Associations between pollen and allergic rhinitis in children and adolescents

Allergic rhinitis (AR) is a type of rhinitis accompanied by sensitization to allergens. One of the most clinically important allergens is pollen. Recently, due to climate change and CO 2 air pollution, the flowering period starts earlier and persists longer. In addition, antigenicity due to environmental pollution is also being strengthened. As a result, the sensitization rate to pollen antigens is on the rise. It is known that the prevalence of AR especially caused by pollen is rapidly escalating. Although the causal relationship between pollen exposure and the severity of rhinitis is not precisely established, an association of rhinitis symptoms with the time of pollen scattering exists. In addition, the mixed effect of environmental pollution and pollen may play a role in the development of rhinitis symptoms. Therefore, in order to avoid pollen, it is necessary to constantly improve pollen forecast and minimize the contact with pollen indoors and outdoors. Treatment of AR should be performed according to guidelines. Also, continuous efforts to solve the environmental problems affecting the ecology of pollen are needed.

Effects of outdoor air pollution on children with allergic rhinitis

The global worsening of air pollution has decreased the quality of life. Air pollutants can induce oxidative stress, epigenetic changes, and alterations to microRNA expression in the airway and skin, leading to immune dysregulation. Previous epidemiological studies suggest a strong association between outdoor environmental pollution and childhood allergic disease, especially allergic rhinitis (AR). Moreover, traffic-related air pollution has increased the severity and incidence of AR, and heavy traffic has been associated with an increased prevalence of AR. Thus, this review aimed to define outdoor environmental pollution and clarify the mechanisms by which air pollutants aggravate AR. In addition, we performed a systematic review and meta-analysis to summarize the findings of several domestic and international epidemiological and clinical studies about the effects of air pollution on AR in children.

Risk factors and protective factors in pediatric patients with allergic rhinitis

Among allergic diseases of the Korean pediatric population, allergic rhinitis shows the most rapidly increasing prevalence. Its economic burden is substantial in many Asian countries including South Korea. This investigation of its risk factors aims to reduce the socioeconomic burden by blocking exposure of susceptible individuals to identified causes. However, the risk factors of allergic rhinitis varied considerably depending on the seasons, geographical locations, and populations involved. This review article primarily deals with studies on the risk factors for allergic rhinitis in Korean children that were published during the last 10 years and additionally investigates associated large scale international studies. Our investigation identified several single-nucleotide polymorphisms, inhalant allergens, pollution, tobacco smoke, chemicals, and family affluence as risk factors for allergic rhinitis. In contrast, breastfeeding, older sibling, and microbial diversity were protective factors against allergic rhinitis. This suggests that various genetic and environmental factors might affect the manifestation and presentation of allergic rhinitis complexly. These findings are beneficial as they can provide insights into modifiable risk factors that may hinder the development of allergic rhinitis.

Eosinophil activation markers in blood and urine in preterms developing bronchopulmonary dysplasia

Purpose@#Eosinophil-derived neurotoxin (EDN) is not the only a marker for eosinophil activation, but also acts as an alarm protein.Very few studies have examined the potential role of eosinophils in the development of bronchopulmonary dysplasia (BPD). This study aims to address the roles of eosinophil and EDN in the early phase of BPD development. @*Methods@#Patients were preterm neonates with respiratory distress syndrome (RDS) born at 36 weeks of gestation or less. Blood and urine samples were collected to measure total eosinophil count in the blood, serum eosinophil cationic protein (ECP), serum EDN, and urinary EDN during the first week of life. @*Results@#Fifty-two preterms were recruited, of whom 43 infants were analyzed. Comparisons were made between the RDS (n = 16) and non-RDS groups (n = 27) and between the BPD (n = 6) and non-BPD groups (n = 26). There were no differences between RDS and non-RDS group in total eosinophil count, serum ECP, serum EDN, or urinary EDN, except when compared by gestational age, birth weight and prenatal dexamethasone use. Urinary EDN was increased significantly in the BPD group compared to the non-BPD group. @*Conclusion@#We demonstrated the roles of eosinophil and EDN in the development of BPD and suggest that urinary EDN may be utilized as a noninvasive factor predicting the development of BPD.

Main epidemiological characteristics and natural history of pediatric allergic rhinitis

Allergic rhinitis (AR) is one of the most common allergic diseases characterized by stuffy nose, rhinorrhea, sneezing, and itching. Researchers have indicated an increase in the prevalence of AR and younger-age onset during the last few decades. The increasing burden of AR has caused many researchers to investigate time trends of the prevalence of AR and to identify its risk factors. The most commonly used epidemiological studies are cross-sectional ones such as the International Study of Asthma and Allergies in Childhood study and big data from National Health Insurance Service or National Health and Nutrition Examination Survey. However, these studies have many limitations including recall bias, selection bias, and deficit of objective evaluation. Furthermore, crosssectional studies cannot reflect new risk factors associated with the development of AR. New epidemiological studies will be needed to cover genetic factors, environmental changes, microbiomes, and lifestyles that are known to be risk factors for AR. Further studies will be needed to determine the prevalence, natural history, and risk factors of AR in order to advance our understanding of the pathophysiology, prevention, and management of comorbidities of AR.

Multicenter Adherence Study of Asthma Medication for Children in Korea

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.

Current Status of Patient Education in the Management of Atopic Dermatitis in Korea

Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.

The publication of the 30th anniversary journal of Korean Academy of Pediatric Allergy and Respiratory Disease

No abstract available.

Research on pediatric allergic rhinitis in Korea

Allergic rhinitis is the most common chronic rhinitis in children and is the most common allergic disease in childhood and adolescence in Korea and most countries around the world. In this review article, we have summarized some of the research articles on allergic rhinitis that have been published in the Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD) Journals so far in order to celebrate and look back on the 30th anniversary of the KAPARD. Over the past 30 years, the members of the KAPARD have published many research papers on the epidemiology, causes, risk factors, and comorbid conditions of allergic rhinitis based on ‘one airway diseases’ and treatment and we hope that these studies will be helpful not only in confirming the research capacity of KAPARD but also in setting up research subjects and research topics related to allergic rhinitis in the future.

Does Breast-feeding Relate to Development of Atopic Dermatitis in Young Korean Children?: Based on the Fourth and Fifth Korea National Health and Nutrition Examination Survey 2007–2012

PURPOSE: There have been conflicting reports concerning the relationship between breast-feeding and the development of atopic dermatitis (AD) in early childhood. The objective of this study was to investigate the associations between breast-feeding and the risk of AD in early childhood in Korea. METHODS: We combined the fourth and fifth Korea National Health and Nutrition Examination Survey data collected from 2007 to 2012 and analyzed 2,015 children at 1 to 3 years old. Regression analysis was used to determine the association of the following variables: AD, feeding types, duration of breast-feeding, and others. RESULTS: The annual prevalence of exclusive breast-feeding and AD decreased. Parents with allergic diseases preferred breast-feeding and extended duration of feeding compared with those without. In multiple logistic regression analyses, exclusive breast-feeding in feeding type I (P=0.070; adjusted odds ratio [OR]=1.990), exclusive breast-feeding in feeding type II (P=0.095; adjusted OR=1.495) and breast-feeding duration (P=0.430; adjusted OR=1.013) were not significantly related to AD. CONCLUSIONS: Breast-feeding was not found to be associated with an occurrence of AD in young children. Rather, parents with histories of allergic diseases tended to prefer breast-feeding and extend its duration. To clarify the role of breast-feeding in the development of AD, a nation-wide prospective study is needed.

Comorbidities and Phenotypes of Rhinitis in Korean Children and Adolescents: A Cross-sectional, Multicenter Study

PURPOSE: Rhinitis is a nasal inflammatory disease in children and adolescents. However, little is known about the phenotypes and characteristics of allergic rhinitis (AR) in Korean children and adolescents. The objective of this study was to analyze the symptoms and comorbidities of rhinitis, to compare AR to non-allergic rhinitis (NAR), and to reveal the phenotypes and features of AR in a Korean pediatric population. METHODS: Patients under 18 years of age with rhinitis symptoms were recruited from January 2013 to January 2015 by pediatric allergists. We analyzed symptoms, phenotypes, comorbidities, and allergen sensitization in this cross-sectional, multicenter study. RESULTS: Medical records were collected from 11 hospitals. The AR group has 641 (68.3%) patients, with 63.2% of boys and 7.5 (±3.4) years of mean age. The NAR group has 136 (14.5%) patients, with 55.1% of boys and 5.5 (±2.9) years of mean age. Moderate-severe persistent AR affected 41.2% of AR patients. Nasal obstruction was more common in NAR patients (P<0.050), whereas AR patients sneezed more (P<0.050) and more commonly had conjunctivitis, asthma, and otitis media (P<0.050). Sinusitis was the most common comorbidity in both groups. Allergen sensitization was caused by house dust mites (HDMs) (90.2%), pollen (38.7%), and animal dander (24.8%) in AR patients. Pollen and animal dander sensitization significantly increased age-dependently (P<0.050), but 91.9% of AR patients were already sensitized to HDMs before 5 years old. CONCLUSIONS: Our study revealed that AR was more prevalent than NAR and that 41.2% of AR presented with moderate-severe disease in Korean pediatric populations. Sinusitis was the most common comorbidity, and sleep disturbance was associated with the severity of rhinitis. The majority of AR patients were sensitized to HDMs in preschool ages. Further studies, including nationwide and longitudinal data, will help understand the relationship between these diseases.

Chronic cough in children

Cough is one of the common symptoms, which is usually related to respiratory infections for children. This symptom is not considered crucial. Published data reported that the community prevalence of chronic cough in primary school children is 5%-10%, while the prevalence is likely to be higher in younger children. The cause of persistent cough should be investigated. There were significant differences in the causes and management for cough according to age. Chronic cough is defined as duration of 4 weeks or longer. Common culprits for chronic cough in children are different from those in adults. The authors reviewed articles about chronic cough of children to help improve the understanding and management for pediatric chronic cough.

Clinical characteristics of lung abscess in children: 15-year experience at two university hospitals / 소아과

PURPOSE: Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. METHODS: The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. RESULTS: Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. CONCLUSION: The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.

Relationship between breast-feeding and wheeze risk in early childhood in Korean children: based on the fifth Korea National Health and Nutrition Examination Survey 2010-2012

PURPOSE: There is conflicting evidence concerning the relationship between breast-feeding and development of wheezing in early childhood. Epidemiological evidence for a role of breast-feeding on risk of wheezing is inconclusive. The objective of this study was to investigate the associations between breast feeding and risk of current wheezing in early childhood in Korea. METHODS: We combined the fifth Korea National Health and Nutrition Examination Survey data collected from 2010 to 2012 and analyzed 1,011 children from 1 to 3 years olds who had been surveyed in regards to breast-feeding. Multivariate regression analysis was used to identify association among the following variables: presence of current wheezing, feeding types and duration of breast-feeding. RESULTS: Prevalence of exclusive breast-feeding and current wheezing decreased both annually from 2010 to 2012. In the univariate analysis, breast-feeding, formula-feeding, duration of breast-feeding were not associated significantly with current wheezing of children younger than 3 years old. No measureable statistically significant relation was observed among breast-feeding, formula-feeding, duration of breast-feeding and risk of current wheezing in the multivariate analysis. CONCLUSION: The present study showed no statistically significant relationship between breast-feeding and the risk of wheeze in early childhood in Korean children. National prospective study is needed to clarify the role of breast-feeding in development of current wheezing.

Changing Caregivers' awareness on atopic dermatitis

PURPOSE: The objective of this study investigates the change in the awareness of the caregivers of atopic dermatitis (AD)' children, through questionnaires conducted in 2006 and 2013. METHODS: A questionnaire of 15 items about the diagnosis and management of AD was done to survey a total of 146 caregivers participating in Atopy Friendly School Program in Dongdaemun-gu, Seoul, 2013. A comparison analysis was used to compare the results of the surveys conducted in 2006 and 2013. RESULTS: Diagnosis of AD by doctor has increased while that by traditional Korean medical (TKM) doctor has decreased, but it was not statistically significant (P=0.07). Self-treatment has increased while the treatment by doctor remained similar. Treatment by TKM doctor has decreased. Overall change in medical institutions was statistically significant (P=0.01). The use of emollient has significantly increased while the use of topical steroid and oral medication has decreased with no statistically significant difference. Food restriction has significantly decreased (P=0.00), but it is still recognized as an important treatment option in 2013. As for the frequency of the emollient use, using it once a day has decreased whereas using it 2-3 times a day has increased, but there was no statistically significant difference. CONCLUSION: Caregivers' awareness on AD has improved through 2006 to 2013 with the education provided by academic societies and government, but the accurate understanding of the disease still needs improvement. The future education should focus on the selection of appropriate healthcare services as well as the specific self-management strategies.

Clinical Characteristics of Influenza B Virus in Children and the Efficacy of Oseltamivir: Data from Two University Hospitals / 소아감염

PURPOSE: There has been little research regarding the effectiveness of oseltamivir for influenza B infections. We sought to identify the different clinical manifestations between patients treated with and without oseltamivir. METHODS: We retrospectively studied the medical records of 72 inpatients or outpatients from two medical centers diagnosed with influenza B infections by either a rapid antigen test or multiplex reverse transcriptase PCR between January 2012 and July 2012. We compared gender, age, past medical history, admission period, total fever duration, fever duration after hospitalization, post-oseltamivir medication peak temperature, laboratory test, chest X-ray, antibiotic medication, and the presence of concomitant viral or bacterial infections. RESULTS: The number of subjects in our study was 72 who were diagnosed with influenza B pneumonia, acute bronchitis, acute bronchiolitis, croup, and mean age was 3.6+/-2.8 year old. The demographic characteristics and clinical manifestations of oseltamivir and the non-oseltamivir groups, including hospitalization period (4.18+/-2.10 vs 4.79+/-1.49 days, P=.17) and total fever duration (5.32+/-2.07 vs 6.41+/-3.25 days, P=.09), demonstrated no significant differences. Notably, the oseltamivir group did have significantly reduced usage of antibiotic treatment than the non-oseltamivir group (P=.04). When we limited our patient group to patients under the age of three, similar results were seen. The group prescribed oseltamivir within 48 hours of fever onset had less antibiotic usage, in addition to a shorter fever duration. CONCLUSION: Oseltamivir appeared to have no benefit in improving the clinical course. However, if it is prescribed within the first 48 hours of symptoms, it may be more effective.

An overview and considerations in prescribing H1-antihistamine

H1-antihistamines have been prescribed widely for the treatment of allergic diseases, such as rhinitis, atopic dermatitis, and urticaria besides common colds since the 1940s. H1-antihistamines are classified by chemical structures (akylamine, piperazine, piperidine, ethanolamine, ethylendiamine, and phenothiazine) or functionally by permeability through blood brain barrier (first or second generation). The first generation antihistamines have been prescribed up to now with several adverse effects such as central nervous system dysfunction, anticholinergic and antiserotonic action and cardiotoxicity with overdose. Hence second generation antihistamines are recommended for the treatment of allergic rhinitis and urticaria. Physicians should consider concomitant diseases or medications when prescribing first generation antihistamines.

Relationship between serum total IgE, specific IgE, and peripheral blood eosinophil count according to specific allergic diseases

PURPOSE: Elevated IgE, and blood eosinophil count are considered the hallmarks of allergic diseases, while the levels of those parameters are shared with normal population. This study is aimed to investigate the relationship between those factor and clinical value according to specific allergic diseases. METHODS: We reviewed medical records of 946 patients with allergic diseases who had taken the allergy tests from 2001 to 2010. The effects of age, sex, specific diagnoses of diseases, such as atopic dermatitis (AD), allergic rhinitis (AR), bronchial asthma (BA), urticarial on allergy tests were assessed. RESULTS: In contrast to those of total eosinophil counts, there was the trend of increasing IgE value with the age in children with allergic diseases. The titer of total IgE and eosinophil count were higher than those of control group of patients with acute urticaria. There was the positive relation between total IgE and eosinophil count in patients with allergic diseases. The positive predictive value and negative predictive value of total IgE for specific IgE were higher than those of total eoshinophil count. CONCLUSION: There were the positive relation of total IgE and total eosinophil count in allergic diseases and the higher value of those compared with the control in this study. These values over a certain level have a positive predictive value of serum specific IgE and help us to determine whether we should test the serum specific IgE in patients with allergic diseases.

Role of Fractional Exhaled Nitric Oxide in Predicting Development of Allergic Rhinits in Children with Bronchial Asthma / 소아알레르기및호흡기학회지

PURPOSE: Fractional exhaled nitric oxide (FeNO) has been widely reported as a marker for airway inflammationin, and FeNO have shown increased levels in the non-asthmatic patients with other atopy related diseases, such as rhinitis. Bronchial hyperresponsiveness is a characteristic feature of asthma, which is often associated with airway inflammationin allergic rhinitis. It has been suggested that asthma is associated with rhinitis, which is a link between the upper and the lower airways, beyond allergy associated inflammation in the respiratory tract. To evaluate the usefulness of FeNO measurement, as a risk factor of allergic and nonallergic rhinitis in children with asthma. METHODS: Fifty-three children included in this study were diagnosed as asthma from April through August 2005 in the Department of Pediatrics, Kyung Hee University School of Medicine. They conducted FeNO monitoring, total eosinophil count and serum immunoglobulin E at that time. We put a question to the participants' parents about the doctor diagnosed participants' manifestations (sneezing, nasal congestion, nasal itching, rhinorrhea), via a telephone interview survey or at the outpatient department in July 2011. Statistical analyses were performed using IBM SPSS ver. 18.0. RESULTS: The overall prevalence of rhinitis, among the 53 children, was 67.9%. The means of FeNO differed significantly between the two groups, being higher in children who have rhinitis symptoms and lower in asymptomatic children. (mean+/-SD, 29.4+/-24.6 to 13.6+/-11.8 parts per billion; P=0.003; T-test) CONCLUSION: To take the measurement of FeNO value in asthmatics may be a tool in the predictor of the causes of rhinitis.

Predisposing Factors Associated With Chronic and Recurrent Rhinosinusitis in Childhood

PURPOSE: There is currently no information regarding predisposing factors for chronic and recurrent rhinosinusitis (RS), although these are considered to be multifactorial in origin, and allergic diseases contribute to their pathogenesis. We evaluated the predisposing factors that may be associated with chronic and recurrent RS. METHODS: In this prospective study, we examined patients with RS younger than 13 years of age, diagnosed with RS at six tertiary referral hospitals in Korea between October and December, 2006. Demographic and clinical data related to RS were recorded and analyzed. RESULTS: In total, 296 patients were recruited. Acute RS was the most frequent type: 56.4% of the patients had acute RS. The prevalences of other types of RS, in descending order, were chronic RS (18.9%), subacute RS (13.2%), and recurrent RS (11.5%). Factors associated with recurrent RS were similar to those of chronic RS. Patients with chronic and recurrent RS were significantly older than those with acute and subacute RS. The prevalences of allergic rhinitis, atopy, and asthma were significantly higher in patients with chronic and recurrent RS than those with acute and subacute RS. CONCLUSIONS: An association between atopy and chronic/recurrent RS, compared to acute and subacute RS, suggests a possible causal link.