A case of acetaminophen induced anaphylaxis without aspirin sensitivity / 대한내과학회지

Acetaminophen is a world-wide used analgesic and anti-pyretic drug with less anti-in-flammatory effect, available without prescription in most countries. Allergic-like reactions to this drug, including urticaria, angioedema, and anaphylactic reactions have only rarely been reported. This report describes a systemic reaction to acetaminophen documented by oral provocation test in a 30-year-old female patient with a history of anaphylaxis associated with acetaminophen use, in a subject who tolerated aspirin. After an oral challenge with 108.3 mg of acetaminophen, the subject had itching sensation of tongue. With a dose of 162.5 mg (cumulative dose 270.8 mg) acetaminophen, systemic urticaria and rash developed. Also, hand and facial angioedema and chest tightness were noted. Significant change of FEV1 was not noted. But, this patient has bronchial hyperresponsiveness. A rare acute hypersensitivity reaction to acetaminophen without aspirin sensitivity is described in this study. The results of study suggest an other mechanism rather than inhibition of cyclooxygenase as responsible.

Comparison of Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test for detecting specific IgE in atopic patients / 천식및알레르기

BACKGROUND AND OBJECTIVE: Auro Dex(R) Visual ENS(TM) allergy screening test is a simplified and newly developed method for the detection of allergen-specific IgE in human serum. This system has advantages in several ways compared to the Pharmacia CAP system, such as the need for relatively small amounts of serum, no expensive equipment and rapid detection. The purpose of this study is to evaluate the efficiency of Auro Dex(R) Visual ENS(TM) screening test for the detection of specific IgE compared to the Pharmacia CAP system in atopic patients. METHOD: In 27 atopic patients (M:F = 11:16, age:13-51 years, average 27.9+/-10.2 years) who had positive response on skin prick test, the Pharmacia CAP system for the sensitized allergen and Auro Dex(R) Visual ENS(TM) screening test were performed. For comparison, 5 normal subjects who had negative response on skin prick test were tested for 5 allergens(Dermatophagoides(D) farinae, D. pteronyssinus, cockroach, dog epithelium, cat epithelium) by the Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test. RESULTS: Using skin prick test results as the reference standards, the sensitivity of the Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test was 87.5%, 57.1%, respectively. The specificity of Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test were 100%. There was a significant correlation between the Auro Dex(R) Visual ENS(TM) and CAP system (D.f. r=0.755, D.p. r=0.856) for D. farinae and D.pteronyssinus. CONCLUSION: Auro Dex(R) Visual ENS(TM) screening test showed high specificity for detection of allergen-specific IgE and good correlation with the Pharmacia CAP system. This system may be useful in general practice. However, due to relatively low sensitivity to some antigens compared to skin prick test, further development may be necessary.

The effect of Der p 2 antigen on the production of interferon gamma by CD3+T, CD56+NK and CD3+CD56+TNK cells from patients with mild persistent allergic asthma / 천식및알레르기

BACKGROUND: Asthma is a chronic inflammatory disease of the bronchial mucosa and is associated with excess production of Th2 cytokines (IL-4, IL-5) relative to Th1 cytokine (IFN-V). The NK cell and TNK cell are supposed to be involved in the pathogenesis of allergic inflammation by cytokine regulation. OBJECTIVES: The aim of this study was to investigate the effect of allergen (Der p 2) on the production of IFN-V by CD3+T cell, CD56+NK cell and CD3+CD56+TNK cells in patients with mild persistent asthma. METHOD: Peripheral blood mononuclear cells (PBMCs) from patients with mild persistent asthma (n=12) who were sensitive to dust mite, were cultured with or without Der p 2 for 3 days, and phorbol ester plus calcium ionophore and intracellular protein transport inhibitor were added 4 hours before staining. A three-color flow cytometric analysis was done to detect intracytoplasmic IFN-V, surface DC3 and CD56 antigen simultaneously. RESULTS: When PBMCs were cultured only in media, there were no significant differences in the percentage of IFN-V positive CD3+T cell, CD56+NK cell and CD3+CD56+TNK cells between asthmatic patients and normal subjects. However, there were significant decreases in the percent change of IFN-V positive CD3+T cell, CD56+NK cell and CD3+CD56+TNK cell in asthmatic patients comparde to normal subjects after stimulation of PBMCs with Der p 2. CONCLUSION: This study suggests that NK cell and TNK cell may participate in allergic reaction by IFN-V regulation.

Giant Aneurysm of a Congenital Coronary Arteriovenous Fistula Arising from the Left Coronary Artery

Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.

A Case of Acute Respiratory Failure Presenting Lobar Consolidation / 결핵

Pulmonary embolism is one of the most common acute pulmonary disease in the adult general hospital populalion. However, the disease is still frequenfly unsuspected and underdiagnosed due to the nonspecifieity of both clinical findings and laboratory tests. The chest radiography in a patient suspected acute pulmonary embolism do not provide adequate information to establish or exclude the diagnosis of pulmonary embolism. Even in the case of infarction, there is no pathognomonic clues on the chest film. Rarely infarction presents unusual roentgenologic manifestation such as lobar consolidation, coin lesion, multinodular opacity, or massive pleural effusion. Especially, lobar consolidation in pulmonary embolism might mislead into the diagnosis of pneumonia. We experienced a case of pulmonary embolism presenting lobar consolidation in a 62 years old woman, originated from deep vein thrombosis. She took a compression stocking and underwent anticoagulant therapy with excellent outcome.

A Case of Dermatomyositis Manifestated by the Paroxysmal Supraventricular Tachycardia

Dermatomyositis is a disease of unknown etiology characterized by inflammation and degeneration of skeletal muscles and cutaneous abnormalities. Cardiac involvement in dermatomyositis-polymyositis is thought to be rare. In recent year, however, there has been an increasing number of reports on cardiac abnormalities in adult dermatomyositis and polymyositis due to development of noninvasive diagnostic techniques. Categorically, these abnormalities have included electrocardiographic changes, cardiac arrhythmias, congestive heart failure, coronary artery disease, and pericarditis. A 56-year-old woman was admittied to the Ewha womans University Hospital with dyspnea and palpitation. She was diagnosed as having dermatomyositis and followed up our department of Dermatology. Electrocardiogram showed a paroxysmal supraventricular tachycardia at as rate of 195/min. The patient was treated with 240mg/day verapamil p.o, 60mg/day prednisone p.o, there was marked improvement of symptoms. Systematic study of cardiac function utilizing echocardiography, Holter monitoring, thallium-201-scan, and gated blood pool studies were conducted in five newly diagnosed patients with dematomyositis-polymyositis. A significant elevation of serum CPK-MB is indicative of cardiac involvement. Cardiac involvement is a serious prognostic sign. We report a case with the review of the literature.