Effect of Egg White Elimination Diet on Clinical Progress and Specific IgE Levels in Egg White Sensitized Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Food allergies play a major role in childhood atopic dermatitis. Egg white is the most common causative allergen in IgE mediated food allergies, and the only treatment is complete elimination of egg white from diet. The purpose of this study is to evaluate the effect of an egg white elimination diet on clinical progress and egg white-specific IgE concentration in childhood atopic dermatitis. METHOD: In 20 children with mild to severe atopic dermatitis, clinical progress was monitored by Jakob's atopic dermatitis grading system, and serum specific-IgE levels to six common food allergens and two house dust mites were measured by CAP-FEIA. RESULTS: In the study subjects, eight patients had been exposed to egg before diagnosis. During the six to 48 months of egg white elimination diet, clinical symptoms and signs were improved in 15 out of 20 patients. However, egg white-specific IgE levels were reduced by less than 1.20 kU/L (the cut off level suggesting immunological tolerance) in only seven patients. In the five patients with clinically persistent atopic dermatitis, egg white-specific IgE levels were 10.6-100 kU/L and house dust mite-specific IgE levels were 25.9-100 kU/L at the time of final examination. CONCLUSION: After 6-48 months of the egg white elimination diet, 75% of egg allergic infants and children with atopic dermatitis showed clinical improvement of atopic dermatitis. However, it is suggested that the patients need more than 1-3 years of a complete elimination diet to obtain immunological tolerance determined by egg white-specific IgE levels.

Reduced allergenicities of irradiated egg white ovalbumin determined by skin prick test and ELISA inhibition test / 천식및알레르기

BACKGROUND: Hen's egg is the most frequent cause of food hypersensitivity in infants and young children. The major egg white(EW) proteins are ovalbumin(OVA), ovomucoid(OM), ovotransferrine, and lysozyme. OVA and OM have been generally considered to be the most allergic EW proteins. Food irradiation has been permitted in the fields of agriculture and food handling. Currently, it was suggested that the binding ability of specific IgE to gamma-irradiated OVA was rapidly decreased depending upon the irradiation dose. OBJECTIVE: The purpose of this study is to evaluate the application of food irradiation technology as a method for reducing the allergenicities of EW proteins. METHODS: A total of 10 egg-allergic patients less than 24 months of age were enrolled in this study. OVA was gamma-irradiated at 10 kGy in an aqueous state(2.0 mg/mL). Skin prick test and ELISA inhibition test were done to compare the IgE binding capacities before and after irradiation of OVA. RESULTS: One hundred percent of patients showed positive skin reactions with EW and native-OVA. Negative skin reactions to irradiated-OVA were observed in 7 of 10 patients and remainder 3 showed reduced skin reactions(p=0.001). In IgE-ELISA inhibition test, the IgE-binding capacities of irradiated-OVA reduced 1/80 (50% inhibition concentration: native-OVA-0.1 microgram/mL, irradiated-OVA-8 microgram/mL), respectively. CONCLUSION: We suggest that the allergenicity of OVA can be reduced by the treatment with gamma irradiation.

A Study on the Animal Epithelium as A Causative Allergen in Children with Asthma and Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The exposure to domestic animals has been increased, but there is no systematic evaluation for the clinical importance of animal antigens in Korea. The purpose of this study is to evaluate the significance of animal epithelial antigens as the causative allergens in childhood asthma and rhinitis. METHODS: In 228 children with asthma and rhinitis, allergic skin tests were done with 72 extracts, including 5 animal epithelial antigens. RESULTS: According to the results of allergy skin tests, 208 out of 228 children showed positive skin reactions to more than one antigens, and 128(61.4%) showed positive reactions to animal epithelial extracts. Among them, 17(8.1%) were mites non-sensitive to house dust and sensitive to animal epithelium. The positive reaction to each antigens were as follows:D. farinae(72.6%), D. pteronyssinus(69.7%), rabbit(40.3%), cat(33.1%), dog(24.0%), horse(16.8 %), and cow(14.9%). The degree of skin reactions to animal epithelial antigens were weaker than those to house dust mites. The positive concordance rates between skin tests and specific IgE reactions to D. pteronyssinus and cat/dog were 89.1%, and 25.9%, respectively. We experienced six patients with asthma and rhinitis who suspected animal epithelium as a causative allergen. CONCLUSION: Up to 61.4% of children with respiratory allergy showed positive reactions to animal epithelial extracts and 8.1% of them were house dust mites non-sensitive cases. Therefore, animal epithelium should be investigated as a causative allergen when skin reactions were strong and showed positive specific IgE antibodies.

Age-dependent changes of B cell and T cell-mediated immune responses in naive C3H/HeJ mice under regular mouse chow feeding conditions / 천식및알레르기

BACKGROUND AND OBJECTIVE: Murine system for studying allergic diseases has been popular in the fields of food allergy and development of their therapeutic strategies. However, there has been no information about the age-dependent changes of natural immune responses of naive C3H/HeJ mice. The purpose of this study was to evaluate the age-dependent changes of B and T-cell mediated immunologic parameters in naive C3H/HeJ mice, which can provide information for experimental planning and analysis of research results. SUBJECTS AND METHODS: Eight naive, female, 5-week-old C3H/HeJ mice were grown under the regular mouse chow feeding conditions for 6 weeks. Sera were obtained at week (w) 5, w6, w8 and w10 for measuring total and chow-specific IgE, IgG1 and IgG2a antibodies. Splenocyte proliferation (at w8 and w10) and cytokine production (at w6, w8 and w10) were evaluated with or without Con A stimulation with pooled splenocytes from two mice of each age group. Serum antibodies and cytokines (IL-4, IL-5, IL-12, INF-gamma, TGF-beta1) were measured by ELISA. Using RT-PCR, IL-4 and INF-gamma mRNA expressions were measured in Peyer's patch and spleen tissue at w10. RESULTS: The levels of total IgE and IgG1 were increased by age while the level of IgG2a was decreased. Chow-specific IgE and IgG2a responses were neglectable through out the whole experimental period (20-30 ng/ml or less). Chow-specific IgG1 levels were measured in the significant concentrations (200-300 ng/ml) but there was no age-dependent change through out the experiment. Con A stimulated-splenocyte proliferation indexes were variable according to the culture-durations and ages of mice. The higher proliferation indexes were observed in the wells receiving thymidine pulse at 48-hour culture, especially in the mice at w10. Con A stimulated IL-4 production in the 72-hour splenocyte culture supernatant was significantly increased at w8, and w10 while INF-gamma production increased only at w10. The changes in the production of IL-5, IL-12 and TGF-beta did not provide significant information in the present study. The ratio of IL-4/IFN-gamma mRNA expression was higher in Peyer's patch than in the spleen. CONCLUSION: The changes of B-cell and T-cell mediated immunologic parameters were complex and variable according to the age in naive C3H/HeJ mice under regular chow feeding conditions. For that reason, the information from the present study needs to be considered in the course of planning or analysing research/data using murine systems.

IgE and IgG Immunoblot Patterns to Three Major Egg Allergens : According to the Routes of Sensitization in Atopic Children(<3 Years Old) / 소아알레르기및호흡기학회지

PURPOSE: Atopic dermatitis is a chronic, inflammatory relapsing skin disease fre- quently seen in children with a history of food allergy. Recently, acute allergic reaction to egg in patients with atopic dermatitis who have never been exposed to egg white protein has been reported. The pattern of antigen-antibody reaction by means of IgE and IgG western blotting was analysed to evaluate the possibility of non- dietary sensitization. METHODS: Total 16 children(<3 years old) with egg allergy were enrolled. Eight patients of them had never ingested egg before(Non-dietary sensitization, NDS) and the other 8 patients had a history of previous egg ingestion without significant clinical symptoms(Dietary sensitization, DS). Egg proteins were analysed by SOS-PAGE and antigen-antibody reaction by means of IgE and IgG was deteded by Western-Blotting. RESULTS: The pattern of IgE antibodies to egg white protein were similar in the two groups. IgG Western blotting to egg white in the two groups, the ovotran sferrine and ovalbumin were significantly bound by 100% of sera, respectively. In DS patients, specific IgG antibodies to ovomucoid was significantly bound by 87% (7/8) of sera whereas only 38%(3/8) of sera had detectable specific IgG antibodies against ovomucoid in NDS patients. CONCLUSION: Theses results suggest that specific IgE to egg white related to exposure of egg white protein regar specific IgG to ovomucoid is related to dietary ingestion of egg. Specific IgG to ovalbumin and ovotrans-ferrine show good clinical correlation, further study might be essential to clarify to this hypothesis.

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 Clinical Study of Foreign Body Aspiration in Children in Suwon-Kyungki Province / 소아알레르기및호흡기학회지

PURPOSE: Foreign bodies in the airway of infant and children require prompt diagnosis and removal. To evaluate the pattern of clinical characteristics and disease course, we reviewed and analyzed a 6-year experience with pediatric airway foreign bodies in children. METHODS: We retrospectively reviewed the medical records of pediatric foreign body aspiration managed by pediatric and otorhinolaryngologic departments of Ajou University Hospital from November 1994 to October 2000. Nineteen cases of aspiration were collected and we analyzed their age, sex, symptoms, duration between onset of symptoms and diagnosis, initial simple radiographic findings, matierials of aspirations, anatomic location of foreign body, length of hospital day, and complications. RESULTS: The mean age was 2.7 years and male-to-female ratio of 1.8 : 1. In 11 cases, choking episode was identified by parents or patients. The correct diagnosis was made within first 24 hours of aspiration in 4 patients; while in 15 cases, the proper diagnosis was done after 24 hours. The most common presenting symptoms were cough (73.6%) and decreased breath sounds (57.9%) and the most common initial finding of simple radiographs was emphysema, presented in 68.4% of patients. Vegetable substances, particularly peanuts were the most common material of identified foreign body. Nine foreign bodies were in the right bronchus, 8 in the left bronchus and 2 in the subglottic area. The mean duration of admissions were 3.75 days in pateints who were diagnosed within 24 hours, however, 8.61 days in those with a delayed diagnosis (P=0.012). CONCLUSION: Taken together, the majority of accidental foreign body aspiration in airway was found under 3-year of age. Pediatricians and parents should be conscious to check for history of foreign body aspiration who have suspicious clinical features of aspiration, for early diagnosis and proper management without complications and long term morbidity.