소아 아토피피부염에서 비타민 D의 역할

염혜영 ( Hye Yung Yum ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, with a prevalence of up to 15%-20% in children and 2%-10% in adults. Patients with AD have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Recently, there has been increasing awareness of the importance of vitamin D, a potential factor, in the development and progression of atopic diseases including AD. Furthermore, some reports suggested that vi￢tamin D deficiency impairs epithelial integrity, leading to increased and inappropriate mucosal exposure to antigens promoting sensitization. Even though numerous studies favor strong associations of vitamin D deficiency during pregnancy and infancy with allergies, high vitamin D intake might be harmful according to conflicting results of other trials. The growing body of the literature indicates an inverse relationship between the severity of AD and vitamin D levels. Animal studies, case reports, randomized clinical trials, and birth cohort studies have suggested that vitamin D may alleviate the symptoms of AD through immune-modulation of the innate and adaptive immune system. Moreover, some studies have shown that in individuals with AD with low vitamin D level, repletion of vitamin D results in decreased severity of diseases. However, all these results have prompted the question of which time, dose, duration, or mode of application of vitamin D might be appropriate in children with AD. Further large cohort studies and clinical trials are warranted to assess the role of vitamin D in the prevention and treatment of AD in children.(Allergy Asthma Respir Dis 2015;3:95-98)

아토피피부염 교육 프로그램을 통한 질병인지도 변화

염혜영 ( Hye Yung Yum ),한기옥 ( Ki Ok Han ),박지애 ( Ji Ae Park ),강미연 ( Mi Youn Kang ),장석일 ( Suk Il Chang ),조상헌 ( Sang Heon Cho ),편복양 ( Bok Yang Pyun ),나영호 ( Yeong Ho Rha ),김규한 ( Kyu Han Kim ),윤호주 ( Ho Joo Yo 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.1

Background: Education programs are essential in improving disease management and quality of life in patients with atopic dermatitis and their families by promoting disease knowledge. In these perspectives, the Seoul Atopy Asthma Education and Information Center has been established under the project ``Atopy-free Seoul`` by Seoul City since 2008. Our goal is an improvement in public health through development of education programs and counseling activities based on scientifically proven medicine. However, implementation and evaluation of effectiveness of education programs are needed to redeem configuration. The aim of this study was to determine the necessity of an education program of atopic dermatitis for optimal disease management. Methods: An education program for citizens was designed by the advisory organization of Korean Asthma Allergy Foundation. To evaluate the efficacy of the education program, 9 questionnaires about disease knowledge were developed. Participants were asked to answer the questionnaires and differences in the percentage of correct answers were compared before and after the program education. Results: In 5 sessions, 359 participants responded to the survey on disease knowledge before and after the education program. There was significant increase in the percentage of correct answers to 5 out of the 9 questions. This result proved that the education program was effective in improving the disease knowledge of atopic dermatitis. Conclusion: Significant improvement in disease knowledge after education of atopic dermatitis supports the need and feasibility of education programs for citizens. (Korean J Asthma Allergy Clin Immunol 2012;32:21-25)

알레르기 질환과 모유수유

염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

난치성 소아간질에서 Lamotrigine의 치료효과

염혜영(Hye Yung Yum),김영래(Young Rae Kim),차병호(Byung Ho Cha),이준수(Joon Soo Lee),고창준(Chang Jun Coe) 대한소아신경학회 1995 대한소아신경학회지 Vol.3 No.1

연구 배경 : 기존의 항경련제로 치료되지 않았던 난치성 간질 소아 간질에 있어서 lamotrigine의 치료 효과를 알아보고자 본 연구를 시행하였다. 방법 : 연세 의대 세브란스 병원 소아과에서 난치성 간질로 진단받은 환아 90명(남 59명, 여31명)에게 그동안 복용하던 항경련제는 그대로 복용하면서 lamotrigine을 추가로 복용하게 하고, 1개월 간격으로 발작의 빈도 및 부작용의 발현 여부를 추적 관찰하였다. 용량은 sodium valproate를 투약받고 있지않은 환아는 2주동안 1일 1회 1mg/kg를 투여 후 2-4주동안 2mg/kg를 하루 2회 투여한 후 점차 증량하였다. Sodium valproate를 투약받고 있는 환아는 2주동안 1일 1회 0.5mg/kg를 투여 후, 점차 증량하였다. 결과 : 전체 대상 환아 중 lamotrigine 추가 투여 후 발작 감소를 보인 환아는 65명(72.2%)이었고 그중 23명(25.6%)에서는 전혀 발작이 없었으며, 25명(27.8%)에서는 50%이상의 발작 감소를,17명(18.9%)에서는 50%미만의 발작 감소를 보였다. 발작의 유형에 따른 치료 결과는 50%이상의 발작 감소를 기준으로 할때 복잡 부분성 발작이 75%(3/4), 전신성 발작이 54.1%(33/61), Lennox-Gastaut 증후군이 54.5%(12/22), 미분류성 발작이 0%(0/3)로 나타났다. 투약 기간중 부작용이 관찰된 환아는 모두 4명(4.4%)이었다. 결론 : 소아 난치성 간질에 lamotrigine을 추가로 투여하여 좋은 효과를 관찰하였으며, 부작용은 매우 적었다. Background : This study was performed to observe the efficacy of lamotrigine in children with intractable epilepsy. Method : 90 patients who have been treated with known antiepileptic drugs Yonsei University College of Medicine Severance Hospital were reviewed. Lamotrigine was added on other antiepileptic drugs. The frequency of seizure attacks, and occurrence of adverse effects were monitored monthly at outpatient unit. Results : Approximately 70% of patients experienced reduction in seizure frequencies after medication of lamotrigine. The percentage of children who experivenced 50% or greater reduction in seizure frequency according to seizure types were 75% in complex partial seizure, 54.1% in generalized seizure, and 54.5% in Lennox-Castaut syndrome. Among them. 4 children had adverse effect. and stopped the medication. Conclusion : Lamotrigine add-on therapy seems to be effective in children with intractable epilepsy and adverse effects were trivial.

쌀과 저항원성 쌀 및 유전자 재조합 쌀의 알레르기 항원성의 비교

염혜영 ( Hye Yung Yum ),이경은 ( Kyung Eun Lee ),최성연 ( Sung Youn Choi ),양혜선 ( Hea Sun Yang ),손명현 ( Myung Hyun Sohn ),이상일 ( Sang Il Lee ),박혜경 ( Hye Kyung Park ),박선희 ( Sun Hee Park ),이순호 ( Soon Ho Lee ),이우영 ( 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2005 Allergy Asthma & Respiratory Disease Vol.15 No.2

천식의 만성기도개형에서 섬유아세포성장인자와 그 수용체의 역할

염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회 2006 Allergy Asthma & Respiratory Disease Vol.16 No.4

A number of structural changes occur in the airway wall in asthma. The most characteristic is thickening of the subepithelial lamina reticularis which is observed in bronchial tissue even in patients with mild disease. This pathophysiological change which was the result of deposition of interstitial collagens by increased numbers of myofibroblasts is likely to be directed by growth factors having fibropoliferative and profibrotic effect. The acivation of the epithelial-mesenchymal unit involves reciprocal activities of growth factors belonging to the fibroblast growth (FGF), epidermal growth factor (EGF), and transforming growth factor-β families. Among them FGF is a member of family of heparin binding growth factors that affect the growth and differentiation of a large number of cell types. Especially basic FGF involved in morphogenesis, wound repair, inflammation, angiogenesis, and tumor growth and invasion, and require the glycosaminoglycan side chains of heparan sulphate, proteoglycans for high affinity binding to their specific receptors. Few studies suggested bFGF would be an important regulator of airway remodeling by means of paracrine control of bronchial myofibroblasts in response to cell damage and repair. [Pediatr Allergy Respir Dis(Korea) 2006;16:267-273]

유전자 재조합 콩과 순수 콩의 단백화학적 특성의 비교

염혜영 ( Hye Yung Yum ),이경은 ( Kyung Eun Lee ),손명현 ( Myung Hyun Shon ),김철홍 ( Chul Hong Kim ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2002 Allergy Asthma & Respiratory Disease Vol.12 No.1

운동유발성 천식의 자연경과에 관한 연구

염혜영(Hye Yung Yum),김규언(Kyu Earn Kim),강혜영(Hay Young Kang),정병주(Byung Ju Jeoung),이기영(Ki Young Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1996 Allergy Asthma & Respiratory Disease Vol.6 No.1

N/A To counsel parents about the future prospects of EIA in their children, it is very important to know the prognosis of EIA, As there is no report concerning the natural history of EJA, we performed this study. Forty-seven children (male 37, female 10) were included in this longitudinal evaluation, all of whom were diagnosed as having EIA through the exercise loading test at least two years ago (mean 35/12 years). We performed a follow-up exercise loading test and compared the results. The children were tested with the up and down stairs method for 6 minutes. The changes in pulmonary function were measured by a peak flow meter. The results are as follows: 1. Twenty-eight cases of 47 children(59.6%) didn't reveal EIA when we performed the follow-up exercise loading test. There was no difference between boys and girls. 2. When we analyzed the data according to the severity of EIA, we had the following results: 70.8% of mild EIA, 53.8% of moderate EIA, and 40.0% of severe EIA were shown to not have EIA. 3. The remission of EIA was not correlated with total eosinophil count, total IgE level and the number of positive allergen in skin test at initial diagnosis. In conclusion, the 59.6% of children with EIA demonstrated to have remission of their EIA after 2 or more years. The remission rate was the highest (70.8%) in mild EIA.

아토피피부염의 보완의학

이수형 ( Soo Hyoung Lee ),염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2008 Allergy Asthma & Respiratory Disease Vol.18 No.4

목적: 아토피피부염은 만성 알레르기 염증성질환으로서 소아에서의 유병률이 10-20% 정도로 흔한 피부질환이다. 설문연구에 의하면 많은 수의환자들은 과학적으로 검증되지 못한 `보완의학`을 이용했거나 이용하고 있는 게 현실이다. 보완의학에 대한 연구는 어느 정도 되어 있는지 살펴보고자 하였다. 방법: 논문 검색은 Entrez Pubmed를 통해 `최근 5년이내`, 검색주제어는 `atopic dermatitis complementary/alternative medicine`으로 검색하여 중복되지 않은 범위에서 약물이나 약초를 통한 치료를 주로 한 논문들을 선택하여 고찰하였다. 결과: 한약제제는 4건의 무작위임상시험이 시행되었는데 증상 감소, 만족도에서 효과가 있을 수 있다고 하였지만 일치되게 나오지는 않았다. 좋은 연구설계의 좀 더 큰 규모의 임상시험을 통한 검증이 필요하다. 동종요법에 대해서는 외국에서는 비교적 많은 연구가 되었는데 일관되게 뚜렷한 효과를 나타내지는 못했다. 특히 아토피피부염 환자만을 대상으로 한 연구는 많이 부족한 실정이다. 그 외 여러 식물 추출물에 관해서는 성분분석 등의 실험연구는 많은 부분 진행되었지만 임상시험은 디자인이나 규모 면에서 아직 부족한 실정이다. 결론: 보완의학은 과학적 검증에 비해 너무나도 많은 사람이 이용하고 있고 그 경제적 비용 또한 무시할 수 없는 현실이기에 우리나라에서도 실험연구에서부터 임상시험까지의 체계적인 접근이 필요하겠다. Purpose: The prevalence rate of atopic dermatitis which is a common disease as is 10-20%. By the questionnaire survey, many patients used or have been used complementary medicine which has not been verificated. We review to look around the studies in complementary medicine of atopic dermatitis. Methods: We searched the journals through Entrez Pubmed within the limits: recent 5 years and atopic dermatitis complementary/alternative medicine. And then, we selected and reviewed the journals which introduced treatment for atopic dermatitis by drugs or herbs within terms which was not overlapped. Results: There were 4 randomized clinical trials about Chinese herbs that had possible effects on relieving symptoms and self-satisfaction, but they were inconsistent. Examinations would be required through well-designed and clinical trials with a large sample size. There were relatively a lot of studies of homeopathy in the foreign countries, but had no consistent and definite effects. Especially, there were few studies of homeopathy in atopic dermatitis patients. In addition, experimental studies in extracts from plants such as flavonoids have proceeded mostly (ex. chemical experiment), but there were few clinical trials which were well-designed or sufficient sample size. Conclusion: Complementary medicine has been used by many people for scientific verification, and economic costs for it were so considerable that systematic approaches from experimental trials to clinical trials would be needed. [Pediatr Allergy Respir Dis(Korea) 2008;18:326-338]

학동기 아토피피부염 환아의 행동문제와 부모 양육태도 및 학교생활과의 관계

김동희 ( Dong Hee Kim ),조성은 ( Sung Eun Cho ),염혜영 ( Hye Yung Yum ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 Allergy Asthma & Respiratory Disease Vol.20 No.3

목적: 본 연구는 학동기 아토피피부염 환아의 행동문제를 파악하고 환아의 행동문제와 관련된 변수를 확인하기 위하여 시도되었다. 방법: 연구대상은 4개 종합병원을 방문한 아토피피부염을 진단받은 학동기 소아를 선정하였으며 총 102명의 대상자가 참여하였다 연구 도구는 유아용 행동 CBCL 1.5-5 유아용 행동평가척도와 양육 태도 측정도구를 사용하였다. 결 과: 대상 환아의 경제상태에 따른 내재화 (F=3.471, P<0.05), 외현화(r=3.227, P<0.05) 문제 행동은 모두 차이가 있었다. 또한 내재화 문제행동은 어머니의 양육 태도 중 거부/방임 양육 태도 (r=0.293, P<0.05), 교우관계(r=-0.297, P<0.05), 교사관계 (r=-0.252, P<0.05)와 상관관계를 나타냈으며 외현화 행동문제는 어머니의 거부/방임 양육 태도 (r=0.257, P<0.05), 아버지의 거부 방임 <0.05), 양육 태도 (r=0.274, P<0.05), 교유관계 (r=-0.275, P <0.05), 교사관계 (r=-0.263, P<0.05) 와 유의한 상관관계를 나타냈다. 다중회귀분석 결과는 내재화 문제행동은 교우관계(β=-1.412, P<0.05)만이 관련 변수로 나타났으며 외현화 행동문제은 어머니의 거부 방임 양육 태도(β=-0.458, P<0.05)와 교우관계 (β=0.402, P<0.05) 가 관련 변수로 나타났다. 결론: 본 연구 결과 아토피피부염 환아의 행동문제와 경제 상태와 부모의 양육 태도 중 거부/방임 태도 교우 관계 교사와의 관계가 유의한 상관관계를 나타내 경제 상태가 낮을수록 부모가 거부/방임의 부정적인 양육태도를 가지고 있을수록 교우 교사와의 관계가 나쁠수록 환아의 행동문제가 높아짐을 알 수 있었다. 그러므로 경제 상태가 낮은 집단의 행동문제에 관련된 예방과 중재를 강화하고 아토피피부염 환아의 부모에게 양육태도의 중요성을 인식시키고 자녀에게 긍정적인 영향을 줄 수 있는 양육태도를 가질 수 있도록 돕고 학교생활에서 긍정적인 교우관계 교사관계를 가질 수 있도록 해야 할 것이다. 또한 앞으로 아토피피부염 환아의 질환에 영향을 줄 수 있는 행동문제와 그와 관련된 요인을 규명하기 위한 심층적인 연구가 뒤따라야 할 것이다. Purpose: To identify relationship of behavioral problems, parenting practice and school life in children with atopic dermatitis. Methods: The participants were parents of 102 school-aged children with atopic dermatitis. The instruments used were a self-reported questionnaire on K-CBCL, Childrearing Behavior Questionnaire, and measurements of relationship with friends and teachers. Descriptive, Pearson correlation and multiple regression analyses were performed. Results: There was no statistically significant relationship between behavior problems for gender, age, parent`s age, parent`s educational level, family structure, academic achievement, and duration and severity of illness. There were significant differences in internalizing (F=3.471, P<0.05) and externalizing problems (F=3.227, P<0.05) according to economic status. In bivariate analysis, rejection-nonintervention maternal parenting practice (r=0.293, P<0.05), the relationship with friends (r=-0.297, P<0.05) and the relationship with teachers (r=-0.252, P<0.05) were significantly correlated with internalizing problems and rejection-nonintervention maternal parenting practice (r=0.257, P<0.05), rejection-nonintervention paternal parenting practice (r=0.274, P< 0.05), the relationship with friends (r=-0.275, P<0.05) and the relationship with teachers (r= -0.263, P<0.05) were significantly correlated with externalizing problems. However, the results of multiple regression analysis showed that only the relationship with friends ( =-1.412, β P<0.05) was significantly associated with internalizing problems and rejection-nonintervention maternal parenting practice ( =-0.458, β P<0.05), the relationship with friends ( =0.402, β P<0.05) were significantly associated with externalizing problems. Conclusion : School-aged children with atopic dermatitis who reported lower socioeconomic status, reported higher rejection-nonintervention parenting practice and had a poor relationship with friends and teachers showed higher internalizing and externalizing problems. A comprehensive intervention program for children with atopic dermatitis is recommended to promote the development of positive relationships with parents, friend and teachers.