Relationship between mode of delivery in childbirth and prevalence of allergic diseases in Korean children

PURPOSE: We tested the hypothesis that cesarean section might increase the risk for allergic diseases compared to vaginal delivery, by depriving the newborn of exposure to maternal microflora. METHODS: We evaluated the prevalence of allergic diseases, allergic inflammation, and allergic sensitization according to mode of delivery for 279 Korean children aged < or =16 years. Data were extracted from medical records and a questionnaire filled out by parents. Logistic regression was used to determine the association between cesarean section and the outcomes of interest. RESULTS: Of the 279 children, 179 (62.6%) were delivered vaginally and 100 (37.4%) by cesarean section. There were no differences in the prevalence of allergic diseases, allergic inflammation, or allergic sensitization according to mode of delivery. Children born by cesarean section had no higher risk of allergic disease than those delivered vaginally, regardless of a parental history for allergic disease. Adjusted odds ratios (95% confidence intervals) for cesarean section compared to vaginal delivery were not statistically significant for any outcome considered: asthma, 0.76 (0.37-1.57), allergic rhinitis, 1.14 (0.61-2.10), atopic dermatitis, 1.01 (0.59-1.71). CONCLUSIONS: Delivery by cesarean section may not be associated with the subsequent development of asthma, allergic rhinitis, or atopic dermatitis in Korean children.

Relationship between Exhaled Nitric Oxide Concentration and Pulmonary Function/Airway Hyperresponsiveness in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Exhaled nitric oxide (eNO) has been proposed as a non-invasive marker for airway inflammation in asthma. Pulmonary function tests have been widely used in the diagnosis and management of asthma. Airway hyperresponsiveness (AHR) is one of the major features in asthma and usually assessed by the methacholine challenge test. The purpose of the present study was to assess the possible relationship between eNO and pulmonary function/AHR in asthmatic children. METHODS: There were 121 asthmatic children and 81 controls in the study. The eNO level was measured, the methacholline challenge test, spirometry, impulse oscillometry (IOS) and assessment of their bronchodilator responses were performed on all subjects. RESULTS: The asthma group had a higher eNO value than the control group [28.3 (15-55.75) vs. 20 (12.35-39.7) ppb, P=0.015]. The eNO level correlated positively with dFEV1 (r=0.230, P= 0.001). It correlate inversely with dR5 (r=-0.149, P=0.036), eNO with PC20 (r=-0.318, P<0.001) and with FEF25-75 (r=-0.17, P=0.015), but not with FEV1. CONCLUSION: This study suggests that eNO values may reflect AHR, as well as airway inflammation, but not pulmonary function.

Clinical Implications of Serum Retinol-Binding Protein 4 in Asthmatic Children

Recently the prevalence of both asthma and obesity have increased substantially in many countries. The aim of this study was to evaluate the role of retinol-binding protein (RBP) 4 in childhood asthma and its association with atopy markers, pulmonary function, and bronchial hyperresponsiveness in relation to obesity. We studied 160 children between the ages 6 to 10 yr, including 122 asthmatics and 38 controls. The body mass index, pulmonary function tests, and methacholine challenge tests were measured on the same day. Total eosinophil count, serum total IgE, serum eosinophil cationic protein, and serum RBP4 were measured in all subjects. There was no difference in serum RBP4 levels between the asthmatics and the control group. In all subjects or subgroups, serum RBP4 was not associated with total eosinophil count, serum total IgE, serum eosinophil cationic protein, or PC20. There was no relationship between serum RBP4 and pulmonary function in female asthmatics. Forced expiratory volume in 1 second/forced vital capacity (FVC) and forced expiratory flow between 25% and 75% of FVC contributed to serum RBP4 in male asthmatics. Our findings show an association between RBP4 and pulmonary function in prepubertal male asthmatics. This relationship may indirectly affect the high prevalence of childhood asthma in males.

Clinical Implication of Sputum CXCL13 in Children with Asthma / 소아알레르기및호흡기학회지

PURPOSE: CXCL13 is known to be a chemokine delivering B cell to the secondary lymphatic follicles, such as spleen, lymph nodes, and Peyer's patches. Recently, there have been some reports that CXCL13 is important for T cell inflammation and expressed by Th17 cell which produces IL-17. This study attempted to examine the clinical implication of CXCL13 in children with asthma. METHODS: This study included a total of 160 children aged 6 to 15 years who visited Severance Children's Hospital. There were 80 children with asthma and 80 children without. The pulmonary function test and the methacholine challenge test were performed. Total eosinophil count, eosinophil cationic protein (ECP) and total IgE in serum and eosinophils, ECP and CXCL13 in sputum were measured. RESULTS: The mean age of the subjects was 8.3+/-2.3 years for the asthma group and 9.3+/-2.5 years for the control group. The male to female ratio was 67.5% and 55.0% respectively. The sputum CXCL13 level for the asthma group was significantly higher than that level for the control group (P=0.003). This significance persisted even after adjustment for age and sex (P=0.010). The sputum CXCL13 level showed a positive correlation with that of sputum eosinophils (r=0.190, P=0.017) and ECP (r=0.285, P=0.002). CONCLUSION: Our results suggest that CXCL13 may play an important role in the pathophysiology of asthma related to eosinophilic inflammation. Further studies on sputum CXCL13 could help to reveal the role of chemokines in asthma.

VEGF and Activated Eosinophils in Children with Asthma and Eosinophilic Bronchitis / 소아알레르기및호흡기학회지

PURPOSE: Vascular endothelial growth factor (VEGF) is an important mediator of airway inflammation and remodeling in asthma. We aimed to explore whether VEGF is expressed at elevated levels in asthmatic airways or eosinophilic bronchitis (EB) and associated with eosinophilic inflammation, pulmonary function, and airway hyperresponsiveness (AHR) in children. METHODS: One hundred seventeen asthmatic children, 77 children with EB, and 84 healthy children were enrolled. Sputum supernatants were collected and VEGF and eosinophil cationic protein (ECP) levels were measured. RESULTS: Asthmatic children had significantly higher levels of VEGF in induced sputum [89.04 (29.95-178.09) pg/mL] compared to children with EB [25.30 (11.02-80.23) pg/mL] and healthy children [37.37 (16.56-71.30) pg/mL; P=0.0003]. VEGF in sputum positively correlated with sputum ECP (r=0.524; P<0.0001). Negative significant correlations were found between sputum VEGF and FEV1, (r=-0.252; P=0.001) or post-bronchodilator FEV1 (r=-0.181; P=0.038) whereas nonsignificant correlations were found between sputum VEGF and sputum eosinophils. CONCLUSION: Our findings suggest that VEGF is associated with activated eosinophils in the asthmatic airway, but not EB. Sputum VEGF could be a supportive marker that represents activation of airway eosinophils and persistent airflow limitation in asthmatic children.

A Case of Perilla Allergy in a 2-Year-old Boy / 소아알레르기및호흡기학회지

Even though perilla is one of the most commonly consumed grain in Asia including Korea, perilla allergy is rare. A 2 year-old boy had erythematous popular urticaria on his whole body, as well as vomiting and diarrhea after ingestion of boiled perilla. On the second day of admission, old blood clots in the vomitus and blood tinged stool were shown. He underwent an esophago gastro duodenoscopy which showed a large duonenal ulcer. After treatment, his general condition improved. We report a case of perilla allergy with brief review of related literature.

Mucoepidermoid Carcinoma in a 12-Year-Old Boy / 소아알레르기및호흡기학회지

Bronchial mucoepidermoid tumors are rare, especially in children. They are commonly misdiagnosed as infections or asthma and treated with bronchodilators without resolution. Based on the available clinical outcome and survival data, it is believed that tracheobronchial mucoepidermoid carcinoma may be successfully managed by surgical intervention alone in children and adolescents. We report a case of a 12-year-old boy with low-grade mucoepidermoid carcinoma in the right intermediate bronchus that caused chronic cough. He underwent sleeve resection of the right bronchus and remained symptom-free without recurrence during the follow-up period of 16 months.

A Case of Chronic Pneumonitis of Infancy in a 3-Year-Old Boy / 소아알레르기및호흡기학회지

Interstitial lung disease, mostly chronic lung disorder, is usually characterized by diffuse infiltrates and disordered gas exchange, is a very rare disease in children. Chronic pneumonitis of infancy (CPI) is a recently described entity representing a distinct form of interstitial lung disease affecting infants and young children. The histologic findings suggest marked alveolar septal thickening, striking alveolar pneumocyte hyperplasia, and alveolar exudates containing numerous macrophages and foci of eosinophilic debris. A 3-year-old boy visited a local clinic with cough and tachypnea for a duration of 3 weeks. His clinical symptoms were aggravated and he was referred to our hospital. He was diagnosed with chronic pneumonitis of infancy after undergoing open lung biopsy. We herein present the case with review of literature.