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

심다운 ( Da Woon Sim ),최인선 ( In Seon Choi ),김승훈 ( Seung Hun Kim ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.5

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.

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)

잡초류 감작에 의한 성인 구강알레르기증후군 2예

이상철 ( Sang Chul Lee ),손영웅 ( Young Woong Son ),심다운 ( Da Woon Sim ),박경희 ( Kyung Hee Park ),이재현 ( Jae-hyun Lee ),박중원 ( Jung-won Park ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.6

Oral allergy syndrome (OAS) is caused by cross-reactivity between certain pollens and plant foods, including vegetables, nuts, or fruits. Here, we experienced 2 cases of OAS patients associated with mugwort pollinosis without sensitization to Fagales. A 54-year-old female repeatedly experienced skin rashes, perioral edema, nasal obstruction after eating fresh vegetables (celery, lettuce, chicory, radish sprouts, ginseng, etc.). She had suffered from allergic rhinitis worsening in autumn for 5 years. Specific IgE (sIgE) titers to ragweed and mugwort were elevated to 54.1 and 24.9 kU/L, respectively. With regard to the allergen component of pollens, sIgE to Art v 1 (mugwort) and Amb a 1 (ragweed) were elevated to 21.9 and 36.1 kU/L, respectively. Birch sIgE (including Bet v 1 and Bet v 2) was not detected. A 35-year-old male suffered from abdominal pain, skin rashes after eating mango and kiwi. In addition, systemic allergic reaction developed after consumption of tomato and ginseng. He had chronic rhinitis. The sIgE levels to ragweed, mugwort, and tomato were elevated to 0.55, 6.39, and 0.78 kU/L, respectively. The sIgE test results were all negative for Amb a 1, Bet v 1, and Bet v 2 sIgE. Specific IgE levels to Art v 1, Art v 2 sIgE were 3.51 and 4.46 kU/L, respectively. Based on the history and sIgE test results, 2 cases OAS were related to mugwort. We experienced 2 cases of weed pollinosis related to OAS. Culprit foods of OAS can vary depending on their cuisine cultures. (Allergy Asthma Respir Dis 2016:4:458-461)

단일 상급종합병원에서의 중대한 약물 유해반응의 임상 양상

서유리 ( Yuri Seo ),한예슬 ( Yeseul Han ),김수현 ( Soo Hyun Kim ),손은선 ( Eun Sun Son ),심다운 ( Da Woon Sim ),박경희 ( Kyung Hee Park ),박중원 ( Jung-won Park ) 대한내과학회 2017 대한내과학회지 Vol.92 No.4

목적: 약물 이상반응의 임상 양상에 대한 조사는 종종 실시되어 왔으나, 중대한 약물 이상반응에 대한 분석을 집중적으로 한 경우는 국내에서 현재까지 보고되지 않았다. 이에 중대한 약물 이상반응이 어떠한 임상 양상으로 발현되는지에 대해 구체적인 분석이 필요하다. 방법: 단일 3차 의료기관 지역의약품안전센터에서 수집한 자료를 바탕으로, 인과성 평가를 완료한 후 2012년 3월부터 2015년 11월까지 한국의약품 안전관리원에 보고한 사례 중에서 중대한 이상사례로 평가된 약물 부작용 사례(3,386사례)를 분석하였다. 결과: 계통별로 백혈구와 세망내피계가 511사례로 가장 많았고, 일반적인 약물 이상반응에서 높은 빈도를 차지하는 피부계통 병변과 소화기계 병변은 각각 296사례로 4번째, 216사례로 8번째였다. 단일 증상별로 백혈구감소증이 499사례(14.7%)로 가장 높았고, 저혈압이 444사례(13.1%), 그 다음이 아나필락시스 215사례(6.3%)였다. 백혈구감소증을 일으키는 약제 성분 중, 항종양제로 인한 경우가 대부분이었으나 piperacilin/tazobactam (28사례), vancomycin (10사례) 그리고 methimazole (6사례)가 상당수를 차지한 것은 주목할 만하다. 저혈압은 해열제로 흔히 사용되는 propacetamol 주사제로 인해 가장 많이 발생하였다(145사례). 아나필락시스는 경구 항생제인 cefaclor (19사례)가 가장 높았고, 그 다음이 ranitidine(12사례), 혼합비타민(9사례) 순이었다. 출혈 관련 질환이 전체 SADRs의 9.8% (332사례)를 차지하였다. 결론: 중대한 약물 이상반응의 임상 양상 및 원인 약제가 전체 약물에 인한 것과는 차이가 있었다. 항생제 및 methima-zole에 의한 백혈구감소증에 주의하고, propacetamol 주사제사용시 저혈압 발생 유무에 대해 주의 관찰이 필요하다. 또한, cefaclor, ranitidine, 혼합비타민제 등 일반적으로 흔히 사용되는 약제에 의한 중대한 약물 이상반응에 대해 경각심을 가져야 한다. Background/Aims: Several studies have reported on the clinical aspects of adverse drug reactions (ADRs). To date, no study has evaluated serious adverse drug reactions (SADRs) in Korea. The current study evaluates the clinical expression of SADRs in a Korean hospital. Methods: We reviewed a total of 3,386 cases of SADR occurring between March 2012 and November 2015 in a single tertiary care institution (Regional Pharmacovigilance Center). Results: When classified by organ system, the most common SADRs were white cell and reticuloendothelial system disorders (n = 511). Skin/appendage (n = 296) and gastrointestinal (n = 216) disorders were the fourth- and eighth-most common SADRs, respectively. The three most common single symptoms were leukopenia (n = 499 events), hypotension (n = 444) and anaphylaxis (n = 215). Leukopenia was mainly caused by anti-tumor drugs, followed by piperacilin/tazobactam (n = 28), vancomycin (n = 10) and methimazole (n = 6). Hypotension was most often caused by propacetamol injection (n = 145), while anaphylaxis was mainly caused by cefaclor (n = 19), ranitidine (n = 12), iopamidol (n = 10) and multi-vitamin infusion (n = 9). Conclusions: Significant differences were noted in the clinical aspects of ADRs and SADRs. Additional studies are warranted to further assess SADRs in response to frequently used causative drugs. (Korean J Med 2017;92:392-400)

사용 전 베타락탐 항생제 피부시험의 유용성에 대한 전문가 의견

김성렬 ( Sung-ryeol Kim ),김수정 ( Sujeong Kim ),김세훈 ( Sae-hoon Kim ),박종숙 ( Jong-sook Park ),박혜정 ( Hye Jung Park ),서동인 ( Dong In Suh ),심다운 ( Da Woon Sim ),양민석 ( Min Suk Yang ),이재현 ( Jae-hyun Lee ),이화영 ( Hwa 대한천식알레르기학회 2022 Allergy Asthma & Respiratory Disease Vol.10 No.1

An allergy skin test is used to diagnose certain allergies by identifying sensitized allergens. In other words, it is a test for patients who are already sensitized to certain allergens. Because of the prevailing perception that beta-lactam allergy can be dangerous and potentially lethal, the intradermal test has long been routinely performed before use to screen beta-lactam allergy in Korea. The prevalence of penicillin allergy is estimated to be 1% to 2%. However, only 14% of the subjects with perceived penicillin allergy is considered to have true penicillin allergy. Moreover, it is difficult to justify performing a skin test on subjects who are very unlikely to be sensitized to beta-lactam, such as those who never used beta-lactam or never experienced allergy after previous use of beta-lactam. Therefore, allergists recommend beta-lactam skin testing in those who have allergy after the use of beta-lactam. Nevertheless, many hospitals in Korea are conducting routine skin tests on patients regardless of a history of beta-lactam allergy, which are not clinically validated but consume considerable human and material resources. False-positive results can consequently result in inappropriate labeling of beta-lactam allergy, leading to the unnecessary restriction of medication prescriptions and the increase in medical expenses. Herein, the drug allergy working group affiliated with the Korean Academy of Asthma, Allergy, and Clinical Immunology announces an expert opinion on the preuse beta-lactam skin test for subjects without a history of beta-lactam allergy based on the objective evidence from the literature and clinical relevance. (Allergy Asthma Respir Dis 2022;10:3-8)