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림프구활성화시험으로 확인된 methazolamide에 의한 독성표피괴사융해 1예
한규형 ( Kyu-hyung Han ),홍구현 ( Ku-hyun Hong ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seup Kim ),박재석 ( Jae-suk Park ),김승현 ( Seung-heon Kim ),지영구 ( Young-koo Jee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after r mission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test. (Allergy Asthma Respir Dis 2016:4:301-304)
심부전과 과다호산구증가증으로 내원한 PDGFRB 유전변이가 동반된 골수성 종양
권재우 ( Jae-woo Kwon ),권지현 ( Ji-hyun Kwon ),허애영 ( Ae-young Her ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.4
Hypereosinophilic syndrome (HES) is a heterogeneous disorder characterized by persistent hypereosinophilia with the evidence of organ dysfunction caused by eosinophilic involvement. HES can be induced by various secondary causes, including helminthic infections, adverse drug reactions, and allergic diseases. Primary/clonal bone marrow disease, including genetic mutations in platelet driven growth factor receptor alpha (PDGFRA), platelet driven growth factor receptor beta (PDGFRB), and fibroblast growth factor receptor 1 (FGFR1) could be its causes. Although corticosteroids are the mainstay of therapy in confirmed HES, imatinib is considered a definitive treatment for HES with these mutations. However, there have been few reports about HES with these genetic mutations in Korea. Here, we report a patient who presented with sudden onset of congestive heart failure and hypereosinophilia, proved to have PDGFRB rearrangement, and was controlled successfully with imatinib after left ventricle thrombectomy. (Allergy Asthma Respir Dis 2017;5:232-236)
박진수 ( Jin Soo Park ),김지혜 ( Ji Hye Kim ),윤문경 ( Moon Gyung Yoon ),김정은 ( Jung Eun Kim ),신유섭 ( Yoo Seob Shin ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1
Seafood is one of the common causes of food allergies to adults. The sea hare Aplysia kurodai is a marine mollusk which belongs to invertebrate gastropod that has been consumed as a food in Korea. Cases of acute toxic hepatitis after ingestion of sea hares have been reported, but few cases of allergic reactions to sea hare have been reported in the literature. A 33-year-old man was referred to our Emergency Department due to urticaria and periorbital/perioral swelling after eating sea hares. Approximately 10 years ago, he experienced similar allergic reactions to it. Skin prick and intradermal tests showed strong positive responses to crude sea hare allergen extract. He was diagnosed with food allergy to sea hares. We herein report the first case of sea hare allergy after ingestion.
폐결핵 환자와 접촉한 소아의 잠복결핵 진단에 영향을 미치는 위험 요소
민동훈 ( Dong Hoon Min ),위화현 ( Hwa Hyun Wy ),심재원 ( Jae Won Shim ),김덕수 ( Duk Soo Kim ),정혜림 ( Hye Lim Jung ),박문수 ( Moon Soo Park ),심정연 ( Jung Yeon Shim ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.2
Purpose: Tuberculosis (TB) is a common and possibly fatal infectious disease, and its incidence and prevalence is quite high in Korea compared to other Organization for Economic Co-operation and Development countries. Patients who have active TB can cause latent tuberculosis infection (LTBI) in children, which may progress to reactivated tuberculosis. This study was performed to analyze the risk of adult TB that affects children`s LTBI. Methods: From June 2013 to May 2014, 60 children (32 boys, 28 girls) who came into close contact with adult patients diagnosed with pulmonary TB underwent LTBI tests. The children were divided into the 2 groups: the first group was finally diagnosed to LTBI, and the second group was proven not to have LTBI. We compared the risk of adult patients with pulmonary TB between children with LTBI and those without through a medical record review. Results: The number of adult patients with TB was 36 (father 68%, mother 23%, grandparents 8%). The patients who came into close contact with the LTBI group were older (47.0±12.8 years vs. 41.3±6.6 years) and had higher erythrocyte sedimentation rate (ESR) levels than those of the second group. The rate of negative acid-fast-bacilli smear with positive culture results in patients who came into contact with the LBTI group was higher than in the second group. The cutoff value of ESR for the diagnosis of LTBI was 31 mm/hr with a sensitivity of 0.75 and a specificity of 0.85 (area under curve=0.748). Conclusion: Adult pulmonary TB patients who are older and have higher ESR levels may be risk factors for LTBI in children coming into close contact with them. (Allergy Asthma Respir Dis 2017:5:105-110)
황선혜 ( Sun Hye Hwang ),김동현 ( Dong Hyun Kim ),김정희 ( Jeong Hee Kim ),손병관 ( Byong Kwan Son ),임대현 ( Dae Hyun Lim ) 대한천식알레르기학회(구 대한알레르기학회) 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4
Toxic epidermal necrolysis (TEN) is the most severe form of skin reactions caused by drugs or infection. Acute pulmonary complications in TEN are often observed. The mortality is especially high in those who suffer chronic pulmonary complications of TEN such as bronchiolitis obliterance, which occur as a consequence of bronchial epithelial injury. We report a case of a 16-year-old male who had required mechanical ventilation due to acute respiratory distress syndrome caused by TEN at 8 years of age. Although the patient initially recovered from acute respiratory distress syndrome, he required mechanical ventilation again due to severe chronic pulmonary complications of bronchiolitis obliterance and bronchiectasis caused by respiratory epithelial detachment. Thereafter, chronic bronchitis and chronic sinusitis has persisted due to mucosal ciliary dysfunction and several episodes of spontaneous pneumothorax has occurred. However, despite these persisting and serious sequelae of TEN, the patient has survived for 8 years. We report a rare case ofa patient with long-term chronic pulmonary complications who had previously suffered TEN 8 years ago.
합병증을 동반한 기관지 땅콩 흡인에서 체외막산소화 장치를 통한 치료 1예
정재화 ( Jae Hwa Jung ),설인숙 ( In Suk Sol ),윤서희 ( Seo Hee Yoon ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),신홍주 ( Hong Ju Shin ),박한기 ( Han Ki Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2
Foreign body aspiration commonly occurs, especially among children younger than 3 years of age. Most endobronchial foreign bodies may be easily removed by bronchoscopy and have a good prognosis. Despite advances in bronchoscopic procedures, difficulties in management of and complications from foreign body aspiration are still noted. We present a foreign body aspiration case with acute respiratory distress syndrome caused aspiration pneumonia, which was successfully treated by bronchoscopy under extracorporeal membrane oxygenation (ECMO). ECMO can be an effective and potentially life-saving method in complicated foreign body aspiration with uncompensated respiratory failure. (Allergy Asthma Respir Dis 2016;4:140-144)
송한솔 ( Han Sol Song ),최우혁 ( Woo Hyeok Choi ),최원복 ( Won-bok Choi ),양승 ( Seung Yang ),황일태 ( Il-tae Hwang ),백혜성 ( Hey Sung Baek ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
The drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug-induced reaction. Acetaminophen is extensively used as an over-the-counter drug as well as a medical therapeutic. In spite of its frequent use, drug eruptions related to DRESS caused by acetaminophen are rare. This case report describes a 9-year-old boy who experienced fever and maculopapular skin rashes after taking acetaminophen. Leukocytosis with marked eosinophilia and slightly elevated levels of liver enzymes were observed. Symptoms resolved after withdrawal of acetaminophen, followed by intravenous methylprednisolone administration. The diagnosis of DRESS induced by acetaminophen was confirmed by an oral challenge test after 2 months. No allergic reactions to ibuprofen were observed. (Allergy Asthma Respir Dis 2016:4:296-300)
단일기관에서 전산을 통해 수집된 자발적 소아 약물유해반응 보고사례의 분석
박근미 ( Geun-mi Park ),박주현 ( Joo Hyun Park ),정주원 ( Joo Won Jung ),한혜원 ( Hye Won Han ),김재연 ( Jae Youn Kim ),이은 ( Eun Lee ),조현주 ( Hyun-ju Cho ),김영호 ( Yeongho Kim ),윤지선 ( Jisun Yoon ),유진호 ( Jinho Yu ),김태범 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.5
Purpose: The incidence of adverse drug reactions (ADRs) is increasing. However, studies on the prevalence of ADRs in children are rare. The aim of this study was to investigate the causative drugs and clinical features of ADRs for children in a tertiary university hospital of Korea. Methods: We retrospectively collected ADRs by a computerized self-reporting system in Asan Medical Center. ADRs of children under the age 18 were collected from January 2005 to August 2015, and we analyzed only ADRs containing current symptoms among total ADR data. Results: A total of 1,408 ADR cases were reported, There were 764 male (54.3%) and 644 female patients (45.7%), and the mean age was 11.5±5.8 years (range, 0.18 years). Antibiotics (n=479, 34.0%) were the most common causative drugs, followed by tramadol (n=173, 12.3%), nonsteroidal anti-inflammatory agents (NSAIDs) and acetylsalicylic acid (n=103, 7.3%), narcotics (n=91, 6.5%), antineoplastics (n=87, 6.2%), and sedatives (n=82, 5.8%). The most common clinical features were skin manifestations (n=500, 34.4%). Gastrointestinal symptoms (n=435, 29.9%) were the second most common clinical features, followed by neuropsychiatric symptoms (n=155, 10.7%) and respiratory symptoms (n=123, 8.5%). Among antibiotics, glycopeptides (n=110, 23.0%), third-generation cephalosporins (n=83, 17.3%), and penicillin/ß-lactamase inhibitors (n=60, 12.7%) were the most frequently reported causative drugs. Conclusion: Antibiotics were the most reported common causative drugs of ADRs in children, followed by tramadol, NSAID, and narcortics. Compared with adults, the prevalence of contrast medium-induced ADR was lower in children with a higher prevalence of sedative-associated ADR. Greater attention to possible ADRs in children is needed among medical personnel. (Allergy Asthma Respir Dis 2016:4:354-359)