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Purpose Chronic urticaria (CU) is a common and debilitating disease, and the need for effective treatment has increased. Omalizumab may be an alternative regimen in patients with CU who do not respond to conventional treatments. The aim of this study is to investigate the efficacy and to observe the clinical results of omlizumab in patients with refractory CU. Methods We conducted a retrospective analysis of 26 patients with refractory CU who were treated with omalizumab. Omalizumab was administered every 2 or 4 weeks, depending on body weight and the total serum IgE level, for 24 weeks. Results Fourteen patients (53.8%) achieved remission after the treatment; they had a significantly higher prevalence of personal (P=0.033) and family history of allergic diseases (P=0.002) than those who did not achieve remission. During omalizumab treatment, the urticaria activity score declined significantly (12.11±1.97 to 2.7±4.23; P=0.001) and the CU-quality of life score improved significantly (34.65±13.58 to 60.88±11.11; P=0.004). There were significant decreases in the use of systemic steroids (42.3%-11.5%; P=0.027) and immunomodulators (65.4%-19.2%; P=0.002). The dose of antihistamines required to control CU also decreased significantly (215.66±70.06 to 60.85±70.53 mg/week of loratadine equivalents; P<0.001). No serious adverse event was noted. Conclusions These findings suggest that omalizumab can be an effective and safe treatment in patients with refractory CU. Keywords: Chronic urticaria, refractory, omalizumab.
This paper aims to examine the social roles of culture and arts spaces reusing closed schools. To this end, the case of ‘Nori-maru' in Busan which is a culture and arts education center and ‘3331 Arts Chiyoda' in Tokyo which is culture and arts complex as well as the center of local community activities were analyzed. Both were created by remodeling closed schools located in downtown. The two spaces were respectively reviewed in the way of creation, operation system, projects and main functions. As a result, the social roles of culture and arts spaces reusing empty spaces including closed schools in cities were identified in three categories; securing publicness and recovering local community, enforcing local centripetal tendency and leading local culture and arts development, diffusing culture and arts value and culture and arts education. To exist and perform these roles successfully in local society for culture and arts spaces reusing closed schools, it is necessary to change the awareness of publicness from the notion of official thing by government institutions based on proprietary rights to the idea of common and open thing by members of the local society based on their voluntary participation. Further, knowing how to contribute to the local society as the station of community activities and local culture and arts development is also required. 이 논문에서는 폐교를 활용한 문화예술 공간의 사회적 역할을 고찰해 보고자 도심지 폐교를 문화예술교육 공간으로 활용하고 있는 부산 ‘놀이마루'와 복합문화예술 공간이자 커뮤니티 활동 거점 공간인 도쿄 ‘3331 아트 치요다'의 사례를 분석하였다. 두 공간의 조성방식, 운영방식, 주요 기능, 사업을 종합적으로 비교 분석한 결과를 바탕으로, 폐교를 활용한 문화예술 공간의 주된 역할을 공공성과 지역 커뮤니티 회복, 지역구심주의의 강화와 지역문화 발전 견인, 문화예술가치와 교육의 확산이라는 세 가지 측면에서 규명하였다. 폐교와 같은 도시의 빈 공간을 활용한 문화예술 공간이 지역 사회에 존속하면서 이러한 역할을 성공적으로 수행하기 위해서는 소유권을 기반으로 한 공적인 개념의 공공성에서 나아가 구성원의 자발적 참여를 기반으로 한 공동성과 개방성으로서의 공공성 확보가 필요하다. 아울러 커뮤니티 활동, 지역문화 발전을 위한 거점 공간으로서 지역사회에 어떻게 기여할 것인지에 관한 인식도 요구된다.
Purpose: Cefaclor, a second-generation oral cephalosporin, is known to cause IgE-mediated hypersensitivity. Assays of serumspecificIgE (sIgE) to cefaclor are commercially available via the ImmunoCAP system (Thermo Fisher Scientific). While serumlevels of sIgE >0.35 kU/L are considered indicative of an allergy, some patients with cefaclor allergy show low serum IgE levels. This study aimed to evaluate the proper cut-off levels of sIgE in the diagnosis of immediate hypersensitivity to cefaclor. Materials and Methods: A total of 269 patients with drug allergy history, who underwent assays of sIgE to cefaclor at Ajou Universityhospital and Dong-A University Hospital, were reviewed retrospectively. Among them, 193 patients exhibited cefaclor-inducedimmediate hypersensitivity with certain or probable causality of an adverse drug reaction according to the WHO-UMC (theWorld Health Organization–the Uppsala Monitoring Centre) algorithm, and 76 controls showed delayed hypersensitivity reactionsto non-antibiotics. Results: In total, 126 of the 193 patients (65.3%) experienced anaphylaxis; they had higher serum sIgE levels than patients withimmediate hypersensitivity who did not experience anaphylaxis (6.36±12.39 kU/L vs. 4.28±13.61 kU/L, p<0.001). The best cut-offvalue for cefaclor-induced immediate hypersensitivity was 0.11 kU/L, with sensitivity of 80.2% and specificity of 81.6%. A cut-offvalue of 0.44 kU/L showed the best sensitivity (75.4%) and specificity (65.7%) for differentiating anaphylaxis from immediate hypersensitivityreactions. Conclusion: Patients with cefaclor anaphylaxis exhibit high serum IgE levels. A cut-off value of 0.11 kU/L of sIgE to cefaclor isproper for identifying patients with cefaclor allergy, and 0.44 kU/L may be useful to detect anaphylaxis.
Hydroxyapatite is commonly used as a filler to replace amputated bone or as a coating to promote bone ingrowth into prosthetic implants. Many modern implants, such as hip replacements and dental implants, are coated with hydroxyapatite. We report a patient with occupational asthma due to hydroxyapatite, proven by a specific inhalation challenge, who experienced an early asthmatic reaction after exposure to hydroxyapatite, without increased airway responsiveness to methacholine despite an increased eosinophil count in the peripheral blood. A 38-year-old male dental implant worker visited our allergy department for the evaluation of occupational asthma. He had treated dental implant titanium surfaces with hydroxyapatite for 1.5 years. One year after starting his employment, he noticed symptoms of rhinorrhea, paroxysmal cough, and chest tightness. His symptoms were aggravated during and shortly after work and subsided several hours after work. When he stopped working for 2 months because of his chest symptoms, he became asymptomatic. After restarting his work, his symptoms reappeared and were aggravated. A methacholine bronchial challenge test had a negative response. The following day, a specific bronchial provocation test with wheat powder was negative. On the third day, a specific bronchial provocation test with hydroxyapatite powder produced an early asthmatic response. On the fourth day, a methacholine bronchial challenge test was negative. Further studies are needed to evaluate the exact pathogenetic mechanism of hydroxyapatite-induced occupational asthma.