A Clincal Follow-up Study of Asthma from Childhood to Adulthood / 소아알레르기및호흡기학회지

PURPOSE: Intermittent bronchial obstruction and increased airway responsiveness to inhaled nonspecific stimuli are main features of asthma. We retrospectively studied a group of children with asthma to investigate the contribution of childhood asthma characteristics and degree of bronchial responsiveness in combination with other variables in the prediction of adult level of pulmonary function & bronchial responsiveness. METHODS: We carried out the retrospective study on 65 adult patients who had been performed methacholine provocation test at Yonsei university children's allergic clinic from March 1994 to July 1997. These cases were diagnosed bronchial asthma on childhood. RESULTS: 1) In this study 65 patients were investigated, 45 subjects(69.3%)(A) were negative on methacholine provocation test, & 20 subjects(30.7%)(B) were positive. 2) Age of onset of asthma, A group was earlier than B group.(1.2 vs. 3.8 year) 3) There was significant relationship between mean PC20-methacholine and % predicted FEV. 4) There was no significant difference between A & B group in the number of allergen & duration included in the immunotherapy. CONCLUSIONS: We conclude that age of onset, degree of symptoms, % predicted FEV of childhood asthma are relevant to predict the outcome of the adult pulmonary function level, and the childhood degree of bronchial responsiveness are important for the prediction of adult degree of bronchial responsiveness among children with asthma.

A Case of Ganglioneuroma Combined with Pneumonia / 소아알레르기및호흡기학회지

Ganglioneuroma most commonly arise from sympathetic ganglia. This neoplasm may be located wherever ganglion cells are normally found from the skull base to the pelvis, including the adrenal gland. We reported a case of gaglioneuroma in posterior mediastinum in 3 year old boy, which was removed successfully by surgery and confirmed histolgically. We have presented this case and have reviewed the literatures.

Immediate Type Reaction of Food Allergy Confirmed by Open Food Challenge Test: Diagnostic Value of History and Skin Test in Food Allergy / 소아알레르기및호흡기학회지

PURPOSE: Food allergy is one of the common allergic diseases and elicits various clinical manifestations in children. Although the offending food could be suspected by history of food allergy and skin test with food allergen, it should be confirmed by food challenge test. We investigated the result of open food challenge test(OFCT) with offending food as suspected by history and/or skin test. Thereafter we analyzed the relationship between positive history of food allergy and positive skin test to food allergen, and positive food challenge test. METHODS: The subjects consisted of 208 children (age range, 3-15 years) with history of food allergy and/or positive skin test to food allergen. Open food challenge test was performed in 276 cases with 33 kinds of suspected foods. Increasing doses of natural food were given every 20 minutes, and the clinical manifestations elicited by challenge test were observed for 1 hour. RESULTS: 1) One-hundred twenty eight of 276 cases were positive for OFCT, and the provocation rate was 46.4%. 2) The provocation rate of individual food was highest in buckwheat flour(72.3%), followed by crab(60.0%), shrimp(45.8%), milk(41.6%), and egg(41.4%). 3) OFCT elicited allergic manifestations in 44.8% of positive history alone and 31.1% of positive skin test alone. Allergic manifestations were elicited in 91.2% when both the positive history and skin test were positive for the same food. 4) Positive and negative predictive values for OFCT were 67.8% and 68.9% in history, 46.8% and 55.2% in skin test, and 91.2% and 65.3% in history and skin test respectively. 5) Urticaria was the most common symptom(84.4%) elicited by OFCT. There were various allergic manifestations such as asthma, rhinitis, conjunctivitis and burning sensation in throat. Anaphylactic shock was observed in 3 cases with buckwheat flour allergy. 6) For the most cases(51.5%) symptoms occurred by the ingestion of small amount(1-100gm) of offending food. But symptoms in 27 cases were elicited just by scrubbing the food on lips or licking it by tongue. CONCLUSIONS: Open food challenge test showed the highest positive provocation rate with buckwheat. The most common symptom was urticaria, which was elicited with only a small amount of offending food. In predicting the result of OFCT, food allergy history was more reliable than the positive skin test, and if both the history and the skin test were positive for the same food, almost all the cases showed positive results with OFCT.

Predisposing Factors of Recurrent Pneumonia in Children / 소아알레르기및호흡기학회지

PURPOSE: While the recurrent pneumonia is a relatively common problem, there are very few studies or reports in the literature on the subject. This study was designed to provide with a systematic approach to evaluation of the patient who presented with recurrent pneumonia. METHODS: We reviewed clinical records of 12,137 patients who had been admitted to Yonsei University Severance Hospital with pneumonia for the period of 10 years from January 1986 to December 1995. Recurrent pneumonia is defined as pneumonia with at least 2 episodes in a year or with at least 3 episodes for the period of 10 years mentioned above. We investigated incidence of recurrent pneumonia, age distribution, number of recurrent episodes. Then we reviewed the interval period of episodes, location of lesions in chest X-ray, associated etiology in 200 patients with recurrent pneumonia who were selected randomly. RESULTS: Among the patients with pneumonia, 840 patients(6.9%) had recurrent pneumoia. The patients with two episodes of pneumonia were in the highest in incidence(66.9%). The intervals between episodes were usually 1 to 3 month(45.2%). The lesions involved most frequently in both lung fields(61%) on simple chest X-ray. Predisposing factors were widely varied. They were in orders of frequency respiratory disease(43.0%), neuromuscular disease(9.5%), anatomic problem(6.5%), immunologic disease(3.5%) and gastrointestinal disease(1.5%). The most frequent predisposing factor among the respiratory diseases was bronchio;itis(24.0%) and asthma(14.0%). CONCLUSION: The key to optimal treatment lies in the prompt detection of the predisposing factors. We emphasize that patients present recurrent pneumonia should be carefully evaluated for possibility of underlying bronchiolitis in children under age two years and asthma in older children.

A Case of Job Syndrome-Experience with Thymopentin / 소아알레르기및호흡기학회지

The Job syndrome is a primary immunodeficiency disorder characterized by markedly elevated serum IgE levels, recurrent severe infections of the skin and sinoplmonary tract, including staphylococcal pneumonias, chronic eczematoid dermatitis, coarse facial features, and mild eosinophilia. In 1966, Davis et al discribed two patients with severe eczema, chroic sinopulmonary infections, and recurrent staphylococcal abscesses originally. The reason for immunocompromise in the Job syndrome remains unclear, but a chemotactic defect in neutrophils has been described. We have experienced a case of Job syndrome in a 9-year-old girl who had suffered from severe recurrent multiple infections since 2 month of age. After treatment with thymopentin, she was improved clinically. A brief review of related literature is presented.