Long-Term Effects of Diesel Exhaust Particles on Airway Inflammation and Remodeling in a Mouse Model

PURPOSE: Diesel exhaust particles (DEPs) can induce and trigger airway hyperresponsiveness (AHR) and inflammation. The aim of this study was to investigate the effect of long-term DEP exposure on AHR, inflammation, lung fibrosis, and goblet cell hyperplasia in a mouse model. METHODS: BALB/c mice were exposed to DEPs 1 hour a day for 5 days a week for 3 months in a closed-system chamber attached to a ultrasonic nebulizer (low dose: 100 microg/m3 DEPs, high dose: 3 mg/m3 DEPs). The control group was exposed to saline. Enhanced pause was measured as an indicator of AHR. Animals were subjected to whole-body plethysmography and then sacrificed to determine the performance of bronchoalveolar lavage and histology. RESULTS: AHR was higher in the DEP group than in the control group, and higher in the high-dose DEP than in the low-dose DEP groups at 4, 8, and 12 weeks. The numbers of neutrophils and lymphocytes were higher in the high-dose DEP group than in the low-dose DEP group and control group at 4, 8, and 12 weeks. The levels of interleukin (IL)-5, IL-13, and interferon-gamma were higher in the low-dose DEP group than in the control group at 12 weeks. The level of IL-10 was higher in the high-dose DEP group than in the control group at 12 weeks. The level of vascular endothelial growth factor was higher in the low-dose and high-dose DEP groups than in the control group at 12 weeks. The level of IL-6 was higher in the low-dose DEP group than in the control group at 12 weeks. The level of transforming growth factor-beta was higher in the high-dose DEP group than in the control group at 4, 8, and 12 weeks. The collagen content and lung fibrosis in lung tissue was higher in the high-dose DEP group at 8 and 12 weeks. CONCLUSIONS: These results suggest that long-term DEP exposure may increase AHR, inflammation, lung fibrosis, and goblet cell hyperplasia in a mouse model.

Analysis of Influenza Related Neurologic Complications for Recent 3 Years

OBJECTIVE: Influenza infection can stimulate secretion of proinflammatory cytokine and induce neurological symptoms due to post-infection immunity reaction. This study attempts to study clinical aspects of patients with neurologic complication and their difference to other patients with no neurological complication. METHODS: From January of 2012 to May of 2014, 535 patients diagnosed to have influenza in Soonchunhyang University Bucheon Hospital were included as subjects. They were classified into two groups based on existence of neurologic complication and retrospectively analyzed of clinical features and lab results. RESULTS: Thirty (5.6%) out of 535 patients showed neurologic complication and there were no significant difference in annual incidence of neurologic complication. Despite that the patient group with neurologic complication had history of neurological disorders and high admission rate, they did not show difference in age, gender, fever duration, and influenza A infection rate as compared with no neurologic complication group. In blood test, erythrocyte sedimentation rate and C-reactive protein was significantly low in patients with neurologic complication, but white blood cell count was not significantly different between two groups. Neurological complication was mostly seizure with 25 patients. Four patients showed encephalopathy and 1 patient was diagnosed with meningitis. CONCLUSION: Five point six percent among infants infected with influenza A were accompanied with neurologic complication, but none showed long-term sequelae. There was no difference in the annual incidence and incidence of neurological complication was higher in patients with history of neurologic disorder, but there were no other risk factors.

Translation and linguistic validation of Korean version of the Test for Respiratory and Asthma Control in Kids instrument

PURPOSE: We aimed to translate the Test for Respiratory and Asthma Control in Kids (TRACK) instrument into Korean, with subsequent linguistic validation. METHODS: The multistep process of forward translation, reconciliation, back-translation, cognitive debriefing, and proofreading of the Korean version of the TRACK was completed. RESULTS: Two bilingual medical personnel independently translated the original English version of the TRACK into Korean one. After moderating the translation into a single reconciled one, 4 other bilingual persons were invited to translate the Korean draft back into an English one. Discrepancies between the original English version and the back-translated one were reviewed, and the need to modify the reconciled Korean draft was discussed. Twenty caregivers of asthmatic children took part in interviews that examine the appropriateness of the Korean version of the TRACK. The feedback from caregivers were then reviewed by a panel of pediatric allergists and reflected in the final Korean version. The document was finally proofread to check the spelling, grammar, layout and formatting. CONCLUSION: Translation and linguistic validation of the Korean version of the TRACK instrument were completed.

The relationships among birth season, sunlight exposure during infancy, and allergic disease / 소아과

PURPOSE: The recent increase in the prevalence of allergic diseases is hypothetically attributed to immune dysregulation in turn caused by a reduction in exposure to sunlight. We explored relationships between birth season, sunlight exposure, exercise duration, and an allergic disease. METHODS: We performed a questionnaire-based survey on allergic diseases among elementary school students. Birth time was categorized according to the season (summer and winter). RESULTS: The prevalence of atopic dermatitis (AD) "symptoms ever" was higher in the children born in winter than in those born in summer (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.03-1.49; P=0.024). Birth in winter was associated with an increase in the "symptoms in the past 12 months" prevalence of food allergy (FA) (aOR, 1.56; 95% CI, 1.09-2.24; P=0.015). The lifetime prevalence of allergic diseases except FA was higher in the children whose parents considered their sunlight exposure prior to 24 months of ageas inadequate than those who considered their exposure as adequate ("diagnosis ever" asthma: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; allergic rhinitis [AR]: aOR, 1.4; 95% CI, 1.17-1.67; P<0.001; AD: aOR, 1.26; 95% CI, 1.06-1.51; P=0.01). Neither recent sunlight exposure nor exercise duration was associated with the prevalence of an allergic disease. CONCLUSION: Birth in winter may be associated with development of AD and FA. Inadequate sunlight exposure before the age of 24 months might possibly increase the risks of development of asthma, AR, and AD.

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.

The Relationship between the Time of First Respiratory Syncytial Virus Bronchiolitis and Later Wheezing and Asthma Development / 소아알레르기및호흡기학회지

PURPOSE: Respiratory syncytial virus(RSV) bronchiolitis is believed to be associated with later development of asthma and wheezing. This study was conducted to determine the relationship between the age of the first RSV bronchiolitis episode, the development of later wheezing and asthma, and the related other factors. METHODS: We studied 255 infants admitted with their first episode of RSV bronchiolitis. Epidemiological and clinical data were collected retrospectively from medical records and through telephone interviews. The patients were divided into < or =3 months, 4 to 12 months, and 13 to 24 months. RESULTS: Eighty-one infants were < or =3 months, 115 were 4 to 12 months, and 59 were 13 to 24 months old. The gender ratios (Male:Female) were 1:1, 1.6:1, and 3.2:1. Familial and personal history of allergic diseases and disease severity did not significantly differ according to the age of the first RSV bronchiolitis episode. The occurrence of wheezing was associated with the presence of a familial and personal history of allergic diseases, but not with gender (male) or disease severity. The risk for asthma increased when the infants had their first RSV bronchiolitis episode at an older age. A personal history of allergic diseases was associated with an increased risk for asthma. CONCLUSION: Asthma was more frequently diagnosed in older infants. The most important risk factors for recurrent wheezing and asthma were a familial and personal history of allergic diseases. Therefore, it was thought that RSV bronchiolitis is not the cause of recurrent wheezing and asthma, but that infants with a genetic predisposition to asthma have an increased risk for RSV bronchiolitis.

A Clinical Review of Staphylococcal Scalded Skin Syndrome for the Last 10 Years

OBJECTIVE: Staphylococcal scalded skin syndrome (4S) is not common, but has been increasingly recognized. We investigated the clinical features of 4S for the last 10 years. METHODS: This retrospective study was performed on 68 children who were admitted with 4S during 2001 to 2011. The patients were divided into 3 age groups: or =48 months. We evaluated the clinical findings and the differences among the 3 age groups. RESULTS: The mean age was 32 months with a peak incidence at age 12 to 47 months. The peak incidence was observed in 2007 with a seasonal occurrence, mainly from July to October. Except 2007, there was no obvious seasonal pattern in incidence. Atopic dermatitis was combined in 10 patients (14.7%). By clinical types, 4 patients (5.9%) were in generalized type, 17 patients (25%) in intermediate type, and 47 patients (69.1%) in abortive type. The patients with generalized type were all neonates, and intermediate type was more frequent in children younger than 12 months. In contrast, abortive type was a most frequent form after 12 months of age. Of 44 patients performed skin culture, methicillin-resistant Staphylococcus aureus was isolated in 25 cases. All affected patients recovered completely with semi-synthetic penicillin or 3rd generation cephalosporins. Four neonates were treated with vancomycin or teicoplanin. CONCLUSION: The peak incidence of 4S was at age 12 to 47 months. The severity of 4S was most severe in children younger than 12 months, showing a difference in clinical types according to the age groups.

Clinical features of Epstein-Barr virus-associated infectious mononucleosis in hospitalized Korean children / 소아과

PURPOSE: Few studies have been conducted on the recent status of infectious mononucleosis (IM) in Korean children. The aim of this study was to evaluate the recent trend in the clinical manifestations of Epstein-Barr virus (EBV)-associated IM as well as the clinical differences according to age. METHODS: A retrospective study was performed on 81 children hospitalized with EBV-associated IM who fulfilled the serological criteria for the diagnosis of EBV infection (viral capsid antigen immunoglobulin M positive). The patients were divided into 3 age groups: or =10 years. We evaluated the recent trend in clinical manifestations and the differences in clinical and laboratory findings among the 3 age groups. RESULTS: Thirty (37%) children were under 5 years of age, 38 (46.9%) were 5 to 9 years of age, and 13 (16%) were 10 years of age or older. The differences in the symptoms and signs among the 3 age groups were not statistically significant, except for headache. The mean duration of fever was 7.7 days (range, 0 to 18 days). A comparison of liver enzyme elevation among the age groups showed an association with advancing age (26.6%, 63.1%, and 76.9%, respectively, P=0.04) CONCLUSION: This study showed that EBV-associated IM in Korean children continues to occur mostly in children under 10 years of age. In children with EBV-associated IM, the incidence of headache and liver enzyme elevation, the duration of fever, and the proportion of females to males were all positively associated with advancing age.

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.

A study on the incidence of anemia according to feeding patterns and the status of weaning diet / 소아과

PURPOSE: Iron-deficiency anemia remains the most common nutritional deficiency in young infants. This study aimed to survey the actual condition of feeding patterns and weaning diet and to study the association between these factors and the prevalence of anemia in infants aged over 9 months. METHODS: We studied 171 infants aged 9-24 months who were hospitalized in the general ward with mild to moderate acute illnesses. The mothers answered a questionnaire about the feeding patterns and the status of the weaning diet of their infants. The infants were divided into three groups: infants who were exclusively breast-fed, those who had been given mixed feeding, and artificial milk feeders. RESULTS: The incidence of anemia was significantly higher in exclusively breast-fed infants (23/68, 33.8%) than in the infants with mixed feeding (11/62, 17.7%) and artificial milk feeders (5/41, 12.1%). The mothers' awareness about the state of their infants' weaning diet was not related to the presence of anemia in the exclusively breast-fed infants. About 70% of the infants had started the weaning diet before age 6 months in all three groups, without any difference according to feeding patterns. CONCLUSION: The incidence of anemia was significantly higher in the breast-fed group than in the other infants. Many mothers of breast-fed infants with anemia also believed that their infants were taking sufficient weaning foods. Therefore, further education of the mothers about iron-rich weaning foods and the importance of iron intake during infancy is needed to prevent anemia, especially in breast-fed infants.

Clinical aspects of chronic urticaria in children / 소아과

PURPOSE: Chronic urticaria is a disorder characterized by the appearance of wheals for more than 6 weeks; in most cases, the etiology is unknown. This study was aimed to discover the clinical aspects, the etiologic factors, and the course of chronic urticaria. METHODS: 51 children who were diagnosed with chronic urticaria in the past 4 years, and who had had follow-ups more than 6 months after diagnosis in the pediatric department of Soonchunhyang University Hospital in Bucheon, were enrolled in the study. The laboratory findings, clinical aspects, and courses were retrospectively investigated by medical record review and telephone interview. RESULTS: The median age of children with chronic urticaria was 4 years (8 months to 16 years) and the ratio of male to female was 1.4:1. Of the total, 39.2% of patients had a history of atopy. Angioedema occurred concurrently with urticaria in 11.8% of patients, and dermographism was seen in 41.2%. Results of thyroid function tests were normal and thyroid autoantibodies were absent in all cases. Regarding etiology, most cases (74.5%) were forms of idiopathic urticaria. Urticaria was induced by physical factors in 19.6% of patients. Open challenge tests revealed that 3 patients were allergic to food additives (glutamate 2, glutamate, and sulfite 1). In this study, most of the patients reported good response after medication of 1st- or 2nd-generation antihistamines alone. Follow-up at 6 months revealed that 70.6% of patients had experienced remission, and 84.8% of children who had follow-up at 1 year presented remission. CONCLUSION: Chronic urticaria in most patients was idiopathic. Remission occurred within 1 year of diagnosis, in most cases so chronic urticaria in children seems to have good prognosis.

A Clinical Study of Lobar/Lobular Pneumonia in Children / 소아알레르기및호흡기학회지

PURPOSE: We aimed to evaluate the clinical characteristics and etiological organisms associated with lobar/lobular pneumonia in Korean children. METHODS: Children hospitalized due to radiographically confirmed lobar/lobular pneumonia were evaluated prospectively between June 2006 and May 2008. Anti-Mycoplasma pneumoniae IgM/IgG (at admission and follow-up), blood cultures, throat swabs for bacterial detection or sputum culture, respiratory viruses (Respiratory syncytial virus, Adenovirus and Influenza A/B) antigen testing, and urinary antigen testing for S. pneumoniae were performed. RESULTS: Two hundred eighty-eight immunocompetent children (mean age, 5.9 years) were enrolled. The age distribution showed a peak frequency at 2-6 years of age (<2 years, 8.7%; 2-6 years, 60.8%; 7-10 years, 22.6%; 11-15 years, 8.0%). Typical respiratory organisms were identified in 64.9% of cases. Identified organisms were Mycoplasma pneumoniae (50.7%), bacteria in (5.9%), viruses (2.1%) and mixed infection (5.9%). Mycoplasma pneumoniae was the most commonly identified organism in all age groups. The majority (88.9%) of bacterial pneumonias including mixed infection were caused by Streptococcus pneumoniae. Mycoplasma pneumonia was the most frequent at 5-6 years of age, but bacterial pneumonia was most frequent at 1-2 years of age. Lobar/lobular pneumonia began to increase from August and showed peak incidence in November and December. The levels of WBC, ESR, and CRP more significantly elevated in those with bacterial pneumonia than in children with mycoplasma pneumonia. Pleural effusion was present in 18.1% of cases. In these cases, the duration of fever and hospitalization was prolonged, and the ESR and CRP levels were significantly higher, than those without pleural effusion. CONCLUSION: Mycoplasma pneumoniae was the most common organism causing lobar/lobular pneumonia in children. Mycoplasma pneumoniae was the most frequent causative organism at 5-6 years of age. On the other hand, bacterial pneumonia was more common at 1-2 years of age. Thus, age may be a significant factor for the diagnosis and treatment of lobar/lobular pneumonia in children.

A clinical study of deep neck abscess in children / 소아과

PURPOSE: It has been reported that deep neck abscesses are recently increasing again. We analyzed pediatric cases with deep neck abscesses during the last several years to contribute to the treatment of the disease. METHODS: The clinical data of 30 children under 16 years of age with deep neck abscess from February 2001 to July 2006 were analysed retrospectively. RESULTS: The mean age was 9 years (2-16 years), and the male/female ratio was 19/11. Abscesses in the peritonsillar space were most common (57%), followed by the retropharyngeal (30%) and parapharyngeal (13%) spaces. Upper respiratory infection in 10 cases (33%), dental infection in four case (14%), cervical lymphadenitis in three case (10%) and sinusitis in two case (6%) contributed to the development of deep neck infections. The frequent symptoms were fever in 16 case (53%), sore throat in 15 case (50%), poor oral intake in 10 (33%), odynophagia in eight (27%), and neck pain in eight (27%). Unilateral tonsillar hypertrophy and displacement in 15 case (50%) were most common. Neck mass in 13 patients (43%), neck stiffness in three (10%) and trismus in three (10%) were also found. Bacteria were isolated in 8 among 10 pus cultures; Streptococcus species 7 and Micrococcus luteus 1. All of those bacteria except Micrococcus luteus were sensitive to penicillin G. Surgical intervention was applied to 12 cases (40%), and the remaining 18 patients (60%) were treated with antibiotics only. There were no differences between the two groups in the duration of admission and antibiotic treatment. No complicated cases were observed. CONCLUSIONS: Peritonsillar abscesses were most frequent. Upper respiratory infection was the most common predisposing factor, followed by dental infection and sinusitis. Symptoms of respiratory tract obstruction were not found. The most common pathogens were Streptococcus species. Deep neck abscesses in children, if diagnosed at the early stage, possibly can be treated by antibiotics only, without surgical intervention.

Meconium Obstruction Syndrome in Two Extremely Low Birth Weight Infants

Ileal obstruction by meconium in premature and low birth weight infants is an unique clinical entity, and it is differentiated from other types of meconium obstruction not associated with cystic fibrosis. Markedly premature infants may present with intestinal obstruction symptoms resembling those of necrotizing enterocolitis, and perforation secondary to inspissated meconium. Between 2001 and 2006, two extremely low birth weight infants were treated for intestinal obstruction secondary to inspissated meconium. They were successfully treated with gastrografin enemas. Prompt diagnosis and appropriate management resulted in a beneficial patient outcome.

Severe Airway Hyperresponsiveness in School-aged Boys with a High Body Mass Index

BACKGROUND: An association between obesity and asthma has been reported. The prevalence of airway hyperresponsiveness (AHR), results of skin prick tests, body mass index (BMI), and asthma symptoms were examined in schoolchildren. METHODS: The results of BMI (kg/m2) determination, skin prick testing, spirometry, asthma questionnaires, and methacholine challenge tests were obtained in a cross-sectional survey of 667 schoolchildren. The methacholine concentration causing a 20% fall in FEV1 (PC20) was used as the threshold of AHR. If the PC20 was less than 16 mg/mL, the subject was considered to have methachloine mediated AHR. RESULTS: The mean BMI was 17.1+/-0.09 kg/m2. The prevalence of AHR was 42.7%. The sensitization rate to common inhalant allergens was 30.3%. PC20 in children with BMIs >or=17.1 kg/m2 was significantly lower than that in children with BMIs 17.1 kg/m2. The mean BMIs of boys and girls were not significantly different. The levels of PC20 by sex were not different. The children were grouped by sex into percentile of BMI. PC20 in boys was lower in the obese group than in the non-weight and overweight groups (p<0.05). PC20 in boys and girls with atopy was significantly lower than in those without atopy. In a multiple logistic regression model that included all of the children and adjusted for confounding variables, independent associations with AHR were seen with BMI, asthma symptoms, and atopy . CONCLUSIONS: BMI had an association with AHR in school-age boys.

X-linked Opitz G/BBB Syndrome: Identification of a Novel Mutation and Prenatal Diagnosis in a Korean Family

X-linked Opitz G/BBB syndrome (XLOS; MIM 300000) is a rare multiple congenital anomaly disorder that is characterized by facial anomalies, laryngeal/tracheal/esophageal defects and genitourinary abnormalities. XLOS is caused by mutations in the MID1 gene which encodes a microtubule-associated RING-Bbox-Coiled-coil (RBCC) protein. We recently found a four-year Korean male patient who was suspected of having XLOS. Mutation analysis of the MID1 gene in the patient and his mother demonstrated that the patient had a novel insertion mutation (c.1798_1799-insC), and his mother was a heterozygous carrier of the mutation. After identification of the causative mutation in this family, prenatal diagnosis of two consecutive fetuses were successfully undertaken. This is the first report on a genetically confirmed case of XLOS in Korea.

A Case of Jejunal Juvenile Polyp Presented as Intussusception / 소아과

Single or scattered sequential hamartomatous juvenile polyps are common in the large intestine, especially the rectosigmoid area, where they are usually nonfamilial. Juvenile polyps arising in the small inestine are very rare. Juvenile polyps are usually found in children aged between 1 and 10 years, the majority of cases are between 2 and 4 years of age. Bleeding is the most common symptom, but some children may suffer from autoamputation or prolapse through the anus, and rare cases are presented as intussusception. Approximately six cases of juvenile polyps in the small bowel have been reported. Jejunal intussusception arising from juvenile polyp is uncommon in comparison with the ileocolic form. It has an atypical subacute presentation. It must be better understood for its diagnosis can be made too late. Surgical exploration is the treatment of choice because of the recurrence of various clinical symptoms. We report a case of single juvenile polyp of jejunum found in a 10-year-old girl who presented with signs of intussusception.

Reactive Airways Dysfunction Syndromes Induced by Inhalation Injury / 소아알레르기및호흡기학회지

PURPOSE: Reactive airways dysfunction syndrome (RADS) is characterized by the appearance of asthma-like symptoms and an increase in nonspecific bronchial hyperresponsiveness in previously healthy individuals after a single large exposure to irritating gas, fume, or vapor, usually as a result of an accident. The purpose of this study is to evaluate the incidence of RADS and clinical characteristics after inhalation injury in children. METHODS: We analyzed nine male children with inhalation injuries from an elementary school fire accident. Clinical manifestations, PFTs including provocation test by methacholine and exercise, radiologic evaluations, skin test and serologic test for evidence of allergy were evaluated at 8 months after the inhalation injury. RESULTS: No documented preexisting respiratory illness was identified, nor did subjects relate past respiratory problems. All subjects suffered from the persistence of respiratory symptoms (cough on exertion, dyspnea on exertion or voice change in five subjects). All subjects showed normal chest X-rays, but a mosaic pattern was documented in the HRCT of three subjects. Basal FEV1 (%predicted) was decreased in one subject and FEF25-75% was decreased significantly in two subjects. Methacholine challenge test was positive in four subject and Exercise provocation tests showed significant decreases of FEV1 and FEF25-75% in three subjects. In four subjects, atopy was documented and but in all others, no evidence of atopy was identified. CONCLUSION: This study showed that RADS could develop after inhalation of irritants, and might persist. Inhalation injury patients should be closely monitored on respiratory symptoms and PFT.

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.

Lymphoproliferative Disorder as an Unusual Causen of Stridor in a Post-Liver Transplant Child / 소아알레르기및호흡기학회지

Otolaryngologic symptoms and findings are often the first manifestations of post-transplant lymphoproliferative disorder (PTLD) in children. We report a case of lymphoproliferative disorder which occurring in the epiglottis and aryepiglottic fold of a post-liver transplant, 28-month-old girl. Inspiratory stridor and mild respiratory distress were presented 7 months after the transplantation. Bronchoscopy revealed swelling of the epiglottis, multiple nodular lesions in the arytenoid and the pharyngeal wall, and collapse of the false vocal cord due to a redundant nodular mass during inspiration. Microscopic examination showed polymorphic, polyclonal small lymphoid aggregates, which were dominantly stained by monoclonal antibody to CD20. In this case, PTLD was associated with Epstein-Barr virus (EBV) infection. The patient was treated successfully by the surgical excision of the obstructing redundant mass in the arytenoids, dose reduction of immunosuppressive drugs and the administration of an antiviral agent. A diagnosis of PTLD should be considered in transplanted children who later develop upper airway obstruction.