Allergen sensitization and clinical characteristics in young children with atopic dermatitis

PURPOSE: Few studies have demonstrated the effects of aeroallergen sensitization on the development of atopic dermatitis (AD) in young children. This study aimed to investigate the sensitization rate of food and aeroallergens in AD patients under 2 years of age and to compare clinical characteristics between IgE- and non-IgE-mediated AD patients. METHODS: Children aged less than 2 years who had visited CHA Bundang Medical Center from 2013 through 2016 were enrolled. Allergen sensitization was measured by specific IgE levels for common allergens. Detailed information was obtained using an atopy questionnaire. RESULTS: A total of 173 patients were examined, 118 (68.2%) were male patients. The prevalence of aeroallergen sensitization under 1 year of age was 4.8% and increased to 19.5% for children aged 2 years (P=0.005). The mean age (13.6±6.3 months vs. 9.0±5.1 months, P=0.003) and the proportion of children born prematurel (15.4% vs. 2.3%, P=0.013) were higher in the aeroallergen-sensitized group than in nonsensitized group. Sensitization to food allergens between children aged less than 1 year and 2 years appeared to be similar (61.1% vs. 57.1%, P=0.651). There were no significant differences in clinical characteristics between food allergen IgE-mediated and non-IgE-mediated AD children. CONCLUSION: Aeroallergen sensitization increased markedly in AD patients aged 2 years which is about 4 times that of the general population. However, there were no significant differences in clinical manifestations between allergen IgE-mediated and non-IgE-mediated AD children in both food and aeroallergens.

Relationship between exhaled nitric oxide and small-airway dysfunction in children with asthma using spirometry and the impulse oscillometry system

PURPOSE: Fractional exhaled nitric oxide (FeNO) is a maker of airway inflammation, and impedance of low frequency in the impulse oscillometry system (IOS) reflects small-airway obstruction. We investigated the association of the FeNO level with IOS parameters and spirometry results in asthma patients. METHODS: Fifty-eight children with asthma (60.3%, male), mean age 8.3 years (range, 4.5-16.0 years), were enrolled in the study. Reactance and resistance at 5 Hz with IOS, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25%-75% of the vital capacity (FEF25%-75%) with spirometry and FeNO were measured in all patients. The Z-score of spirometry and IOS parameters and the mean level of FeNO were used for correlation and regression analysis. RESULTS: FeNO was not significantly associated with height, age, or other demographic parameters. There was a statistically significant correlation between spirometry results and IOS measurements. The FeNO level was not significantly correlated with IOS variables. After adjusting for height, sex, atopic status, and the use of inhaled corticosteroid, the FeNO level showed significant correlations with Z-score of FEV1/FVC (P=0.037, adjusted R 2=0.234). CONCLUSION: FeNO was significantly correlated with Z-scores of FEV1/FVC, but not with IOS variables. Therefore, FeNO may be used to detect whole airway obstruction, but not small-airway obstruction.

Food allergen sensitization in young children with typical signs and symptoms of immediate-type food allergies: a comparison between monosensitized and polysensitized children / 소아과

PURPOSE: The clinical interpretation of children sensitized to allergens is challenging, particularly in children with food allergies. We aimed to examine clinical differences between children with monosensitization and those with polysensitization to common food allergens and to determine risk factors for polysensitization in young children <10 years of age with immediate-type food allergies. METHODS: The study included children <10 years of age with signs and symptoms indicative of immediate-type food allergies. Serum total IgE level was measured, and ImmunoCAP analysis for food allergens was performed. RESULTS: The mean age of the study subjects was 1.6+/-1.6 years (75 boys and 51 girls). Thirty-eight children (30.2%) were monosensitized and 88 children (69.8%) were polysensitized. Multivariate logistic regression analysis showed that the development of polysensitization to common food allergens was positively associated with a parental history of allergic rhinitis (adjusted odds ratio [aOR], 6.28; 95% confidence interval [CI], 1.78-22.13; P=0.004), season of birth (summer/fall) (aOR, 3.10; 95% CI, 1.10-8.79; P=0.033), and exclusive breastfeeding in the first 6 months of age (aOR, 3.51; 95% CI, 1.20-10.25; P=0.022). CONCLUSION: We found significant clinical differences between children with monosensitization and those with polysensitization to common food allergens and identified risk factors for the development of polysensitization in young children with immediate-type food allergies. Clinicians should consider these clinical risk factors when evaluating, counseling, treating, and monitoring young children with food allergies.

Remodelling of Patellar Ligament Autograft after ACL Reconstruction: A Histological and Electron Microscopic Study / 대한정형외과학회잡지

A histological and electron microscopic study were conducted in order to observe a morphological changing pattern of patellar ligament autograft after endoscopic ACL reconstruction. Seventeen patients among 117 consecutive series which underwent endoscopic ACL reconstruction from January 1990 to March 1995, were involved in this study according to the various follow-up periods. In second-look arthroscopic finding at 6 months follow-up after ACL reconstruction, reconstructed ACL was covered with synovium and round-shaped, and after the biopsy active bleeding could be seen. In histological study, 6 months follow-up, spindle or ovoid shaped fibroblast with hypercellularity, high crmp patterns of collagen fiber, and parallel arrangement of fibroblast to collagen fiber were noted. The cellularity of fibroblast decreased in according to periods of follow up. At 12 months follow up, spindle or ovoid fibroblast, its cellularity and arrangement pattern and crimp pattern of collagen fiber seemed to be almost similar to those of normal ACL. This similaryity continued up to 2 years and 2 months after reconstruction. In EM study, until 6 months follow-up after reconstruction, the graft showed randomly arranged fibroblasts with hypercellularity, which had abundant cytoplasm with marked irregular cytoplasmic borders and prominent nuclear indentation, Collagen fibrils were immature and showed a unimodel distribution with small diameter. At 12 months follow-up, elongated fibroblasts appeared, but these cells contained folded nuclei and abundant cytoplasm. Collagen fibrils had parallel arrangement and sparse cross striation, and comprised of mainly small fibrils and scattered large fibrils. After 24 months follow-up, the cellularity decreased more. The regular arrangement of collagen fibrils with wavy pattern similar to normal anterior cruciate ligament was noted. Two distinctive population of the small and large diameter of fibrils was also observed (bimodal distribution). At 26 months, the large and small collagen fibrils compresed a characteric bimodal pattern with parallel arrangement, but the majority of fibroblasts had irregular cytoplasmic contour, and abundant cytoplasm with increased organelles, which indicated the active function. These findings suggest that the graft are still immature even at 26 months in postoperative follow up despite considerable maturation of collagen fibril.

Transpedicular Zielke Instrumentation for the Spondylolisthesis: Result of 73 Cases / 대한정형외과학회잡지

Although several kinds of instrumentation systems are available for the transpedicular screw fixation in the treatment of spondylolisthesis, the clinical results and the difference between them remdins unclear. In order to study the feasibility of Zielke instrumentation system for that purpose, the author analysed the clinical results of 73 patients with mild or moderate degree of spondylolisthesis who were instrumented with the systems and followed up 25 months in average(Min. 12Ms). The results between the groups with different rod thickness in the system, 3.2mm(20 patients), 4mm(33 patients) and 5mm(20 patients), were compared to study the most appropriate thickness. Reduction of the deformity were done by aid of temporarilly applied Harrington system in 3.2mm group. Inlayed reduction potential coming from the jointing mechanism was utilized in the cases with less than 30% of slippage in 4 and 5mm group. Percentage of slippage was changed from 20% preoperatively, to 4% postoperatively and 6% at the end of follow up. The methods of fusion after reduction and fixation were anterior in 25 and posterolateral in 48. Bony fusion was achieved in all but one with pathological spondylolisthesis. Rod failures were observed in two of 3.2mm and one of 4mm group, and loosening of the joint were developed in three of 5mm group. Clinically, 93% of the patient showed excellent and good results at the end of follow up. From the results, we concluded that the instrumentation is a efficient method of treatment with several advantages in the reduction capacity and the stability of fixation. However, this system has several points in its mechanics that needs to be improved.