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( Deok In Kim ),( Hyouk Soo Kwon ),( Woo Jung Song ),( Sang Min Lee ),( Sae Hoon Kim ),( Seong Wook Sohn ),( Chang Han Park ),( Heung Woo Park ),( Sun Sin Kim ),( Sang Heon Cho ),( Kyung Up Min ),( Yo 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 2008 천식 및 알레르기 Vol.28 No.2
배경: 노인 천식은 한 보고에서 우리나라 유병률이 12.7%에 달하며 전세계에서 가장 빠르게 고령화 사회로 진입하고 있는 우리나라에서 점차 더 임상적으로 중요한 위치를 차지할 것이다. 노인 천식에 대한 다각적인 연구가 필요한 시점이다. 목적: 노인 천식에서 성별, 발병 연령 등에 따른 임상적 차이를 알아보고자 하였다. 방법: 분당서울대학교병원 천식 및 알레르기 클리닉을 방문한 65세 이상의 환자들을 대상으로 성별, 발병 연령에 따른 임상 양상에 대해 연구하였다. 65세 이전 발병의 경우를 조기 발병 천식, 65세 이후 발병의 경우를 후기 발병 천식으로 분류하였다. 결과: 총 180명 중, 81명이 조기 발병 천식, 99명이 후기 발병 천식이었다. 조기 발병 천식의 유병 기간은 18.8±17.1년, 후기 발병 천식은 3.4±3.5년이었다. 조기 발병 천식에서 천명음, 피부단자검사 양성, 기관지확장 소견이 더 높게 나타났으며, 기도 폐쇄 정도가 더 심하였으나, 천명 외의 다른 호흡기계 증상, 약물 요구 정도, 혈청 총 IgE에는 차이가 없었다. 일부 환자에서 유도객담을 분석하였고 후기 발병 천식에서 호중구 분율이 높았다. 결론: 65세 이상의 천식 환자를 일반적으로 노인 천식 환자라 부르고 있으나, 발병 연령에 따라 임상적인 차이가 있으며 후기 발병 천식에서는 호중구의 역할을 시사하는 연구결과를 보였다. 따라서 관련 연구 진행이나 진료에 있어 발병 연령에 따른 고려가 필요할 것으로 사료된다. (Korean J Asthma Allergy Clin Immunol 2008;28:98-104)
Background: Chronic cough is a common non-specific symptom and has various causes including asthma. Objective: The aims of this study were to compare eosinophilic degranulation in the airways between chronic cough patients with and without asthma and to evaluate correlations between sputum eosinophils and eosinophilic degranulation proteins. Method: Thirty-seven patients with chronic cough and 9 normal individuals (control group) were enrolled. Patients with chronic cough were divided into 2 groups based on positivity for bronchial hyperresponsiveness (BHR): those with asthma (asthma group, n=18) and those without asthma (non-asthma group, n=19). Sputum levels of eosinophil- derived neurotoxin (EDN) and major basic protein (MBP) levels were measured, and eosinophil counts were performed in all patients. Result: Sputum % eosinophils were increased in both the asthma and non-asthma groups compared to the control group. However, sputum EDN/MBP levels were increased only in the asthma group compared to the non-asthma and control groups. Sputum % eosinophils correlated positively with sputum EDN/MBP levels in the asthma group, but not in the Non-asthma group. Conclusion: Increased EDN/MBP levels and significant correlations between % eosinophils and EDN/MBP levels were observed only in the asthma group, suggesting that eosinophil degranulation proteins could be a marker for identifying chronic cough due to asthma. (Korean J Asthma Allergy Clin Immunol 2010;30:293-298)
Background: Many children who have allergic rhinitis (AR) have adenoid hypertrophy (AH) which can cause significant morbidity. Objective: To know the risk factors for AH in children with AR. Method: 208 children aged 3∼15 years with AR who visited the allergy clinic of the Department of Pediatrics between January 2006 and December 2008 were enrolled. We measured the size of adenoids on lateral X-rays of the neck using the Fusioka`s method and defined AH. Children were divided into 2 groups: those with AR and those without AR. The 2 groups were compared in terms of parameters, including obstructive sleep apnea (OSA) score, body mass index (BMI) and atopic charac teristics. Result: AH was observed in 52 (25.0%) of 208 children with AR. OSA score of >3.5 was observed in 19 (36.5%) of 52 children with AH. Obesity [odds ratio (OR)= 4.1; 95% confidence interval (CI) 1.8∼9.2], nasal eosinophil counts (OR=2.0; 95% CI, 1.0∼3.9), positive skin reactivity to molds (OR=4.1; 95% CI, 1.8∼9.2), positive skin reactivity to Dermatophagoides farinae (Df) or Dermatophagoides pteronyssinus (Dp) (OR=2.6; 95% CI, 1.1∼5.7) were significant risk factors for AH in AR children. Conclusion: Obesity, elevated nasal eosinophil counts, positive skin reactivity to molds and Dp or Df in children with AR may be associated with AH. (Korean J Asthma Allergy Clin Immunol 2010;30:299-306)
나선영 ( Sun Young Na ),전수연 ( Soo Yeon Jeon ),김유진 ( Yu Jin Kim ),박정웅 ( Jeong Woong Park ),정성환 ( Sung Hwan Jeong ),이상표 ( Sang Pyo Lee ),성연미 ( Yon Mi Sung ),박상희 ( Sang Hui Park ) 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 2010 천식 및 알레르기 Vol.30 No.4
Churg-Strauss syndrome is a rare syndrome that is characterized by hypereosinophilic systemic necrotizing vasculitis affecting small- to medium-sized arteries and veins. The manifestations of multiple tracheobronchial mucosal lesion and thrombus of left ventricle are rarely reported in Churg-Strauss syndrome. We report a case of Churg-Strauss syndrome with diffuse tracheobronchial mucosal lesions in a 52-year-old man who developed a left ventricular thrombus after discontinuation of treatment. Bronchial asthma, rhinosinusitis, peripheral eosinophilia, p-ANCA positive, eosinophilic lung infiltration, vasculitis led to a diagnosis of Churg-Strauss syndrome. On bronchoscopic evaluation, diffuse necrotizing mucosal lesions were observed on tracheobronchial tree. With methylprednisolone (125 mg/day), his asthmatic symptoms were well-controlled and eosinophil count and eosinophil cationic protein concentration in peripheral blood maintained in normal ranges over a 20 month period, but he was lost to follow-up. After 12 months from discontinuation of treatment he readmitted with relapsed Churg-Strauss syndrome with left ventricular thrombus. The thrombus gradually disappeared after prednisolone (1 mg/kg/day) and warfarin treatment. (Korean J Asthma Allergy Clin Immunol 2010;30:314-319)
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug hypersensitivity syndrome characterized by fever, skin rash, blood eosinophilia and multiple organ involvements including liver and kidney developed following drug administration. Vasculitis could be infrequent one of manifestations of DRESS syndrome. Mortality rate of DRESS syndrome is at least 10%. Here, we reported a case of DRESS syndrome with vasculitis. A 67-year-old man with essential hypertension presented with fever and maculopapular rash after being given allopurinol over 2 weeks for gout. He had severe oral mucositis. He had peripheral blood eosinophilia and abnormal hepatic and renal functions. A skin biopsy showed leukocytoclastic vasculitis. Gastroduodenoscopy showed spontaneous mucosal oozing in mid-to-lower esophagus. He was diagnosed as having DRESS syndrome with vasulitis. Allopurinol was stopped and systemic corticosteroid was administrated. His clinical manifestations improved gradually. However, he died of sudden onset of massive intracranial hemorrhage. The case suggests that DRESS syndrome could sometimes present manifestations of vasculitis, which might be fatal. (Korean J Asthma Allergy Clin Immunol 2010;30:320- 324)
Apitoxin, honeybee venom, is used in alternative medicine as a treatment option for arthritis and chronic pain because it is reported to have an anti-inflammatory property. Hypersensitivity responses to bee venom range from local reaction to life-threatening anaphylaxis, and most of them present in a few hours after exposure to bee venom. Delayed-type allergic reactions have been reported, although unusual, such as serum sickness. We describe a 47-year-old woman who had serum-sickness reaction 7 days after undergoing honeybee acupuncture to relieve her back pain. She complained of maculopapular skin rash, fever, arthralgia and myalgia. High levels of specific IgE and IgG to honeybee venom were observed by immunoCAP. We report herein the first case of serum sickness reaction developed after bee venom acupuncture. (Korean J Asthma Allergy Clin Immunol 2010;30:325-328)
Background: Enzyme powders inhaled at workplace can induce respiratory allergy in health care workers. It is important to elucidate which risk factors contribute to the sensitization of these enzymes in health care workers. Objective: This study evaluates the prevalence and the risk factors of sensitization to pancreatic enzyme powders in health care workers. Method: A total of 220 health care workers (199 nurses and 21 pharmacist`s office workers) who were exposed to pancreatic enzyme powders during work and 64 unexposed controls (office workers) in a single hospital were analyzed using a questionnaire, and measurements of total serum IgE level and specific IgE against house dust mite and the most popular pancreatic enzymes (α-amylase and pancreatin). Result: The overall prevalence of sensitization to pancreatic enzymes was 4.7%. Sensitization to pancreatic enzymes is significantly higher in pharmacist`s office workers (28.6%) than in controls (0%) or nurses (5.0%). In multivariate analysis, occupational exposure (OR, 25.5; 95% CI, 5.7∼113.5), and elevated total IgE level (OR, 6.95; 95% CI, 1.6∼28.9) were associated with sensitization to pancreatic enzymes. Conclusion: Occupational exposure and elevated serum IgE level may be important determinants of sensitization to pancreatic enzymes in health care workers. Measures to reduce exposure may be the most effective means to reduce sensitization. (Korean J Asthma Allergy Clin Immunol 2009;29:21-26)
Background: Approximately 10% of patients with near-fatal asthma (NFA) die within a year of an attack, and close follow-up is helpful to prevent fatal events. Objective: To investigate the clinical outcomes of acute severe asthma and whether close follow-up may help to improve clinical outcomes. Method: Asthma patients (N=225), who were hospitalized due to severe exacerbation during the period 1998∼2006, were followed up using questionnaires or phone interviews. The 146 patients, who had regularly visited our hospital until the examination, were assigned as regular hospital visitor. Result: Twenty-two (9.8%) of the total patients and 7 (15.9%) of 44 NFA patients died (mean follow-up period: 138.9 weeks). The mortality rate was significantly lower in regular hospital visitors than in the others (total: 6.2% vs. 16.5%, P<0.05; NFA: 3.4% vs. 40.0%, P<0.01). The regular hospital visitors controlled their asthma better (controlled/partly controlled/uncontrolled: 75/38/33 vs. 20/28/31; P<0.001), had better knowledge of asthma (9.7±0.2 vs. 8.5±0.3, P<0.01) and used inhaled steroid more frequently (74.7% vs. 55.7%, P<0.001) than the others. Conclusion: Not a few patients with acute severe asthma die after discharge from hospital. However, close follow-up and adequate asthma control seem to help in the reduction of asthma mortality. (Korean J Asthma Allergy Clin Immunol 2009;29:27-32)