유도객담검사를 통해 분류된 저과립구 천식 환자군의 임상 양상 및 의의

심다운,유지은,고영일 대한 소아알레르기 호흡기학회 2023 Allergy Asthma & Respiratory Disease Vol.11 No.4

Purpose: Asthma phenotypes are often defined by relative cell counts of airway granulocytes. Induced sputum test results enable clinicians to determine the inflammatory phenotype of asthma based on the eosinophil and neutrophil counts. This study aimed to investigate clinical characteristics of patients with asthma according to the inflammatory phenotype of their condition. Methods: Data from 107 patients with asthma reported at a single tertiary allergy center in Korea during October 2016 to January 2019 were obtained. Patients were categorized into 4 asthma phenotypes based on the cell counts on the induced sputum test: eosinophilic, neutrophilic, mixed, and paucigranulocytic types. Blood eosinophil count, total IgE level, eosinophil cationic protein, spirometric measurements, fractional exhaled nitric oxide, atopy based on the skin prick test, PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second) in methacholine provocation test, type of asthma controller used, frequency of exacerbation, and use of systemic corticosteroids were examined. Results: The frequency of phenotype is as follows: eosinophilic (21.4%), neutrophilic (34.8%), mixed (13.4%), and paucigranulocytic types (30.4%). During the observation period, the proportion of patients who experienced an exacerbation and received systemic glucocorticosteroids were significantly lower in patients with the paucigranulocytic type of asthma than in those with the mixed type of asthma (6.3% vs. 40.0%; P=0.007 and 5.9% vs. 40.0%; P=0.004, respectively). Conclusion: Paucigranulocytic asthma may be associated with lower incidence rates of asthma exacerbation and systemic corticosteroid use than the other phenotypes, classified according to induced sputum test results.

약물알레르기

심다운 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

A Case of Type 2 Hereditary Angioedema With SERPING1 Mutation

심다운,박경희,이재현,박중원 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.1

Hereditary angioedema is a disease of congenital deficiency or functional defect in the C1 esterase inhibitor (C1-INH) consequent to mutation in the SERPING1 gene, which encodes C1-INH. This disease manifests as recurrent, non-pitting, non-pruritic subcutaneous, or submucosal edema as well as an erythematous rash in some cases. These symptoms result from the uncontrolled localized production of bradykinin. The most commonly affected sites are the extremities, face, gastrointestinal tract, and respiratory system. When the respiratory system is affected by hereditary angioedema, swelling of the airway can restrict breathing and lead to life-threatening obstruction. Herein, we report a case of a 24-year-old woman with type 2 hereditary angioedema who presented with recurrent episodic abdominal pain and swelling of the extremities. She had no family history of angioedema. Although her C4 level was markedly decreased (3.40 mg/dL; normal range: 10-40 mg/dL), she presented with a very high C1-INH level (81.0 mg/dL; normal range: 21.0-39.0 mg/dL) and abnormally low C1-INH activity (less than 25%; normal range: 70%-130%). The SERPING1 gene mutation was confirmed in this patient. She was treated with prophylactic tranexamic acid, as needed, and subsequently reported fewer and less severe episodes. To our knowledge, this is the first reported case of type 2 hereditary angioedema in Korea that was consequent to SERPING1 mutation and involved a significantly elevated level of C1-INH as well as a low level of C1-INH activity.

한국 프로기사의 法的 地位에 관한 연구

심다운,남치형 국제바둑학회(구 한국바둑학회) 2014 바둑학연구 Vol.11 No.1

두드러기의 진단과 치료

심다운 대한내과학회 2023 대한내과학회 춘계학술대회 Vol.2023 No.0

바둑진흥법의 실효성

심다운 국제바둑학회(구 한국바둑학회) 2023 바둑학연구 Vol.17 No.2

The Baduk Promotion Act, which was enacted for the purpose of contributing to the expansion of leisure opportunities for the people, the cultivation of healthy minds, and the globalization of Baduk, legally supported the policy of supporting the promotion of Baduk and the creation of Baduk culture, and prepared a legal basis for it. This has a significant meaning for Baduk community. However, in order for the law to be effective, it must be practiced in real society. Therefore, the purpose of this study is to examine the effectiveness of the Baduk Promotion Act enacted on April 17, 2018 for its legislative purpose. The results of examining the characteristics and limitations of the Baduk Promotion Act are as follows. First, there is an issue regarding the lack of clear definitions within the law for terms such as ‘Baduk instructor,’ ‘Baduk professional player,’ and ‘Baduk organization.’. Second, there is an issue concerning the term ‘special circumstances’ used in defining cooperation with relevant agencies, as it leaves room for various interpretations. Third, the provisions of the Baduk Promotion Act, which stipulate support policies such as funds, are meaningful in that they provide a legal basis for receiving financial support from the state budget. There is a problem that consists of regulations that are too comprehensive and abstract to be taken as a legal basis for materialization. Lastly, there is an issue within the content related to the cultivation and support of Baduk professional players, which may prioritize a sports policy focused on fostering elite athletes and elevating the national stature rather than aligning with the primary objectives set forth by the Baduk Promotion Act. Therefore, to enhance the effectiveness of the Go Promotion Act, it is necessary to enact legal provisions that specify clear criteria and procedures. Through such improvements, it is believed that effective support and development for the promotion of Go can be facilitated.

DRESS (drug reaction with eosinophilia and systemic symptoms) 증후군에 속발된 거대세포바이러스 재활성화 관련 독성표피괴사융해 1예

심다운,손세영,유지은,고영일 대한 소아알레르기 호흡기학회 2020 Allergy Asthma & Respiratory Disease Vol.8 No.1

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. Although viral reactivation is associated with DRESS syndrome, its role in TEN remains unclear. An 80-year-old woman visited our hospital because of fever and skin eruption. DRESS syndrome was diagnosed and was thought to caused by the use of the drug allopurinol. She was treated by discontinuation of the drug and administration of systemic steroids. She recovered from DRESS syndrome and was discharged from the hospital with tapering doses of steroids prescribed. One week after discharge, she visited our hospital again as the skin rash recurred and oral pain as well as oral and ocular mucosal lesions developed. In addition to the skin rash, blisters and Nikolsky’s sign that were different from the skin lesions present in the previous DRESS syndrome were observed. Unlike those in DRESS syndrome, the viral serological test results were positive for anti-cytomegalovirus (CMV) IgM and CMV polymerase chain reaction. Therefore, it was thought that TEN was due to reactivation of CMV and she was treated this with ganciclovir and intravenous immunoglobulin. Here, we report a case of TEN caused by viral reactivation after DRESS syndrome developed after use of allopurinol which recovered after steroid treatment. .

천식 환자에서 흡입용 스테로이드 장기 사용의 시상하부-뇌하수체-부신축 억제 효과

심다운 ( Da Woon Sim ),최인선 ( Inseon S Choi ),김승훈 ( Seung Hun Kim ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

성인 천식의 바이오마커와 맞춤의학

심다운 ( Da Woon Sim ),이재현 ( Jae Hyun Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1

The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma. (Allergy Asthma Respir Dis 2016;4:4-13)

천식 환자에서 흡입용 스테로이드 장기 사용의 시상하부-뇌하수체-부신축 억제 효과

심다운 ( Da Woon Sim ),최인선 ( Inseon S Choi ),김승훈 ( Seung Hun Kim ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.4

Purpose: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. Methods: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. Results: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; X2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. Conclusion: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.