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.

Incidence of Vesicoureteral Reflux and Renal Scar in Asymptomatic Siblings of Patients with Primary Vesicoureteral Reflux

PURPOSE: Vesicoureteral reflux(VUR) is known to be the main cause of childhood hypertension and renal failure. Knowing its familial occurrence, we determined the incidence of VUR and renal scar in asymptomatic siblings of Korean patients with primary VUR. METHODS: A total of 50 siblings from 37 index patients were included. Voiding cystourethrography(VCUG) and renal scintigraphy using 99mTc-DMSA were performed in these siblings from June, 1994 to May, 2001. Index patients were classified into two groups according to the presence of VUR in their siblings, and the clinical factors of the index patients such as age, sex, grade of reflux and renal cortical defect were compared between the groups. RESULTS: Among the 50 siblings, VUR were found in 8(16%) and renal cortical defects were detected in 8(16%) siblings respectively. The incidence of renal cortical defects was 87.5%(7 out of 8) in the VUR(+) siblings. There was a case of VUR(-) cortical defect in one sibling, presumed as a scar from an old VUR. There was no relationship among age, sex, grade of reflux and renal cortical defect of the index patient to the presence of VUR in siblings. CONCLUSION: This study confirmed a significant incidence of VUR(16%) and renal cortical defects(16%) in the asymptomatic siblings of patients with primary VUR in Korea. It is resonable to recommend screening studies to the siblings of patients with VUR for the early detection and prevention of probable reflux nephropathy.

Incidence of Vesicoureteral Reflux and Renal Scar in Asymptomatic Siblings of Patients with Primary Vesicoureteral Reflux

PURPOSE: Vesicoureteral reflux(VUR) is known to be the main cause of childhood hypertension and renal failure. Knowing its familial occurrence, we determined the incidence of VUR and renal scar in asymptomatic siblings of Korean patients with primary VUR. METHODS: A total of 50 siblings from 37 index patients were included. Voiding cystourethrography(VCUG) and renal scintigraphy using 99mTc-DMSA were performed in these siblings from June, 1994 to May, 2001. Index patients were classified into two groups according to the presence of VUR in their siblings, and the clinical factors of the index patients such as age, sex, grade of reflux and renal cortical defect were compared between the groups. RESULTS: Among the 50 siblings, VUR were found in 8(16%) and renal cortical defects were detected in 8(16%) siblings respectively. The incidence of renal cortical defects was 87.5%(7 out of 8) in the VUR(+) siblings. There was a case of VUR(-) cortical defect in one sibling, presumed as a scar from an old VUR. There was no relationship among age, sex, grade of reflux and renal cortical defect of the index patient to the presence of VUR in siblings. CONCLUSION: This study confirmed a significant incidence of VUR(16%) and renal cortical defects(16%) in the asymptomatic siblings of patients with primary VUR in Korea. It is resonable to recommend screening studies to the siblings of patients with VUR for the early detection and prevention of probable reflux nephropathy.

Reflux Nephropathy Detected by Post-voiding Image on Scintigraphic Tc-99m MAG3 Scan

99mTc-MAG3 Scintigraphic Scan is sensitive at depicting focal parenchymal abnormalities and can be used for the measurement of overall renal function. We experienced a 12-year-old girl presenting with fever and flank pain. On the ultrasonogram and post-voiding delayed image of 99mTc-MAG3 scintigraphic scan, severe right cortical atrophy and hydronephrosis with vesicoureteral reflux were detected. We could demonstrate the reflux nephropathy by these two diagnostic work-up without conventional voiding cystourethrography.