Current health issues in Korean adolescents / 소아과

During the adolescent period, they experience rapid physical, emotional, cognitive developments while they establish their lifestyle and habitual routines that strongly influence adult health and life. Recent rapid economic growth in Korea, and the earlier onset of physical, sexual, and psychological maturation of adolescents, has resulted in changes in the health status of adolescents from many years ago. Risk-taking behaviors such as drinking alcohol, smoking, and sexual experiences are critical issues that affect the health of, adolescents. Therefore, it is important for pediatricians to note the that risk-taking behaviors of adolescents in Korea that are caused by individual psychosocial factors. This review article illustrates the current health status of Korean adolescents and provides an overview of risk-taking behaviors, to inform pediatricians about some of the key issues.

Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients / 임상소아혈액종양

BACKGROUND: The useful tools for early diagnosis and diagnostic criteria need to be developed for controlling invasive aspergillosis (IA) which causes life-threatening conditions in high risk group such as immunocompromised hematology-oncology patients.METHODS: 103 cases of suspected IA on the ground of pathologic or Aspergillus Galactomannan (AG) test from March 2006 to March 2011 were reviewed. The patients with IA was classified into 4 groups 'Proven', 'Probable', ('Probable-1'), 'Possible' and 'Non' based on the criteria of European Organization for Research and Treatment of Cancer/Mycoses study Group (EORT/MSG) 2008 (and 2002).RESULTS: Of the 103 patients who underwent AG test, 16 cases were diagnosed as IA; 2 'Proven', 9 'Probable', 5 'Probable-1' and 4 'non' (false-positive). Underlying diseases were acute lymphoblastic leukemia (N=8), acute myeloid leukemia (N=5), severe aplastic anemia (N=4), neuroblastoma (N=2) and non-Hodgkin lymphoma (N=1). Risk factors were severe neutropenia for 10 days (80%), prolonged use of steroid (70%), receipt of an allogeneic stem cell transplant (45%) and treatment with immunosuppressants (40%). Major involved organs of IA were lung (N=15) and sinus (N=1). Overall sensitivity, specificity, positive predictive value and negative predictive value of the AG test were 94%, 95%, 79% and 99%, respectively. The mortality of 16 patients with IA was 50%.CONCLUSION: A combined use of the AG test and modified criteria of EORT/MSG 2008 allows not only early diagnosis but also prompt classifying risk groups of IA so that proper antifungal agents were used in pediatric hematology-oncology patients.

Waist-to-height Ratio, a Simple and Practical Index for Screening of Adolescent Metabolic Syndrome Aged 17~19 Years / 대한소아소화기영양학회지

PURPOSE: To evaluate the validity and usefulness of the waist circumference-to-height ratio (WHtR) in screening for metabolic syndrome in Korean adolescents aged 17~19 years. METHODS: Data (body mass index, waist circumference, and height) and blood samples were obtained from adolescents in A University Hospital in 2011. This study included 554 adolescents (176 boys and 378 girls) aged 17~19 years. Dependent variables were systolic and diastolic blood pressure, fasting blood glucose (FBS), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Using the Pearson's correlation analysis and logistic regression analysis, we measured the WHtR against Body mass index (BMI). RESULTS: An assessment was carried out of the ability of the 2 indexes to 1) account for the variability in each metabolic risk factor and 2) correctly identify adolescents with metabolic risk factors. The results revealed that the predictive abilities of the waist-to-height ratio index were better values. The waist-to-height ratio showed superior values in predicting concentrations of DBP, FBS, TC, TG and LDL-C. However, BMI showed better values in identifying adolescents with high systolic blood pressure and HDL-C. 3) Normal weight adolescents (BMI: 5th or =0.51 in male, > or =0.49 in female). WHtR was better than the BMI index for signaling metabolic risk in the normal-weight adolescents. CONCLUSION: The WHtR is a better predictor for finding metabolic risk factors in adolescents aged 17~19 years with normal BMI. The WHtR is proposed as an alternative, convenient measure of screening metabolic syndrome for adolescents aged 17~19 years independent of age and sex.

Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients / 임상소아혈액종양

BACKGROUND: The useful tools for early diagnosis and diagnostic criteria need to be developed for controlling invasive aspergillosis (IA) which causes life-threatening conditions in high risk group such as immunocompromised hematology-oncology patients. METHODS: 103 cases of suspected IA on the ground of pathologic or Aspergillus Galactomannan (AG) test from March 2006 to March 2011 were reviewed. The patients with IA was classified into 4 groups 'Proven', 'Probable', ('Probable-1'), 'Possible' and 'Non' based on the criteria of European Organization for Research and Treatment of Cancer/Mycoses study Group (EORT/MSG) 2008 (and 2002). RESULTS: Of the 103 patients who underwent AG test, 16 cases were diagnosed as IA; 2 'Proven', 9 'Probable', 5 'Probable-1' and 4 'non' (false-positive). Underlying diseases were acute lymphoblastic leukemia (N=8), acute myeloid leukemia (N=5), severe aplastic anemia (N=4), neuroblastoma (N=2) and non-Hodgkin lymphoma (N=1). Risk factors were severe neutropenia for 10 days (80%), prolonged use of steroid (70%), receipt of an allogeneic stem cell transplant (45%) and treatment with immunosuppressants (40%). Major involved organs of IA were lung (N=15) and sinus (N=1). Overall sensitivity, specificity, positive predictive value and negative predictive value of the AG test were 94%, 95%, 79% and 99%, respectively. The mortality of 16 patients with IA was 50%. CONCLUSION: A combined use of the AG test and modified criteria of EORT/MSG 2008 allows not only early diagnosis but also prompt classifying risk groups of IA so that proper antifungal agents were used in pediatric hematology-oncology patients.

Adolescent menstrual disorders / 소아과

The age of puberty represents a very critical time in the life history of every young woman. The menarche stands as primary indicator of the onset of sexual maturation in females. By late adolescence, 75% of girls experience some problem associated with menstruation. Delayed, irregular, painful, and heavy menstrual bleeding are leading reasons for physician office visits by adolescents, and dysmenorrhea is the leading reason for school absenteeism among girls. This article discusses normal menstrual function during adolescence, then reviews the clinical presentation, evaluation, and management of adolescent dysmenorrhea, dysfunctional uterine bleeding, amenorrhea, and polycystic ovary syndrome.

Serum IGF-I and IGFBP-3 in 919 Healthy Korean Children and Adolescents: Normal Values and Correlations with Age, Sex, Height, Body Mass Index and Bone Age / 대한소아내분비학회지

PURPOSE: IGF-I and IGFBP-3 are usually used for the diagnosis of growth hormone deficiency. Until now we don't have normal values of IGF-I and IGFBP-3 in Korea. Therefore, we evaluated the normal values of IGF-I and IGFBP-3 in healthy Korean children and adolescents and compared with reference values in Pediatric endocrinology which was published by the Korean society of pediatric endocrinology. We also evaluated correlation of age, sex, height, body mass index and bone age with serum IGF-I and IGFBP-3 levels. METHODS: We studied the serum levels of IGF-I and IGFBP-3 in 919 and 686 normal healthy children and adolescents respectively who were examined for the growth evaluation at the department of Pediatrics, Ajou University Hospital from January, 1994 to September, 2004. IGF-I and IGFBP-3 were measured using IRMA method. RESULTS: Serum levels of IGF-I and IGFBP-3 were increased with age from early childhood into adolescence. Serum IGF-I correlated significantly with age, sex and BMI but serum IGFBP-3 correlated significantly only with age and sex (P<0.05). IGF-I levels in our data were lower than reference values in Pediatric Endocrinology during early childhood but were higher in puberty. IGFBP-3 levels were higher throughout childhood and puberty. CONCLUSION: There was a significant difference between our data and reference values which were evaluated in U.S.A., so longitudinal antegrade large scale study must be undertaken to obtain the normal reference range of healthy Korean children and adolescents. We believe that one should take into account the patient's age, sex, height, BMI and bone age when measuring serum IGF-I and IGFBP-3 levels for the evaluation of short stature.

Growth and Development in Adolescence

No abstract available.

School Health and Physician's Role

Student health is increasingly being recognized as a public health priority because of the high risk of diseases exposed to students in each stage of growth and development. School-based clinics are primary health care centers located on the campuses of schools and offer a variety of services to promote student health, emphasizing medical care, healthy school environment, nutrition services and health education. However, student health problems related to drug abuse, mental health, and sexually transmitted diseases, etc., have been increasing due to social complexity, attainment of higher education and economic growth. Recently, there has been a controversy over the effectiveness of school health programs in dealing with juvenile health and social problems. The gravity of the situation lies in the fact that health problems generally encountered in middle and high school students occur more frequently in elementary school children. Therefore, in order to strengthen student health programs, health services that assess, promote and protect student health need to be designed to ensure access and referral to primary health care services in the community by establishing close networks with community physicians and making use of the available facilities and resources.

Anti-cardiolipin Antibody and Coagulopathy in a Patient with Kawasaki Disease Complicated by Meningitis / 대한소아혈액종양학회지

Antiphospholipid antibodies are a family of autoantibodies directed against certain phospholipids or phospholipid-binding proteins. Antiphospholipid antibody syndrome can occur as a secondary event to an underlying autoimmune disease, most commonly systemic lupus erythematosus and also occur in certain infectious diseases and drug reactions. We experienced a patient with Kawasaki disease who had anticardiolipin antibodies accompanied by coagulation abnormalities. A 4-month-old female patient was admitted due to fever, irritability, lymph node swelling on the right submandibular area and maculopapular skin rashes on trunk and both extremities. She had prolonged activated partial thromboplastin time (aPTT). Further investigations revealed a positive anticardiolipin antibody detected by ELISA. She had right lateral sinus thrombosis on parieto-occipital area on brain MRI and thrombotic microangiopathy, resulting in necrosis of toe. She showed considerable improvement in affected skin after dexamethasone treatment for 3 weeks. Thrombosis was resolved completely 2 months later.

Comparison of child behavior checklist between allergic and non-allergic patients / 천식및알레르기

BACKGROUND AND OBJECTIVE: There have been several reports suggesting close relationships bet- ween problem behavior syndrome scale and/or social competence scale and pediatric allergic disorders such as bronchial asthma and atopic dermatitis. The aim of the present study was to confirm these relationships. We compared the behavioral symptoms and social competence scale between allergic and non-allergic patient groups using Korean-Child Behavior Checklist (K- CBCL). MATERIALS AND METHOD: One hundred and seventy-one subjects(aged 4-11 years) were enro- lled in this study. Allergy patient group(N=84) was divided into 4 subgroups, according to the allergic diseases such as atopic asthma(Group 1, BA), allergic rhinitis(Group 2, AR), atopic dermatitis(Group 3, AD), and chronic urticaria(Group 4, CU). Eighty-seven non-allergic patients (Group 5, NA) included those with pediatric general disorders, except psychomotor retardation, neurologic deficit, malignancy or other chronic disorders. K-CBCL which was filled in by parents or guardian, included eight dimensions of problem behavior: withdrawal, somatic problems, anxiety/ depression, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. The first three scales were classified as an Internalizing broadband group and the last two scales as Externalizing group. In addition, the questionnaire included social scale, school scale, and total competence scale. RESULTS: There were no significant differences in age, sex, social economic status between 5 subgroups of allergic and non-allergic patients(p>0.05). The mean problem behavior scores tended to be higher in allergic patient group, but no statistical significance was noted(p>0.05). The mean school scale, social scale, total competence scale of allergic patient group were not significantly higher than those of non-allergic patient group(p>0.05). Combined disease group with more than 2 allergic disorders showed problem behaviors compared to non-allergic group or asthma only group. Total social competence scale was lower in allergic patient group with 1-3 years of disease duration than for shorter(less than 1 year) and longer(more than 3 years) durations. CONCLUSION: Taken together, combined disease group and allergic disease group with 1-3 years of duration showed more problem behaviors and the lowest total social competence scales, respectively.

The Significance of Buckwheat Chaff Stuffed Pillow on the Sensitization to Buckwheat in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Buckwheat flour (BF) is known as a potent food allergen. Its sensitization usually occurs by ingestion, but also by inhalation due to occupational or domestic exposure. We underwent this study to identify an effect of buckwheat chaff stuffed pillow (BCP) exposure on sensitization to BF and clinical BF allergy in asthmatic children. METHOD: We obtained detailed history of BCP exposure in 36 asthmatic children (aged 0.7-14.2 years). We also performed RIA for specific IgE, BCP-elimination-provocation test. All subjects were divided into 3 groups, Group I (continuous BCP exposurers, n=13), Group II (previous exposurers, n=11), and Group III (non-exposurers to BCP, n=12) and all subjects had no history of ingestion of BF containing foods. RESULTS: In the 13 Group I cases, the durations of BCP exposure were 1-6 years, and 8 of them were users of BCP themselves, 5 were indirect exposurers by family members' BCP. The positive rates of BF specific IgE were 92.3, 36.4% and 8.3% in the Group I, II and III, respectively (Chi-square test, P<0.05). While the positive rates of house dust mites specific IgE were not significantly different among three groups. Twelve out of 13 Group I cases sensitized to BF, and 9 of those 12 were not sensitized to house dust mites. Eight out of 13 Group I cases were positive in BCP elimination-provocation test, during 6-24 month follow-up periods, 7 of them were managed effectively by BCP elimination only. CONCLUSION: Taken together, a small amount of BF attached to BCP can induce BF sensitization and BCP can be a major cause of childhood nocturnal asthma.

A Study on the Cross-allergenicity between Buckwheat and Rice Flour Using IgE-immunoblot Inhibition and ELISA-inhibition Test / 소아알레르기및호흡기학회지

PURPOSE: Buckwheat is one of the potent allergenic foods, whereas rice is considered as the safest and hypoallergenic food in Korea. However rice can be a causative food allergen, and several report about allergic reactions to rice in Japan. And it is partially true that there is some cross-allergenicity among cereal allergens such as buckwheat, barley, wheat, rice. So, we should consider a false positive reaction to rice during allergic skin tests, especially in cereal allergic patients. We found that a part of buckwheat allergic children showed positive skin reactions to rice antigens, without any allergic reactions after rice ingestion. Therefore the positive skin test results to rice were considered as the false positive reactions due to cross-allergenicity with buckwheat allergen. To evaluate this possibility, we undertook this study. METHODS: To evaluate the cross-allergenicity between rice and buckwheat antigens. With the buckwheat sensitive sera and crude extracts of buckwheat flour and rice flour obtained in Korea, we carried out SDS-PAGE analysis, IgE immunoblot, IgE-immouoblot inhibition test and ELISA inhibition test. RESULTS: Buckwheat extract showed more than 13 antigenic bands and rice extract showed more than 9 bands by SDS-PAGE analysis. IgE immunoblot revealed at least 20 IgE-binding components (ranged 120-4 kDa) with buckwheat extract. IgE-binding capacity of 22 kDa buckwheat component was markedly inhibited by rice extract and 8 kDa component was inhibited slightly. Using IgE ELISA inhibition test, we confirmed buckwheat IgE-ELISA was profoundly inhibited by rice extract, and 50% inhibition was shown in 10-100 ug/ml concentration of rice extract. CONCLUSION: Taken together, the positive reactions to rice antigen would be shown by the result of cross-allergenicity of rice with buckwheat antigen.

A Survey on the Adolescent Health Care in Pediatric Practice

PURPOSE: This study was designed to establish standard guidelines to meet the growing health care needs of adolescents by direct assessment of pediatricians' current practices, attitude and obstacles to the primary care of adolescents. MEHTODS: A questionnaire consisting of 9 questions, including personal characteristics of respondents, current health care practice of adolescents, attitude, obstacles to providing adolescent care, interest in further training, roles of Korean Pediatric Society for adolescent medicine, etc., was completed by 214 pediatricians. RESULTS: Among the respondents, 87.4% were in the 4th or 5th decade of age, and 88.8% of respondents were working for private clicins. More than 60% of respondents were managing patients without age limits. Most of the respondents were interested in adolescent medicine. However, approximately one half of all respondents answered that they could not currently provide satisfactory care to their adolescent patients. Obstacles to providing adolescent care include : their image as "baby doctors", lack of knowledge and skills in adolescent medicine, lack of separate hours for adolescents and concern that parents would object to certain types of care. Among respondents who wanted to further training, many were interested in Continuing Medical Education(CME) course, lecture series, introducing reading lists and publishing textbooks, while others expressed their interest in a newsletter and mini-fellowship. Respondents expected the Korean Pediatric Society to play a role in activating the adolescent medicine as a field for pediatric practice through educating adolescents, pediatricians and advertising via mass media. CONCLUSION: Future policy decisions and medical education must respond to these realities in pediatric practice.

Molecular Diagnostic Test for Prader-Willi Syndrome with SNRPN Expression / 대한소아내분비학회지

PURPOSE: Prader-Willi Syndrome(PWS) is caused by absence of paternal contributions of the chromosome region 15q11-q13. To detact this region, high resolutional cytogenetic analysis, FISH with probe at PWS critical region or microsatellite polymorphism can be used. The gene for the small nuclear ribonucleoprotein polypeptide N(SNRPN) is not expressed in patients with PWS. We conducted molecular analysis with RT-PCR with SNRPN primers to find out more useful diagnostic tool in PWS. METHODS: Four patients with obesity and other characteristics of PWS were studied. The exprssion of SNRPN and control gene were studed by RT-PCR from peripheral lymphocytes. RESULTS :The SNRPN expression in reverse transcribed RNA from blood were easily detected in normal control but not in patients with suspected Parder-Willi Syndrome. CONCLUSION: We conclude that SNRPN expression study is a useful diagnostic method for detection of Prader-Willi Syndrome.

Isolated Native Valve Endocarditis on Tricuspid Valve: A Case Report / 대한흉부외과학회지

Native valve endocarditis (NVE) without preexisting structural valve or congenital cardiac malformation especially in pediatric group is rare. A case of isolated tricuspid valve endocarditis in a 7-year-old child without any cardiac malformation is described. This child had suffered from fever and productive cough for 3 weeks. Blood culture grew Staphylococcus aureus. Fever was not controlled even with proper antibiotic treatment. Transthoracic echocardiogram and lung perfusion scan revealed a large vegetation on the tricuspid valve with multiple embolism Surgical procedures included vegetectomy partial cusps resection and pericardial patch valvuloplasty. Th patient was in NYHA class I during follow up.

Meckel-Gruber syndrome

Meckel-Gruber syndrome is a multiple malformation syndrome featuring occipital meningoencephalocele, multicystic dysplasia of kidney, cystic and fibrotic change of liver, polydactyly, and other characteristics inherited by the autosomal recessive trait. We exprienced a case of Meckel-Gruber syndrome in a newborn male diagnosed clinically and confirmed pathologically. Abnormalities of the fetus were found prenataly by ultrasonogram, and subsequently the baby was terminated by cesarean section delivery at 32 weeks of gestational age. We report this case with brief review of literature.

Carrier Rate in Normal Korea School Children in 1996

PURPOSE: The accuracy of bacteriologic diagnosis of beta-hemolytic streptococcal pharyngoton sillitis depends on the degree of carrier rate in that area. It is the purpose of this study to obtain the carrier rate from seven different areas and to find results and epidemiologic factors. METHODS: Throat swab was obtained from the tonsillar fossa of normal school children during March through May 1996. It was then plated on a 5% sheep blood agar plate and incubated overnight at 37 degrees C before examination for the presence of beta-hemolytic colonies. RESULTS: The carrier rate of beta-hemolytic streptococci and group A streptococci were 27.6%, 20.0% at Uljin; 16.3%, 6.3% at Checheon; 16.4%, 2.7% at Seoul; 12.8%, 3.4% at Masan; 33.0%, 26.0% at Osan; 20.0%, 12.3% at Kunsan; and 17.7%, 11.4% at Chongju, respectively. Among 2,159 normal school children from 7 different areas, we obtained 450 plates of beta-hemolytic streptococci. Osan had the highest carrier rate (33.3%) and Masan had the lowest rate (12.8%) of beta-hemolytic streptococci. Among 450 plates of beta-hemolytic streptococci, we obtained 265 strains of group A streptococci. Osan had the highest carrier rate (26.0%) and the Seoul had the lowest rate (2.7%) of group A streptococci. CONCLUSION: Higher carrier rates were found in Uljin and Osan, where there is a lower population density. We supposed that low carrier rates might be related to antibiotic abuse or some epidemiologic factor should be investigated.

Pollen Allergy in Children (ll): The Significance of Tree Pollen As a Causative Allergen in Children with Allergic Diseases

PURPOSE: The positive rates of allergy skin test of pollens are relatively higher in children in Suwon compared to other areas in Korea. To evaluate the significance of tree pollen as a causative allergen, we undertook this study. METHODS: In 252 children with asthma, scratch tests were done with 72 extracts, including 9 tree pollen. Antigen specific serum IgE antibodies were measured by radioimmunoassay. In 2 children, birch-bronchial challenges were performed. RESULTS: By allergic skin tests, 231 of 252 children showed positive skin reactions to more than 1 antigen, and 102 (44.2%) showed positive reactions to tree pollen extracts. Twenty-five (24.5%) were house dust mites non-sensitive, tree pollen sensitive children. The skin test positivity to individual antigens are as follows : D. pteronyssinus (72.7%), D. farinae (68.4%), hazel (53%), willow (53%), birch (19.9%), oak (19.5%), beech (17.3%), alder (10.4%), ash (8.7%) and elm (7.4%). The degree of skin reaction to tree pollen was relatively weaker than those of house dust mites. The positive concordance rates between skin tests and specific IgE reactions to D. pteronyssinus, D. farinae and tree pollens were 94.4%, 77.3% and 64.1%, respectively. Seven out of 25 mite non-sensitive children had seasonal pollinosis and 2 children experienced early asthmatic responses due to birch-bronchial challenge tests. CONCLUSION: Up to 44.2% of children with respiratory allergy showed positive reactions to tree pollen extracts and 24.5% of them were house dust mites non-sensitive cases. Therefore, tree pollen should be investigated as a causative allergen, regardless of a patient's age.

A Case of FGFR2 Exon lllc Mutation in Crouzon Syndrome

Crouzon syndrome, an autosomal dominant disorder, has characteristic features of craniosynostosis, hypertelorism, exophthalmos, maxillary hypoplasia and relative mandibular prognathism. Mutations of fibroblast growth factor receptor 2 (FGFR2) gene are associated with craniosynostotic conditions, such as Crouzon syndrome, Jackson-Weiss syndrome, Pfeiffer syndrome, Apert syndrome and Beare-Stevenson cutis gyrata. We found one child with common morphological features of Crouzon syndrome. Interestingly, she was found to have Cys342Ser mutation in FGFR2 exon lllc which has been previously observed in Jackson-Weiss syndrome. This finding supports the variable expression of FGFR2 in human and allelic heterogeneity in these apparently clinically distinct craniosynostotic conditions.

Comparison of Antigenicities of Whole Milk and Partial Hydrolysate of Cow's Milk Proteins by Western Blot Analysis / 소아알레르기및호흡기학회지

For the prevention or the management of milk allergy in infancy, partial or extensive hydrolysates of cow's milk have been used in western countries for a couple of decades. Recently a Korean product of partial hydrolysate(HA-21) became available for the prevention of sensitization to cow's milk proteins. In this study, to compare the antigenicities of whole milk(WM) and HA-21, we performed the IgG and IgE western-blot analysis. Sera were obtained from 17 milk sensitive infants and 2 controls, and crude extract of WM and HA-21 and purified beta-lactoglobulin(BLG), bovine serum IgG(B-IgG), alpha-lactalbumin(ALA) were used for blot- inhibition study. After the non-reduced SDS-PAGE, western-blot studies were done using biotinylated anti-human IgG and IgE antibodies, and the reaction were detected by avidine-phosphatase system. By the SDS-PAGE analysis, WM were separated into bovine-IgG(B-IgG), bovine serum albumin(BSA), 56 KD protein, caseins(CAS), BLG and ALA, but there was no visible bands above 14 KD in the case of HA-21. In preliminary blot analysis with 4 milk sensitive sera, we found the broad and strong IgE-binding protein band in the range of 150-200 KD in all cases. This fraction, named as 'P-band' in this study, was completely inhibited by BLG and partially inhibited by B-IgG using blot-inhibition study. Using the western blot analysis of WM, the P-band revealed the most prevalent IgG and IgE binding protein in 16 of 17 tested sera. More than 15 bands were identified by IgG-blot of WM, but the IgE biding proteins were P-band(16 sera), BSA(12 sera), 56 KD protein(8 sera), and CAS(5 sera). In the case of HA-21, BSA(8 sera) was the only protein bound with IgE antibody and the reaction was very weak compared to that of WM. In conclusion, the major IgE binding protein appears to be the p-band which might contain the epitopes of B-IgG and BLG in this study. The antigenicity of HA-21 is remarkably reduced compared to WM, but still minute residual antigenicity and allergenicity are remained in the extract of HA-21.