Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test

Lee, Hyun-Seung,Song, Woo-Jung,Lee, Ji-Won,Cho, Young-Yoon,Park, Han-Ki,Kang, Min-Gyu,Cho, Sang-Heon,Sohn, Seong-Wook Asia Pacific Association of Allergy, Asthma and Cl 2015 Asia Pacific allergy Vol.5 No.3

<P>Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.</P>

Clinical characteristics and long-term outcomes related to sputum eosinophilia in Korean asthmatics

Jung, Jae-Woo,Kim, Sae-Hoon,Kwon, Jae-Woo,Kim, Tae-Wan,Kang, Hye-Ryun,Park, Heung-Woo,Kim, Sun-Sin,Chang, Yoon-Seok,Cho, Sang-Heon,Min, Kyung-Up Asia Pacific Association of Allergy, Asthma and Cl 2011 Asia Pacific allergy Vol.1 No.1

<P><B>Background</B></P><P>Bronchial asthma is usually associated with high sputum eosinophil levels. However, recent reports have suggested the importance of noneosinophilic asthma (NEA) as a distinct phenotype of asthma.</P><P><B>Objective</B></P><P>The aim of this study was to evaluate clinical significance of sputum eosinophilia and long-term treatment outcomes related to sputum eosinophilia in Korean asthmatics.</P><P><B>Methods</B></P><P>A total of 201 steroid-naive asthmatics who had undergone induced sputum analysis at baseline were selected from the Cohort for Reality and Evolution of Adult Asthma study population. Clinical evaluation, spirometry, a skin-prick test, a methacholine bronchial provocation test, and sputum eosinophil analysis were performed initially, and patients received the treatment recommended by the Global Initiative for Asthma. Lung function was evaluated every 6 months, and 53 patients completed 24 months of regular follow-up visits. Sputum eosinophilia was defined as a sputum eosinophil count of >3%.</P><P><B>Results</B></P><P>Of the 201 steroid-naive asthmatics, 97 patients had NEA and 104 had eosinophilic asthma (EA). Only 52% of steroid-naive asthmatic subjects had elevated baseline sputum eosinophil levels. A higher percentage of sputum eosinophils was associated with a lower PC20 (<I>r</I> = -0.193; <I>p</I> = 0.009, Spearman correlation), but not with forced expiratory volume in one second (FEV1) (<I>r</I> = 0.045; <I>p</I> = 0.525). During the 24-month study period, the percentage change of FEV1 was significantly lower in the NEA group than in the EA group at 6, 12, 18, and 24 months (<I>p</I> < 0.05). The NEA group, unlike the EA group, showed no significant improvement in FEV1 at 6, 12, 18, or 24 months (<I>p</I> > 0.05).</P><P><B>Conclusion</B></P><P>A higher sputum eosinophil percentage was correlated with a higher airway hyperresponsiveness. Compared with EA patients, NEA patients had poor treatment outcomes in the 2-year follow-up of a Korean asthma cohort population.</P>

T cell transcriptional factors in allergic rhinitis and its association with clinical features

Mo, Ji-Hun,Chung, Young-Jun,Kim, Ji Hye Asia Pacific Association of Allergy, Asthma and Cl 2013 Asia Pacific allergy Vol.3 No.3

<P><B>Background</B></P><P>Th2 cells are crucially important in allergic disease and the possible involvement of Treg and Th17 cells has not been clearly identified.</P><P><B>Objective</B></P><P>To identify the mRNA expression of T cell transcription factors in nasal mucosa in patients with allergic rhinitis (AR) and to reveal their correlations with clinical features.</P><P><B>Methods</B></P><P>Eighteen patients with AR and 12 controls with turbinate hypertrophy were included. mRNA expression of the following transcriptional factors in nasal mucosa were measured by quantitative polymerase chain reaction; T-bet (Th1), GATA3 (Th2), retinoic acid-related orphan receptor C (RORC; Th17), and forkhead box P3 (Foxp3; Treg). mRNA expression was compared among groups and correlation between mRNA expression level and clinical features (rhinitis symptoms, eosinophil count, and IgE) were also investigated.</P><P><B>Results</B></P><P>GATA3 and RORC were significantly increased and Foxp3 was significantly decreased in the AR group. Moderate-to-severe AR group also had increased expression of GATA3 and RORC than mild AR group, suggesting severity of AR influence expression of transcription factors. Correlation analysis showed that none of these transcription factors were associated with severity of clinical symptoms, eosinophil counts and skin prick test severity and that IgE level was significantly correlated with expression level of GATA3 and RORC, suggesting an association of IgE production with Th2 and Th17 cells.</P><P><B>Conclusion</B></P><P>Increased mRNA expression of GATA3 (Th2), increased expression of RORC and decreased expression of Foxp3 may be important in pathogenesis of AR. GATA3 and RORC may be closed related with IgE level.</P>

Reference ranges for induced sputum eosinophil counts in Korean adult population

Kim, Mi-Yeong,Jo, Eun-Jung,Lee, Seung-Eun,Lee, Suh-Young,Song, Woo-Jung,Kim, Tae-Wan,Hur, Gyu-Young,Lee, Jae-Hyung,Kim, Tae-Bum,Park, Heung-Woo,Chang, Yoon-Seok,Park, Hae-Sim,Min, Kyung-Up,Cho, Sang-H Asia Pacific Association of Allergy, Asthma and Cl 2014 Asia Pacific allergy Vol.4 No.3

<P><B>Background</B></P><P>Induced sputum analyses are widely utilized to evaluate airway inflammation in asthmatics. However, the values have not been examined in Korean adults.</P><P><B>Objective</B></P><P>The purpose of this study is to determine reference ranges for induced sputum eosinophils and their influencing factors in Korean adults.</P><P><B>Methods</B></P><P>A total of 208 healthy nonasthmatic adults were recruited. Sputum induction and processing followed the international standard protocols.</P><P><B>Results</B></P><P>Adequate sputum samples were successfully collected from 81 subjects (38.9%). The upper 90 percentile for sputum eosinophil was calculated as 3.5%. The median value of eosinophil count percentage was significantly higher in subjects with atopy than those without atopy (median, 1.6%; range, 0-11.0% vs. median, 0%; range 0-3.6%, <I>p</I>=0.030). However, no significant correlations were found with age, gender, body mass index, smoking status, blood eosinophil, or fractional exhaled nitric oxide levels.</P><P><B>Conclusion</B></P><P>Current study was the first attempt to determine the reference ranges of induced sputum eosinophils in Korean adults. The cutoff value for sputum eosinophilia was 3.5%, and was significantly associated with atopy.</P>

Validation of the Korean version of the European Community Respiratory Health Survey screening questionnaire for use in epidemiologic studies for adult asthma

Song, Woo-Jung,Lee, So-Hee,Kang, Min-Gyu,Kim, Ju-Young,Kim, Mi-Young,Jo, Eun-Jung,Lee, Suh-Young,Lee, Seung-Eun,Kim, Min-Hye,Yang, Min-Suk,Kim, Sae-Hoon,Kang, Hye-Ryun,Park, Hye-Kyung,Park, Heung-Woo Asia Pacific Association of Allergy, Asthma and Cl 2015 Asia Pacific allergy Vol.5 No.1

<P><B>Background</B></P><P>Standardized questionnaire is one of key instruments for general population surveys.</P><P><B>Objective</B></P><P>The present study aimed to develop and validate the Korean version of the European Community Respiratory Health Survey (ECRHS) screening questionnaire for adult asthma surveys.</P><P><B>Methods</B></P><P>The ECRHS screening questionnaire was translated into Korean language according to the international criteria. Study participants were prospectively recruited from six referral hospitals and one health check-up center. Comprehensibility of the translation was tested in a pilot study of 10 patients. The reliability was evaluated by internal consistency and test-retest repeatability. Validity was assess with regard to physician-diagnosed asthma.</P><P><B>Results</B></P><P>A total of 100 adult asthma patients and 134 volunteers were recruited. Reliability was examined for 10 items in 100 asthmatics; Cronbach α coefficients were 0.84, and test-retest repeatability was good (Cohen κ coefficient, 0.71-1.00). Validity was assessed for 8 items in 234 participants; in particular, 'recent wheeze' showed a high sensitivity (0.89) for physician-diagnosed asthma. 'Recent asthma attack' and 'current asthma medication' showed high specificity (0.96-0.98).</P><P><B>Conclusion</B></P><P>The present study demonstrated that the Korean version of the ECRHS screening questionnaire was comprehensible, reliable and valid. We suggest the questionnaire to be utilized in further epidemiological studies for asthma in Korean adult populations.</P>

Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity

Song, Woo-Jung,Chang, Yoon-Seok Asia Pacific Association of Allergy, Asthma and Cl 2013 Asia Pacific allergy Vol.3 No.4

<P>Immediate-type drug hypersensitivity is an increasingly significant clinical issue; however, the diagnosis is frequently hindered due to lack of safe and precise diagnostic tests. Flow cytometry-assisted basophil activation test is a safe <I>in vitro</I> diagnostic tool for assessing basophil activation upon allergen stimulation. In this review, we have summarized current literature on the diagnostic utilities, new indications, and methodological aspects of the basophil activation test for the diagnosis of drug hypersensitivity.</P>

Educational and decision-support tools for asthma-management guideline implementation

Kim, Sae-Hoon,Cho, Sang-Heon Asia Pacific Association of Allergy, Asthma and Cl 2012 Asia Pacific allergy Vol.2 No.1

<P>Many international and national asthma guidelines are now available in large parts of the world, but they are not yet implemented appropriately. There is a gap between scientific evidence-based medicine and real clinical practice. Implementation of guidelines is highly complex. Special strategies are needed to encourage guideline-based, high-quality care. It is important to understand the contents, the format, and the learning strategies which physicians prefer for the dissemination of guidelines. Physicians prefer more concise and immediately available guidelines that are practical to use. Thus, asthma guidelines should be disseminated as convenient and easily accessible tools. Various education programs and decision-support tools have been designed and applied to the clinical management of asthma to solve these challenging problems. Many of them have been shown to be effective at increasing physicians' knowledge and adherence to asthma guidelines and improving patients' clinical outcomes. These educational and decision-support tools are expected to contribute to a narrowing of the gap between asthma guidelines and practice/implementation of the guidelines.</P>

Allergen-specific intralymphatic immunotherapy in human and animal studies

Kim, Seon Tae,Park, So Hyun,Lee, Sang Min,Lee, Sang Pyo Asia Pacific Association of Allergy, Asthma and Cl 2017 Asia Pacific allergy Vol.7 No.3

<P>Clinical trials of intralymphatic immunotherapy (ILIT) have been performed to overcome the limitations of long-term therapy and the local or systemic hypersensitivity reactions in conventional allergen-specific immunotherapy, including subcutaneous or sublingual immunotherapy. Additionally, several animal studies of ILIT have been conducted in the form of translational or veterinary research. We conducted a literature review to examine the treatment efficacy and adverse effects of ILIT.</P>