an in vivo experiment, treatment with Lfcin-B one day before RV infection effectively prevented RV-induced diarrhea and significantly reduced RV titers in the bowels of infected mice. These results suggest that Lfcin-B plays meaningful roles in the maintenance and repair of intestinal mucosal tissues, as well as in protecting against intestinal infection by RV. Collectively, Lfcin-B is a promising candidate with potential applications in drugs or functional foods beneficial for intestinal health and mucosal immunity.

Artificial Intelligence-Based Identification of Normal Chest Radiographs: A Simulation Study in a Multicenter Health Screening Cohort

Yoo Hyunsuk,Kim Eun Young,Kim Hyungjin,Choi Ye Ra,Kim Moon Young,Hwang Sung Ho,Kim Young Joong,Cho Young Jun,Jin Kwang Nam 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.10

Objective: This study aimed to investigate the feasibility of using artificial intelligence (AI) to identify normal chest radiography (CXR) from the worklist of radiologists in a health-screening environment. Materials and Methods: This retrospective simulation study was conducted using the CXRs of 5887 adults (mean age ± standard deviation, 55.4 ± 11.8 years; male, 4329) from three health screening centers in South Korea using a commercial AI (Lunit INSIGHT CXR3, version 3.5.8.8). Three board-certified thoracic radiologists reviewed CXR images for referable thoracic abnormalities and grouped the images into those with visible referable abnormalities (identified as abnormal by at least one reader) and those with clearly visible referable abnormalities (identified as abnormal by at least two readers). With AI-based simulated exclusion of normal CXR images, the percentages of normal images sorted and abnormal images erroneously removed were analyzed. Additionally, in a random subsample of 480 patients, the ability to identify visible referable abnormalities was compared among AI-unassisted reading (i.e., all images read by human readers without AI), AI-assisted reading (i.e., all images read by human readers with AI assistance as concurrent readers), and reading with AI triage (i.e., human reading of only those rendered abnormal by AI). Results: Of 5887 CXR images, 405 (6.9%) and 227 (3.9%) contained visible and clearly visible abnormalities, respectively. With AI-based triage, 42.9% (2354/5482) of normal CXR images were removed at the cost of erroneous removal of 3.5% (14/405) and 1.8% (4/227) of CXR images with visible and clearly visible abnormalities, respectively. In the diagnostic performance study, AI triage removed 41.6% (188/452) of normal images from the worklist without missing visible abnormalities and increased the specificity for some readers without decreasing sensitivity. Conclusion: This study suggests the feasibility of sorting and removing normal CXRs using AI with a tailored cut-off to increase efficiency and reduce the workload of radiologists.

Case Reports : A Case of Occupational Asthma Induced by Cleaning Agent

( Young Hee Nam ),( Hyun Jung Jin ),( Hye Soo Yoo ),( Yoo Seob Shin ),( Young Min Ye ),( Hae Sim Park ) 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.4

Background: Cleaning agents have an airway irritant effect. There have been few reports of occupational asthma induced by cleaning agents at workplace or at home. Chlorine, the most common chemical used in cleaning products, has a strong irritative effect on the airways. We experienced a case of occupational asthma caused by chlorine that developed in a health care worker. Case History: Eleven years later, she developed dyspnea and cough, which was aggravated after exposure to cleaning agent spray that released chlorine at workplace. Results: The patient was positive to 2 house dust mites on skin prick tests but negative to the cleaning agent. Methacholine bronchoprovocation tests showed a negative result; however, a specific bronchoprovocation test with exposure to the cleaning agent showed a positive response of more than 15% fall of forced expiratory volume in 1 second. There were no significant changes in sputum cell counts and exhaled nitric oxide levels after the specific bronchoprovocation test. Conclusion: To the best of our knowledge, this is the first case of occupational asthma caused by, chlorine, a cleaning agent that developed in a health care worker in Korea, which was confirmed by the specific bronchoprovocation test.

Oxygen Transfer and Shear Stress in CHO cell culture reactors

Ye Young YOO,Juno JANG,Ik-Hwan KIM 한국생물공학회 2011 한국생물공학회 학술대회 Vol.2011 No.4

Poster Session : PS 1489 ; Allergy : A Case of Eosinophilic Gastroenteritis Which Led to Malabsorption and Iron Defl ciency Anemia Associated with Multiple Food Allergies

( Young Soo Lee ),( Ga Young Ban ),( Ji Hye Kim ),( Dae Hong Seo ),( Young Min Ye ),( Yoo Seob Shin ),( Dong Ho Nahm ),( Hae Sim Park ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Eosinophilic gastroenteritis (EG) is a rare disease characterized by massive eosinophilic infiltration of gastrointestinal tissue, increased peripheral eosinophilia and nonspecific gastrointestinal symptoms. EG have no known causes for eosinophilia such as drug, parasite, or malignancy. About 50% of EG patients have allergic diseases suggesting EG may be associated with allergic status since some EG patients exhibit elevated serum immunoglobulin E (IgE) levels. We report a case of EG which led to severe malabsorption and iron deficiency anemia associated with multiple food allergies. A 28-yearold Caucasian male patient visited emergency room complaining general weakness and leg swelling for 2 months. He had allergic rhinitis and vomiting whenever eating eggs, steaks, and salmons. He looked chronically-ill and conjunctivae were pale. In laboratory findings, hemoglobin level and WBC count were 6.4g/dL and 7,400/uL with 24.4% of eosinophil fraction as well as serum total protein and albumin levels were 3.9g/dL and 2.8g/dL, respectively. Serum iron level (12μg/dL), total iron binding capacity (247μg/ dL), and ferritin level (2.2μg/L) were all decreased. Serum eosinophil cationic protein level was increased (30.0μg/L) whereas serum total IgE level was within normal reference value (77KU/L). Serologic tests for parasite were all negative. Endoscopic studies were performed to exclude gastrointestinal bleeding and multiple nodular lesions were seen on gastric antrum with increased eosinophil in. ltration in lamina propria. High serum specific IgE levels to offending foods (beef: 0.82kU/L, pork: 0.83kU/L, egg white: 0.40kU/L, egg yolk: 0.54kU/L, and milk: 0.81kU/L) were noted. He was recommended avoiding offending foods with oral prednisolone therapy. Six months after food restriction, eosinophil count was 400/uL and hemoglobin level was restored to 11.5g/dL with 4.1g/dL of serum albumin level. We report a rare case of eosinophilic gastroenteritis associated with multiple food allergies.

Real-World Incidence of Suboptimal Response to Anti-Tumor Necrosis Factor Therapy for Ulcerative Colitis: A Nationwide Population-Based Study

( Ju-young Shin ),( Hye-min Park ),( Min-young Lee ),( Ja-young Jeon ),( Hyun-jeong Yoo ),( Byong Duk Ye ) 대한간학회 2021 Gut and Liver Vol.15 No.6

Background/Aims: Although anti-tumor necrosis factor (TNF) agents have been widely used to treat ulcerative colitis (UC), the real-world incidence of suboptimal response to anti-TNF agents has not been thoroughly investigated, especially among Asians. Methods: Using the Korean National Health Insurance database, we collected data on UC patients who initiated anti-TNF agents between July 1, 2014, and June 30, 2017. We assessed suboptimal responses, including anti-TNF discontinuation or dose escalation, switching to other biologics, augmentation with a non-biologic therapy, and the requirement for colectomy. Results: A total of 1,268 patients were included as new anti-TNF users (infliximab 713, adalimumab 433, golimumab 122). The proportion of patients who experienced at least one suboptimal response within 1 year among all patients was 63.5%, including 59.1%, 69.5%, and 68.0% of patients treated with infliximab, adalimumab, and golimumab, respectively. The cumulative incidences of at least one suboptimal response over time were 41.5%, 63.7%, 80.5%, and 87.1% at 6, 12, 24, and 36 months, respectively. Cox proportional hazards modeling revealed that adalimumab was associated with a higher risk of at least one suboptimal response (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13 to 1.48), dose escalation (HR, 4.35; 95% CI, 2.97 to 6.38) and discontinuation (HR, 1.25; 95% CI, 1.03 to 1.52) than infliximab. Golimumab was associated with a higher risk of switching to other biologics than infliximab (HR, 1.78; 95% CI, 1.21 to 2.60). Conclusions: More than half of Korean UC patients had suboptimal responses to anti-TNF agents within 1 year. UC patients treated with infliximab might be less prone to suboptimal responses than those treated with adalimumab or golimumab. (Gut Liver 2021;15:867-877))

Clinical features of elderly chronic urticaria

( Ga Young Ban ),( Mi Yea Kim ),( Hye Soo Yoo ),( Dong Ho Nahm ),( Young Min Ye ),( Yoo Seob Shin ),( Hae Sim Park ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.6

Background/Aims: Chronic urticaria (CU) is defined as itchy wheals lasting 6 weeks or more. As the aged population increases worldwide, it is essential to identify the specific features of this disease in the elderly population. Methods: We investigated the prevalence and clinical features of CU in elderly patients. Medical records of 837 CU patients from the outpatient Allergy Clinic of Ajou University Hospital, Korea were analyzed retrospectively. Patients with chronic spontaneous urticaria according to the EAACI/GA2LEN/EDF/WAO guidelines were included. Patients older than 60 years were defined as elderly. Results: Of the 837 patients, 37 (4.5%) were elderly. In elderly versus nonelderly CU patients, the prevalence of atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, respectively; p = 0.022), while that of aspirin intolerance was lower (18.9% vs. 43.6%, respectively; p = 0.003) in terms of comorbid conditions. The prevalences of serum specific immunoglobulin E antibodies to staphylococcal enterotoxin A and staphylococcal enterotoxin B were considerably higher in elderly CU patients with AD than in those without AD (37.5% vs. 0%, respectively). Conclusions: Elderly patients with CU had a higher prevalence of AD. Therefore, there is a need to recognize the existence of AD in elderly CU patients.

Clinical features of elderly chronic urticaria

( Ga Young Ban ),( Mi Yea Kim ),( Hye Soo Yoo ),( Dong Ho Nahm ),( Young Min Ye ),( Yoo Seob Shin ),( Hae Sim Park ) 대한내과학회 2013 대한내과학회 추계학술발표논문집 Vol.2013 No.1

Background: Chronic urticaria (CU) is defined as itchy wheals lasting for at least 6 weeks, with or without angioedema. It is a common disabling disorder occurring in about 0.5-1% of the population. Recently, the aged population is increasing worldwide, and this group responds differently to environmental stimuli. Therefore, it is essential to identify the specific features of disease in aged group. Nevertheless, there have been few studies reporting the features about CU in the elderly population. We investigated the prevalence and clinical features of elderly CU in comparison with non-elderly CU in this country. Method: We retrospectively analyzed the medical records of 827 CU patients who were followed in the outpatient Allergy Clinic of Ajou University Hospital, South Korea. According to the EAACI/GA2LEN/EDF/WAO guideline, physical or other secondary types of urticarial patients were excluded, and chronic spontaneous urticarial patients were included. Elderly CU was defined as the CU patients older than 60 years old. Severe CU was defined when urticaria activity score was ≥13 at initial visit. Results: Of the total 827 patients, 37 (4.5%) were elderly. Among co-morbid conditions, atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, p=0.022), while prevalence of aspirin intolerance was lower (18.9% vs. 43.6%, p=0.003) in elderly CU. However, prevalence of severe CU was not significantly different between the two groups. Other clinical parameters such as sex, atopy and laboratory findings including anti-thyroid antibodies and serum specific IgE to staphylococcal superantigens were found to have no significant differences between the two groups. However the prevalences of serum specific IgE to staphylococcal enterotoxin A (SEA) and staphylococcal enterotoxin B (SEB) were significantly higher in elderly CU with AD than in those without AD (37.5% vs. 0%, respectively). Conclusion: Considering the higher prevalence of AD in elderly CU, it is needed to observe the coexistence of AD in elderly CU. Specific IgE to SEA/SEB may play a role in the pathogenesis of elderly CU, especially who are accompanied by AD.

만성 두드러기의 진단과 치료: 전문가 의견서

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.