Ovarian Volume in Korean Women with Polycystic Ovary Syndrome and Its Related Factors

OBJECTIVES: The aim of this study was to determine the relationship of ovarian volume (OV) to age, height, and weight in Korean young women with the polycystic ovary syndrome (PCOS) undergoing ultrasonography (US) and to investigate the relationship between ovarian follicle count and volume on US and serum hormone levels including the levels of the anti-Müllerian hormone (AMH) and gonadotropin. METHODS: A total of 272 Korean nulliparous women aged 15 to 39 years who were newly diagnosed with PCOS at a university hospital were included in this study. Evaluation of the ovaries and measurement of OVs in all cases were randomly performed by ultrasound. The OV and follicle number (FN) were obtained in all cases. RESULTS: In Korean women with PCOS, mean OV was 7.9 ± 3.6 cm3 (right) and 6.7 ± 3.1 cm3 (left). Mean FN in the PCOS group was 14.2 ± 4.6 (right) and 13.8 ± 4.3 (left). OV and ovarian FN were unrelated to patient weight, height and body mass index. The left ovarian FN was related to patient age. AMH levels ranged from 5.31 to 43.1 ng/mL and the mean level was 13.9 ± 7.2 ng/mL. Serum AMH was related to OV and FN, and serum total testosterone was related to FN in Korean women with PCOS. CONCLUSIONS: In Korean nulliparous women with PCOS, OV was smaller than that in other ethnic groups and the right OV was larger than the left OV. Ovarian FN, AMH, testosterone are good markers for the diagnosis of PCOS in Korean women.

Survey of food allergy in elementary school children in Bucheon-city and relationship between food allergy and other allergic diseases

PURPOSE: This study was performed to evaluate the current status of food allergy (FA) and to analyze the relationship between allergy to individual foods and other allergic diseases in elementary school children. METHODS: We performed a questionnaire survey for FA, asthma, allergic rhinitis, and atopic dermatitis using International Study of Asthma and Allergies in Childhood questionnaires. A total of 1,929 students in 3 elementary schools were enrolled. RESULTS: A total of 324 students (16.8%) had ever suffered from FA symptoms more than once. Only 64 out of 324 students (19.8%) were diagnosed with FA by doctors. The presence of soy allergy was associated with the increased risk of bronchial asthma (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 1.87 to 18.59). The presence of egg (aOR, 1.91; 95% CI, 1.04 to 3.52) and wheat allergy (aOR, 5.45; 95% CI, 1.94 to 15.36) were associated with the increased prevalence of allergic rhinitis. The allergic symptoms to fruits/tomato was associated with the increased risk of allergic rhinoconjunctivitis symptoms (aOR, 2.98; 95% CI, 1.18 to 7.47). The allergic symptoms to egg (aOR, 2.29; 95% CI, 1.22 to 4.29), wheat (aOR, 4.91; 95% CI, 1.86 to 12.95), and shrimp/crab (aOR, 2.48; 95% CI, 1.37 to 4.49) were associated with the presence of atopic dermatitis. CONCLUSION: The prevalence of FA of elementary school students in Bucheon-city was 16.8%. A significant positive association between the suspected foods and the other allergic diseases was found. Soy allergy was significantly correlated to having bronchial asthma and fruits/tomato allergy correlated with allergic rhinoconjunctivitis.

Management of Food Allergies in Young Children at a Child Care Center and Hospital in Korean / 소아알레르기및호흡기학회지

PURPOSE: We studied the management of young children with histories of food allergies at child care centers, along with the diagnosis and follow-up management after a visit to a hospital emergency department (ED). METHODS: 1) The survey was conducted in April 2010 in Seoul, Korea. Three hundred forty-five child care centers caring for children between the ages of 0 and 5 years were contacted by mail. The questionnaire was designed to identify symptoms and management of children in child care centers with histories of food allergies. 2) We studied children who were diagnosed with angioedema or anaphylaxis between January 2002 and August 2010 in the ED of Korea University. RESULTS: 1) According to the 345 collected questionnaires, 243 child care centers asked parents about their children's allergic diseases and 492 children had food allergies. A reported 461 children from 207 child care centers had food restrictions. Only 21 child care centers supplied substitute foods with the same amounts and types of nutrients. One hundred forty-five teachers had received education about food allergies. 2) Thirty children were diagnosed with anaphylaxis or angioedema after food ingestion. Only seven children visited a physician after being discharged from the ED. CONCLUSION: This study identified a lack of food allergy education at child care centers and in homes. Child care centers need to be equipped with knowledge to prevent severe allergic reactions. Also, parents should know more about the importance of food allergies in their children.

Differences of the Clinical Manifestations and Laboratory Tests between Monosensitized and Polysensitized Children: A Single Center Study / 소아알레르기및호흡기학회지

PURPOSE: The objective of this study was to identify differences in the clinical manifestations and allergic indices between monosensitized and polysensitized children. METHODS: We reviewed retrospective data from the medical records of patients who had chronic or recurrent respiratory symptoms and visited the pediatric clinic at Chung-Ang University Hospital for an evaluation of allergic diseases from January 2003 to January 2011. The patients were categorized into nonsensitized (n=111), monosensitized (n=149), and polysensitized (n=205) groups according to skin prick tests (as classified by five allergen groups). We compared gender, age, family history, admission history, food sensitization, total immunoglobulin E (IgE), peripheral eosinophil counts, eosinophil cationic protein (ECP) levels, forced expiratory volume in 1 second (FEV1), and methacholine provocation tests among the three groups. RESULTS: The frequency of food sensitivity was highest in the polysensitized group (n=101, 49.3%), followed by the monosensitized (n=8, 5.4%) and nonsensitized groups (n=0) (P<0.001). The FEV1 was significantly lower in the polysensitized group than that in the monosensitized and nonsensitized groups (79.4+/-20.2% vs. 87.2+/-16.0% vs. 87.6+/-17.1%, respectively) (P=0.013). The total IgE and ECP levels were significantly higher in the polysensitized patients than those in the other patients (P<0.001 and <0.001, respectively). Differences in gender, age, peripheral eosinophil count, and bronchial hyper-responsiveness were not identified between the monosensitized and polysensitized groups. CONCLUSION: The polysensitized group showed more frequent food hypersensitivity, lower FEV1 values, and higher allergic indices such as total IgE and ECP, suggesting a different atopic phenotype compared with those in the monosensitized group.

Comparison of Methods for Measuring House Dust Mite Allergens / 소아알레르기및호흡기학회지

PURPOSE: This study was conducted to evaluate the accuracy of semiquantitative tests targeting house dust mite (HDM) allergens. METHODS: Thirty-nine dust samples were collected from the homes of 14 patients. These samples were evaluated using the following semi-quantitative tests: Rapid test for Mite Allergen(R), Acarex(R), Mitey checker(R), and SD CHECK Quick Mite Test(R). The samples were then assayed by enzyme-linked immunosorbent assay (ELISA) for Der p 1, Der f 1 and group 2 allergens. Finally, the results from the 4 kits were compared and the correlation with ELISA was determined. RESULTS: Concentrations of HDM allergens determined using Acarex(R) were associated with those of SD CHECK Quick Mite Test(R) and Mitey checker(R), (P=0.004 and 0.035, respectively; rho=0.454 and 0.339, respectively). The concentrations determined by SD CHECK Quick Mite Test(R) were associated with those of Mitey checker(R) and Rapid test for Mite Allergen(R) (P=0.000 and 0.001, respectively; rho=0.664 and 0.518, respectively). There was also a significant correlation between the results obtained using Mitey checker(R) and Rapid test for Mite Allergen(R) (P=0.000, rho=0.602). The Der f 1 levels were associated with the concentrations determined by SD CHECK Quick Mite Test(R), Mitey checker(R) and Rapid test for Mite Allergen(R) (P=0.003, 0.000 and 0.005, respectively; rho=0.467, 0.544 and 0.438, respectively). Group 2 allergen levels were associated with the concentrations determined by SD CHECK Quick Mite Test(R) and Rapid test for Mite Allergen(R) (P=0.019 and 0.038, respectively; rho=0.374 and 0.334, respectively). CONCLUSION: Four popular semiquantitative test kits may be adequate for detecting HDM allergens at home. However, quality assurance is needed for clinical usage because they showed variable sensitivity and specificity.

Assessment of Allergenicity in Genetically Modified Herbicide-Resistant Foods Using the Serum Screening Test / 소아알레르기및호흡기학회지

PURPOSE: This study aimed to evaluate the potential allergenicity of genetically modified (GM) herbicide-resistant food by using the serum screenning test. METHODS: Children with allergic disease were recruited, and those who were sensitized to soybean, corn or peanut were selected to obtain their sera. Sensitization to these food allergens was determined when the level of specific IgE was over 0.35 kU/L using ImmunoCAP (Pharmacia, Uppsala, Sweden). Immunoblot analyses were performed for soybean (n=50), corn (n=50) and peanut (n=20). Newly inserted gene was sequenced and cloned from GM soy (Roundup Ready Soybean, Monsanto), GM corn (Bt 11, Syngenta) and GM canola (MS8/RF3 canola, Bayer CropScience). These proteins, such as CP4 EPSPS, PAT, and BAR, were expressed and purified for the serum screening test. RESULTS: Immunoblot analysis using CP4 EPSPS and sera from soybean-sensitized children showed no bands. Likewise, sera from corn-sensitized children and PAT did not demonstrate IgE binding in immunoblot analysis. In addition, there were no reactions between BAR and sera from peanut-sensitized patients. CONCLUSION: The serum screening test using sera from allergic children and newly inserted protein (CP4 EPSPS, PAT and BAR) in GM soybean, GM corn and GM canola failed to show IgE binding in immunoblot analysis. The results of this study suggest that these newly inserted proteins may not cause allergic disease. Further studies using more sera from allergic children are needed to conclude the safety of herbicide-resistant GM food.

Risk Factors Influencing Growth in Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: The objective of this study was to identify risk factors for growth delay of infants with atopic dermatitis (AD) and to evaluate the nutritional adequacy of therapeutic elimination diets. METHODS: We studied 67 infants with AD aged from 6 to 23 months, who were managed with conservative treatments for more than 3 months in Samsung Medical Center, and compared with 56 normal age-matched infants. Height and weight for age and weight for height were converted to Z score to evaluate their growth. Basic characteristics including birth characteristics, heights and weights of parents, and socioeconomic status of parents were surveyed by the questionnaire. The 24-hour recall method, assessment of all foods eaten on the day prior to the interview, was performed to evaluate dietary intake. A P value <0.05 was considered to be significant. RESULTS: The mean Z scores of height and weight (-0.10+/-1.10 and -0.41+/-0.91, respectively) in male patients were decreased more than those in healthy age-sex-matched controls, (0.44+/-0.77 and 0.07+/-0.77, respectively) (P=0.032 and 0.039 for each) while female infants did not show any difference. Severity of AD, socioeconomic status of parents, duration of breast feeding, and birth characteristics were not different between patient and control groups. Zinc levels of both groups, especially patients, was lower than recommended dietary allowances (RDA). CONCLUSIONS: Infants with AD were shorter than control group, while they did not show nutritional problems. Our study suggests that longitudinal growth assessment should be performed on infants with AD and it may be helpful in counseling about the prognosis of growth.

Dietary Intakes and Serum Lipids and Iron Indices in Obese Children / 대한지역사회영양학회지

This study was performed to compare nutrient intakes, diet quality and serum indices (TG, Total cholesterol, LDL-cholesterol, HDL-cholesterol, RBC, Hb, Hct, Serum iron, ferritin, MCV) of obese and normal weight children. The subjects were 149 children living in the Seoul and Gyeonggi areas. Each subject was assigned to one of such as normal weight group (15th < or = BMI percentile < 85th, n = 82) or obese children (85th < or = BMI percentile, n = 67) according to their percentile of BMI by The Korean Pediatric Society. Data on dietary intakes, body composition and serum indices were obtained. Differences of all the above variables were assessed. Energy, carbohydrate, fat, cholesterol, total fatty acid, SFA, MUFA, PUFA, phosphate, potassium, zinc, vitamin B1 and vitamin B6 intakes of girls in the obese group were higher than those of the normal weight group (p < 0.05). The intake of fiber was as insufficient as below 50% of KDRIs in both groups. Nutrient adequacy ratio of calcium, iron, phosphate, zinc and folate in obese boys were lower than those of normal weight boys (p < 0.05). Energy intakes of grain and milk and dairy food in the obese girl group (905.9 +/- 344.5 kcal, 210.9 +/- 166.4 kcal) were higher than those of normal weight girls (671.2 +/- 360.7 kcal, 184.0 +/- 103.5 kcal) (p < 0.05). HDL-cholesterol level of obese boys (52.7 +/- 6.3 mg/dL) was significantly lower than that of normal weight boys (65.3 +/- 15.6 mg/dL). Serum iron level of obese boys and girls (boys: 79.4 +/- 32.6 mg/dL, girls: 98.3 +/- 16.2 mg/dL) was significantly lower than those of normal weight children (boys: 104.8 +/- 38.6 mg/dL, girls: 106.7 +/- 28.9 mg/dL) (p < 0.05). These results suggest that there should be sensible food selection and more intakes of fruit and vegetable are needed to improve the nutritional status in obese children.

Characteristics of Infants' Temperaments and Eating Behaviors, Mothers' Eating Behaviors and Feeding Practices in Poor Eating Infants / 대한지역사회영양학회지

The purpose of this study was to determine the characteristics of infants' temperaments and eating behaviors, mothers' eating behaviors and feeding practices in poor eating infants. The participants were 80 infants of 12 - 24 months (27 poor eaters and 53 matched normal controls) from a hospital and a public health center. Mothers were questioned about their eating behaviors and feeding practices, and infants' temperaments, eating behaviors, and nutrient intakes by one day food recall. Subjects were divided by mean nutrient adequacy ratio (MAR, < 0.75; poor eater). Intakes of Ca, P, Fe, Zn, thiamin, riboflavin, niacin, vitamin C, E, folate were below 75% RDA in poor eaters, whereas protein, thiamin, riboflavin, vitamin B6, C, folate exceeded 125% RDA in good eaters. Rhythmicity of infants' temperaments and eating behaviors, restriction of mothers' eating behaviors and feeding practices were significantly lower, whereas activity levels of infants' temperaments were higher than good eaters. In multiple logistic regression model of poor eaters, activity of infants' temperaments (T, OR: 1.19, CI: 1.05 - 1.35) and attention spans of infants' eating behaviors (A, OR: 1.18, CI: 1.03 - 1.35) were significantly positive, whereas rhythmicity of infants' eating behaviors (R, OR: 0.79, CI: 0.67 - 0.94) was significantly negative [E (the logit) = -6.8644 + 0.1712 x T - 0.2337 x R + 0.1641 x A]. Our findings suggest that examination of eating behaviors, feeding practices, and temperaments will help target interventions to improve infants' food intakes, and these variables should be examined at the time of nutrition counseling.

Sensitization of Food Allergen in Breastfed Infant with Atopic Dermatitis / 대한지역사회영양학회지

Breastfeeding has been known as the best feeding practice to prevent allergies including atopic dermatitis (AD). However, the benefit on the prevention of allergic disease is still controversial. The objectives of this study were to examine the rate of sensitization to the protein of eggs, cow's milk and soy in exclusively breastfed infants and to evaluate antigen-antibody reaction between breast milk and serum of AD infant. Data on feeding and food hypersensitivity were obtained for 62 AD infants (32 male, 30 female) aged 0.7 kU/L by CAP assay (Pharmacia, Uppsala, Sweden) were considered positive. The rates of sensitization in breastfed infants were 41.9% (26/62) to egg, 30.6% (19/62) to milk and 18.0% (11/62) to soy. Immunoblotting analyses were performed using breast milk with the matched serum of seven AD infants (4 male/3 female). Binding patterns of AD infant's IgE to breast milk extract showed visible specific band for immunoglobulin, especially in case of a lactating mother who did not completely restricted ingestion of egg, milk and soy. These results indicate that sensitization to food allergen develops via breast milk feeding. Breast milk feeding should be recommended in infants at risk of developing allergic disease, but maternal intake of highly allergenic food might be restricted for prevention and treatment of food allergy among the babies with AD.

The Characteristics of Infants' Temperament, Maternal Feeding Behavior and Feeding Practices in Picky Eaters / 대한지역사회영양학회지

The purpose of this study was to determine the characteristics of infants' temperaments, maternal feeding behaviors and feeding practices in picky eaters. Participants were 83 infants (aged 12 - 24 months) from "A" hospital (Seoul) and "B" public health center (Kyunggido). Mothers completed questionnaires that assessed their own feeding behavior, feeding practices, infants' temperament and infants' feeding behavior. Picky eaters' demographics were not significantly different from non-picky eaters after adjusting sex and age. The average of thiamin, niacin and vitamin E intakes of picky eaters were below 75% Korean RDA, whereas vitamin A intakes exceed 120% RDA in both groups. Activity level of infants' temperament and disinhibition of maternal feeding behavior in picky eaters were significantly higher than those in non-picky eater. All constructs of infants feeding behavior were significantly associated with certain constructs of infants' temperament, maternal feeding practice and maternal feeding behavior. The pickiness of infants feeding behavior was positively correlated with activity level of infants' temperament, pickiness and disinhibition of maternal feeding behavior and negatively correlated with adaptability of infants' temperament. Findings suggest that maternal feeding behavior and feeding practices as well as infants' temperament should be addressed in nutrition education for picky eaters.

Anaphylaxis to Curry Powder in Childhood / 소아알레르기및호흡기학회지

A 15-year old boy visited Samsung Medical Center complaining that when he ate curry and rice two months ago, he developed immediate palatal itching, generalized urticaria, headache and dyspnea. His chest radiographs were normal. He had no history of allergy, but a methacholine provocation challenge test revealed positive findings (PC20 3.62 mg/mL). Skin prick tests revealed positive findings to asparagus, house dust mites (Dp, Df), flower pollens (aster, chrysanthemum, golden rod), weed pollens (mugwort, ragweed, dandelion, short ragweed) and crude extract of curry powder. Specific IgE to Dp, Df and soy bean were positive (6.52, 31.2 and 1.91 kU/L) and total IgE was 1, 207 kU/L by the Pharmacia UniCAP- FEIA. After receiving parental consent, we performed an oral provocation test to confirm the relationship between his symptoms and curry powder. He ingested a small amount of curry powder with pure water, which was increased every 1 hour. We then measured his PEFR every 10 minutes after each subsequent curry powder ingestion. After he ate 20 gm of curry powder in one time, he exhibited profuse sweating, skin rash and dyspnea. When we treated him with epinephrine and bronchodilator, his symptoms improved. He developed the same symptoms 2 hours later, but these symptoms were brought under control by the same medication.

Sensitization of Food Allergen in Breastfed Infant with Atopic Dermatitis / 대한지역사회영양학회지

Breastfeeding has been known as the best feeding practice to prevent allergies including atopic dermatitis (AD). However, the benefit on the prevention of allergic disease is still controversial. The objectives of this study were to examine the rate of sensitization to the protein of eggs, cow's milk and soy in exclusively breastfed infants and to evaluate antigen-antibody reaction between breast milk and serum of AD infant. Data on feeding and food hypersensitivity were obtained for 62 AD infants (32 male, 30 female) aged 0.7 kU/L by CAP assay (Pharmacia, Uppsala, Sweden) were considered positive. The rates of sensitization in breastfed infants were 41.9% (26/62) to egg, 30.6% (19/62) to milk and 18.0% (11/62) to soy. Immunoblotting analyses were performed using breast milk with the matched serum of seven AD infants (4 male/3 female). Binding patterns of AD infant's IgE to breast milk extract showed visible specific band for immunoglobulin, especially in case of a lactating mother who did not completely restricted ingestion of egg, milk and soy. These results indicate that sensitization to food allergen develops via breast milk feeding. Breast milk feeding should be recommended in infants at risk of developing allergic disease, but maternal intake of highly allergenic food might be restricted for prevention and treatment of food allergy among the babies with AD.

Urban and rural Differences in the Prevalence of Gender and Age specific Obesity and related Health Behaviors in Korea

The objective of this study was to discuss the residential difference in gender and age specific prevalence of obesity by body mass index (BMI) and obesity related health behaviors in the Republic of Korea. A total of nationally representative 2,583 men and 3,087 women (age: 20-64 yr) was used as subjects from 1998 National Health and Nutrition Survey. All statistics were calculated using SUDAAN to consider a stratified multistage probability sampling design. The prevalence of obesity (BMI> or =25) was significantly different by age, gender and residential areas. Although younger men aged 20-49 yr did not show a residential difference in the prevalence of obesity, men aged 50-64 yr showed differences, highest in big cities and lowest in rural areas. However, in women, a higher prevalence was observed in rural areas compared to urban areas in the younger age group (20-49 yr), but not in the older age group. Residential differences of obesity related health behaviors existed mostly in the older population, but not in the younger population. The urban-rural differences demonstrate the various stages of behavioral transition that Korea is currently undergoing. Therefore, different strategies considering those factors are needed to manage obesity problems in Korea.

Risk Factors of Moderate to Severe Atopic Drmatitis in the First 6 Months of Life / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to analyze the risk factors of moderate to severe atopic dermatitis (AD) in the first 6 months of life. METHODS: Children aged less than 6 months with AD were divided into two groups according to Six Area, Six Sign Atopic Dermatitis (SASSAD) Score. Children with scores of less than 14 were classified as Mild AD (n=90) and above 15 as Moderate to Severe (Mod-severe) AD (n=44). These patients were fed with breast milk or cow's milk formula, and no allergenic food was given except rice and some vegetables. We analyzed the gender, feeding patterns, family history of allergy, number of siblings, total IgE and specific IgE to common food allergens (egg white, cow's milk, soy, wheat) by CAP assay (Pharmacia, Uppsala, Sweden). RESULTS: Total IgE was 180.6+/-44.7 U/mL in mod-severe AD and 32.2+/-6.1 U/mL in mild AD (P=0.002). Specific IgE to egg white, soy and wheat (19.03+/-4.48 U/mL; 7.07+/-0.40 U/mL, 4.68+/-1.89 U/mL in mod-severe AD; 1.78+/-0.43 U/mL, 0.09+/-0.03 U/mL, 0.15+/-0.11 U/mL in mild AD; P< 0.05) were associated with mod-severe AD, but cow's milk (4.34+/-2.50 U/mL in mod-severe AD; 0.80+/-0.44 U/mL in mild AD) showed no statistical difference. Gender, feeding patterns, family history and number of siblings were not significantly associated with mod-severe AD. The total IgE level and egg white specific IgE level significantly increased as the duration of breast feeding increased (P< 0.05). CONCLUSION: Mod-severe atopic dermatitis in the first 6 months of life is associated with sensitization to food allergens, which might be transferred via breast milk.

Analysis of the Rate of Sensitization to Food Allergen in Children with Atopic Dermatitis / 대한지역사회영양학회지

The purpose of this study was to determined the rate of sensitization to food allergen in children with Atopic Dermatitis (AD) in Korea. A total of 3,783 patients (male = 1983, female = 1800) with AD (age under 18 years) who had visited Samsung Medical Center from 1998 to 2003 were enrolled in the study. Food hypersensitivity was measured by specific IgE to egg, cow's milk, soy, peanut, wheat, buckwheat, beef, pork, chicken, shrimp, crab, salmon, mackerel, etc. Specific IgE levels >0.7 kU/L by Captured Allergen Product (CAP) assay were considered positive. Chi-square test at p value < 0.05 was used to examine the difference of the prevalence by sex and age. The rate of sensitization to multiple food allergens was 31.2% and decreased with age. Hypersensitivity to egg showed highest prevalence, which was 24.3%, compared to the prevalence of other foods. High prevalence of hypersensitivity to milk, wheat, soy, peanut, crab or shrimp was observed (11.6 - 17.7%). Low prevalence of hypersensitivity to beef, pork, tuna or chicken was observed (1.9 - 3.5%). Children aged under 3 years had significantly higher prevalence of hypersensitivity to egg, milk, soy and beef than children aged at least 3 years. Our results stress the need for examination of food hypersensitivity aimed at identified and limited each food allergen among children with AD caused by food to help patients outgrow their food allergy.

Marasmus and Kwashiorkor by Nutritional Ignorance Related to Vegetarian Diet and Infants with Atopic Dermatitis in South Korea

Infants and children with food related Atopic Dermatitis (AD) need extra dietary efforts to maintain optimal nutrition due to food restriction to prevent allergy reactions. However, nutrition ignorance and food faddism make patients even more confused and practice desirable diet more difficult. The objective of this study was to report the AD patients' malnutrition cases in Korea. We report on 2 cases of severe nutritional deficiency caused by consuming macrobiotic diets which avoid processed foods and most animal foods, i.e. one of vegetarian diet. Case 1, a 12-month-old male child, was admitted with severe marasmus. Because of a history of AD, he was started on mixed grain porridge at 3 months without any breast milk or formula feeding. His caloric intake was 66% and protein intake was 69% of the recommended dietary allowance. Patient's height and weight was under 3th percentile. On admission the patient was unable to crawl or roll over. Case 2, a 9-month-old AD female patient, was diagnosed with kwashiorkor and rickets. She was also started on mixed grain porridge at 100 days due to AD. Her caloric intake has been satisfied recommended dietary allowance until 7 months, however, she conducted sauna bath therapy and reduced both energy and protein intake at 8 months. The amount of protein intake for case 2 was higher than recommended dietary allowance, but, sauna therapy and severe AD with intakes of low guality protein may increase patient's protein requirement resulting in kwashiorkor. Case 2 patient's height and weight was on 3th percentile. Both cases showed low intake of calcium, iron, zinc, vitamin A, vitamin E and especially very low intake of vitamin B12 and vitamin D. Allergy tests for certain foods had not done prior to admission for both cases. They followed the dietary advise operated by macrobiotic diet internet site. In conclusion, AD infants' parents and caregivers should contact a pediatrician trained as a specialist in allergy for accurate diagnosis. For infant patients, breast or formula feeding including hypoallergenic formula should be continued until their one year of age. When certain foods need to be restricted or to follow special diets such as vegetarian diet, consultation with pediatrician and dietitian is needed.

Cow's Milk Protein-specific IgE Concentrations in Two Age Groups of Children with cow's Milk Allergy / 소아알레르기및호흡기학회지

BACKGROUND: About 70-80% of children with cow's milk allergy (CMA) become outgrown clinically by the age of 3 years. Casein, one of the three major cow's milk proteins (casein, beta-lactoglobulin (BLG), alpha-lactoalbumin (ALA) ) has been reported to play an important role in the persistence of CMA. The aim of this study was to determine different effects of causative milk proteins on the persistence of CMA between two age groups. METHODS: A total of 65 patients with CMA were enrolled in this study. Their cow's milk-specific IgEs were positive ( 0.7 U/ml by Pharmacia CAP). After dividing 65 patients into two age groups, under the age of 3 years and over 3 years (persistent CMA), we compared the levels of casein-, BLG- and ALA-specific IgE antibodies between the two groups. RESULTS: There were 44 patients in the group of less than 3 years of age and 21 patients in the group of more than 3 years of age. The concentrations of the specific IgE antibodies to casein, BLG and ALA were not significantly different between the two groups. However, although statistically insignificant, those more than 3 years of age had higher mean values of casein-specific IgE antibodies and lower mean values of whey protein (BLG and ALA) - specific IgE antibodies compared with those less than 3 years of age. A single dominant allergenic milk protein was not identified within either of the two age groups, but the con centrations of the casein-specific IgE antibodies in children with more than 3 years of age tended to be higher than those of whey protein-specific IgE antibodies. CONCLUSION: Although statistically insignificant, the concentrations of the casein-specific IgE antibodies were higher in the group of more than 3 years of age than in the younger group. Moreover, the concentrations of the casein-specific IgE antibodies in children more than 3 years of age tended to be higher than those of whey proteins. These findings implicate that casein plays a certain role in the persistence of CMA.

Prevalence of Soy Protein Hypersensitivity in Cow's Milk Protein-Sensitive Children in Korea

This study was aimed to evaluate the prevalence of soy protein hypersensitivity in cow's milk protein-sensitive children in Korea. A total of 1,363 patients with atopic dermatitis, urticaria, enterocolitis syndrome, bronchial asthma or allergic rhinitis were recruited. First, we estimated the prevalence of sensitization to soy in children sensitized to cow's milk. Specific IgE levels > 0.7 kU/L by CAP assay were considered positive. Next, the prevalence of soy allergy in cow's milk allergy (CMA) patients was investigated. Those children whose parents agreed to participate the open challenge test with soy had a convincing history of allergic reactions elicited by cow's milk and these symptoms were relieved by elimination. All of them had negative soy-specific IgE. Patients with positive soy-specific IgE accounted for 18.3% of 224 children sensitized to cow's milk protein. The prevalence of sensitization to soy decreased with age (36.8% in the first year of life, 16.4% in the second year, and 13.7% in the third year). Of 21 CMA patients, 42.9% (n=9) were determined to have soy allergy (mean age 10.3 months). Our results suggest that soy protein formula should be carefully used as a substitute for cow's milk in CMA patients, especially during infancy.

Short-term Effect of Partially Hydrolyzed Formula on the Prevention of Development of Atopic Dermatitis in Infants at High Risk

This short-term, prospective study was aimed to assess the effects of partially hydrolyzed formula (PHF) on the prevention of the development of atopic dermatitis in infants at high risk. The infants of parents with allergy symptoms and serum total IgE over 200 kU/L were divided into 3 groups by their feeding patterns: PHF group (n=15), standard formula (SF) group (n=32), and breast milk (BM) group (n=22). No allergenic food was given during the study period of 6 months, and breastfeeding mothers avoided egg ingestion. Their atopic symptoms were monitored every 2 months. The cumulative incidence and prevalence of atopic dermatitis at the age of 6 months were significantly less in the PHF group than in the SF group (47% vs.78%, p<0.05; 20% vs. 59%, p<0.05). Those rates of the PHF group were also less than those of the BM group, but they were not statistically significant. There was no difference in the onset age and disease severity. These results suggest that early feeding of PHF to infants at high risk has a short-term preventive effect on the development of atopic dermatitis during the first 6 months of life. Long-term preventive effects should be evaluated.