소아청소년의 구강알레르기증후군을 중심으로 한 면역글로불린 E 매개 음식알레르기에 대한 고찰

하은교,김주희,신지원,신윤호,지혜미,한만용 대한 소아알레르기 호흡기학회 2024 Allergy Asthma & Respiratory Disease Vol.12 No.2

. Purpose: To assess the prevalence of food allergy, with a focus on oral allergy syndrome (OAS) in a population of children and to investigate relevant allergen sensitization associated with these adverse reactions. Methods: This study involved 1,660 children (aged 4 to 13 years) experiencing seasonal allergy symptoms, who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in a South Korean municipality. Parents completed a structured questionnaire to assess children with OAS, collecting information on the duration, severity, and factors related to symptoms. Skin prick tests (n=498) and blood sampling (n=464) were performed to measure allergic sensitizations, total eosinophil counts, and levels both total immunoglobulin E (IgE) and birch-specific IgE. Results: The prevalence of OAS among the children enrolled in this study was 4.4% (95% confidence interval, 3.7%–5.1%). The most common symptom was mouth itching (n=106, 65.0%), and the primary food allergen associated with symptoms was kiwi (n=48, 29.5%). Peanut sensitization (14.8% vs. 57.1%, P<0.001) and sensitization to other nut products (15.6% vs. 47.6%, P=0.001) were linked to a higher incidence of systemic reactions. Conclusion: The prevalence of 4.4% underscores the significant health impact of OAS, especially in children experiencing food allergy-related symptoms. Notably, common allergens, such as kiwi, and the potential for additional systemic reactions associated with this condition highlight the importance of raising awareness.

Therapeutic Response for Functional Abdominal Pain in Children with Occult Constipation: Laxatives versus Prokinetic Drugs

하은교,장호민,정수진 대한의학회 2017 Journal of Korean medical science Vol.32 No.1

The relationship between functional abdominal pain (FAP) and occult constipation (OC) in children who did not meet the Rome III criteria for constipation has rarely been reported. This study aimed to estimate the prevalence of OC in patients with FAP and to compare the effectiveness of prokinetic drugs and laxatives for FAP and OC. Pediatric outpatients (n = 212; aged 4–15 years) who satisfied the Rome III criteria for childhood FAP were divided into 2 groups based on Leech scores: group 1 < 8; group 2 ≥ 8. Group 2 received either prokinetic drugs or laxatives and pain severity was assessed after 2 weeks, 1 month, and 3 months. A total 52.4% (111/212) of patients had OC in this study. More patients who received laxatives had reduced pain scores compared with those who received prokinetic drugs. Those treated with laxatives in group 2 had a better response than those treated with prokinetic drugs throughout the study period (P < 0.001, P < 0.001, and P = 0.002 after 2 weeks, 1 month, and 3 months, respectively). OC was frequently encountered in children with FAP. Laxatives can be more effective than prokinetic drugs for relieving symptoms of FAP in children with a Leech score ≥ 8 and suspected OC.

Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children

이승진,하은교,지혜미,이경석,이승원,김미애,김동현,정영호,신윤호,성명순,한만용 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.3

Purpose: Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children. Methods: This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done. Results: The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022). Conclusions: A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

Serum Periostin Is Negatively Correlated With Exposure to Formaldehyde and Volatile Organic Compounds in Children

연동근,안재우,하은교,지혜미,Kenji Izuhara,Junya Ono,정영호,이경석,신윤호,백혜성,한만용 대한천식알레르기학회 2018 Allergy, Asthma & Immunology Research Vol.10 No.6

Epidemiological studies have shown that exposure to tobacco smoke causing irritation and inflammation in the airways tends to reduce serum periostin concentrations in adults. We now investigate prospective cross-sectional study on 135 Korean students aged 7 years in the first grade who were participating in the Seongnam Atopy Project for Children's Happiness 2016 (SAP2016) cohort. To the best of our knowledge, this is the first study to show significant inverse correlations between serum periostin concentration and exposure to xylene and formaldehyde in children. Our findings suggested the need for caution in using the serum periostin level as a marker for allergic diseases, since exposure to volatile organic compounds and formaldehyde may confound the interpretation of these results.

발열과 림프절 종대를 보인 환자에서 화농성 경부 림프절염과 가와사키병의 감별 진단

장호민 ( Homin Jang ),하은교 ( Eun Gyo Ha ),김희진 ( Hee Jin Kim ),이택진 ( Taek-jin Lee ) 대한소아감염학회 2016 Pediatric Infection and Vaccine Vol.23 No.3

Purpose: This study identified the characteristics differentiating node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Methods: From July 2007 to June 2015, the medical records of patients with BCL, NFKD, and typical KD were retrospectively reviewed. We analyzed and compared the demographic, clinical, laboratory, and imaging characteristics of the cohorts. Results: Twenty-two patients with BCL, 37 with NFKD, and 132 with typical KD were included in this study. Patients with BCL had longer durations of hospitalization than patients with NFKD. Bilateral and multiple enlarged cervical lymph nodes were associated more with NFKD than BCL. Compared with BCL patients, NFKD patients had lower platelet counts, higher percentages of neutrophils, and higher C-reactive protein (CRP) levels. NFKD patients were older and presented with higher white blood cell counts, percentages of neutrophils, absolute neutrophil counts, and CRP levels as well as lower platelet counts and alanine aminotransferase levels than typical KD patients. Conclusions: In febrile patients with cervical lymphadenopathy, the combination of bilateral and multiple enlarged nodes, low platelet count, high percentage of neutrophils, and high CRP levels should prompt consideration of NFKD for prevention of delayed diagnosis of KD.

Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups

이승원,이신혜,신윤호,하은교,최선희,양민석,황소현,김성순,최장훈,한만용 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.6

Purpose: Seasonal variations in asthma exacerbation (AE) are associated with respiratory virus outbreaks and the return of children to school after vacation. This study aims to elucidate the period, phase, and amplitude of seasonal cycles of AE in 5 different age groups with regard to rhino- and influenza virus epidemics in Korea. Methods: The number of daily emergency department (ED) visits for AE in all age groups of Korea and the nationwide weekly incidence of rhino- and influenza virus, were obtained for 2008-2012. Fourier regression was used to model rhythmicity, and the Cosinor method was used to determine the amplitude and phase of the cycles in each age group. The cross-correlation function (CCF) between AE and the rhino- and influenza virus epidemics was also calculated. Results: There were 157,559 events of AE (0.62 events/1,000 individuals/year) during the study period. There were spring and fall peaks of AE in children and adults, but only 1 winter peak in the elderly. The amplitude of the AE peak in infants was higher in spring than in fall (9.16 vs 3.04, P<0.010), and the fall peak was approximately 1 month later in infants than in school children (October 11 vs November 13, P<0.010). The association between AE and rhinovirus was greatest in school children (rho=0.331), and the association between AE and influenza virus was greatest in those aged ≥60 years (rho=0.682). Conclusions: The rhythmicity, amplitude, and phase of the annual cycle of AE differed among different age groups. The patterns of AE were related to the annual rhino- and influenza virus epidemics.

Association of Sensitization to Different Aeroallergens With Airway Function and Nasal Patency in Urban Children

이신혜,고현용,연동건,이승원,하은교,성명순,이경석,지혜미,신윤호,한만용 대한천식알레르기학회 2019 Allergy, Asthma & Immunology Research Vol.11 No.4

Purpose: Children with sensitization to aeroallergens have decreased lung function and nasal patency. Our purpose was to determine the association of sensitization to different aeroallergens with airway function and nasal patency. Methods: Four hundred and eighty-six randomly selected 11 year-old children who lived in Seongnam City were examined. Serum specific immunoglobulin E (IgE) levels against 6 common allergens (Dermatophagoidesfarinae, birch, cat, dog, Japanese hop and Alternaria), impulse oscillometry (IOS) results for the evaluation of airway dysfunction, and acoustic rhinometry for the determination of nasal airway patency were obtained. Results: IOS indicated that children sensitized to Alternaria (n = 38, 7.8%) and dog dander (n = 69, 14.2%) had decreased lung function, based on resistance at 10 Hz (Rrs10; aβ = 0.0072; 95% CI, 0.017, 0.127; P = 0.010) and 1 Hz (Rrs1; aβ = 0.038; 95% CI, 0.001, 0.074; P = 0.042). Children sensitized to D. farinae (n = 281, 57.8%) had decreased post-decongestant nasal volume at 0 to 5 cm (aβ = −0.605; 95% CI, −1.005, −0.205; P = 0.003), but normal IOS results at all measured frequencies (P > 0.05). Increased serum eosinophil level was associated with Rrs1 (P = 0.007) and Rrs2 (P = 0.018) and post-decongestant nasal volume at 0 to 5 cm (aβ = −0.885; 95% CI, −1.331, −0.439; P < 0.001). Conclusions: Sensitivity to specific aeroallergens, serum eosinophil count and total IgE level had different associations with upper and lower airway dysfunction in urban children.

Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and Neurodevelopment

송주영,Cha Hye Ryeong,이승원,하은교,김주희,Han Man Yong 대한의학회 2023 Journal of Korean medical science Vol.38 No.6

Background: There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children. Methods: This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months. Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date. Results: The median age at the index date was 3.8 (95% confidence interval [CI], 1.7–5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5–17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30–1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ. Conclusion: Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

2016-2017년 겨울철 급성모세기관지염으로 입원한 영아의 임상 양상과 호흡기 세포융합 바이러스 유전적 변이

연동건 ( Dong Keon Yon ),민채연 ( Chae-yeon Min ),하은교 ( Eun Kyo Ha ),지혜미 ( Hye Mi Jee ),정영호 ( Young-ho Jung ),이경석 ( Kyung Suk Lee ),신윤호 ( Youn Ho Sheen ),한만용 ( Man Yong Han ) 대한천식알레르기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Purpose: Circulating patterns of predominant respiratory syncytial virus (RSV) genotypes in the community may be helpful in understanding molecular epidemiology and predicting future outbreaks of the RSV genotype. We investigated the association of genetic variations in RSV with acute severe bronchiolitis in infants. Methods: We reviewed medical records of infants younger than 1 year of age hospitalized due to acute bronchiolitis between November 2016 and February 2017. Subjects were classified as severe or mild based on the use of mechanical or noninvasive ventilation. The associations between severity of the disease, sex, age at admission, oxygen saturation at admission and laboratory test results were analyzed. RSV sequence analysis was performed in the severe group. Results: Among 114 infants, 80 underwent respiratory viral polymerase chain reaction using nasopharyngeal swab; of these, 53 (66.3%) showed positive for RSV. Of the 53 RSV-positive samples, 9 were categorized as the severe group and 44 were categorized as the mild group. Male sex, young age, longer duration of admission, minimum SaO₂ at admission and bronchiolitis severity score were significantly correlated with disease severity in the severe group than in the mild group (all variables, P<0.001). Phylogenetic and sequence analysis in the severe group revealed 8 RSV-A, ON1 genotype and 1 RSV-B, BA4 genotype. Conclusion: Phylogenetic types of RSV in subjects of the severe group were RSV-A, ON1 genotype or RSV-B, BA4 genotype which were prevalent in the Korean community at the same time. Our study showed that disease severity was not significantly associated with RSV genotypic evolution or antigenic drift in Korea during winter season 2016-17. (Allergy Asthma Respir Dis 2018;6:110-115)

대한천식알레르기학회 알레르기 면역요법 진료지침

이화영,강성윤,김경훈,김주희,류광희,민진영,박경희,박소영,성명순,이영수,양은애,지혜미,하은교,신유섭,이상민,정은희,최선희,고영일,김선태,남동호,박중원,심정연,안영민,한두희,한만용,이용원,최정희,대한천식알레르기학회 면역요법/알레르겐연구팀,Hwa Young Lee,Sung-Yoon Kang,Kyunghoon Kim,Ju Hee Kim,Gwanghui Ryu,J 대한천식알레르기학회 2024 Allergy Asthma & Respiratory Disease Vol.12 No.3

Allergen immunotherapy (AIT) is a causative treatment of allergic diseases in which allergen extracts are regularly administered in a gradually escalated doses, leading to immune tolerance and consequent alleviation of allergic diseases. The need for uniform practice guidelines in AIT is continuously growing as the number of potential candidates for AIT increases and new therapeutic approaches are tried. This updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT, published in 2010, proposes an expert opinion by specialists in allergy, pediatrics, and otorhinolaryngology. This guideline deals with the basic knowledge of AIT, including mechanisms, clinical efficacy, allergen standardization, important allergens in Korea, and special consideration in pediatrics. The article also covers the methodological aspects of AIT, including patient selection, allergen selection, schedule and doses, follow-up care, efficacy measurements, and management of adverse reactions. Although this guideline suggests the optimal dosing schedule, an individualized approach and modifications are recommended considering the situation for each patient and clinic.