Bee pollen-induced anaphylaxis: Report of a patient with oral allergy syndrome

Bee pollen is a mixture of pollen, nectar collected by honeybees, and digestive enzymes secreted from honeybees, which is consumed as a dietary supplement. We experienced a case of anaphylaxis after ingestion of bee pollen in a patient with seasonal allergic rhinitis and oral allergy syndrome caused by watermelons, Korean melons, peaches, and plums. The skin prick test was positive for bee pollen, dandelion, ragweed, and mugwort, and specific IgE to honeybee venom was negative. According to the literature, bee pollen causing systemic allergic reactions mainly consists of the plant family Compositae, including dandelion, ragweed, and mugwort. Thus, ingestion of bee pollen should be closely monitored in patients with allergic rhinitis worsening in autumn, especially those with oral allergy syndrome for foods that cross-react with weed pollen.

Analysis of clinical features of adult asthma according to blood basophils and their association with cytokines in exhaled breath condensate

Purpose@#Although basophils are major effector cells involved in asthma, their pathophysiological role in asthma remains uncertain. In this study, we investigated the relationship between blood basophils, clinical features in asthmatics, and cytokines in exhaled breath condensate (EBC) which could be noninvasively obtained. @*Methods@#A total of 13 adult asthmatics were prospectively enrolled. We obtained information on demographics, asthma control levels, history of acute exacerbation as well as the asthma control test and Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA) scores. Peripheral blood and EBC samples were collected, and pulmonary function test was also performed. The association between blood basophil count and clinical feature and severity of asthma or inflammatory cytokines in EBC was analyzed. @*Results@#The percentage of blood basophils was positively correlated with that of blood eosinophils (Spearman r=0.665, P=0.013). The number of acute exacerbations was significantly larger (1.2±0.6 vs. 5.3±5.8, P=0.049) in the group with blood basophils ≥50 cells/μL, while the QLQAKA score was lower (68.8±7.9 vs. 49.0±12.0, P=0.028). There were no significant differences in age, atopy status, smoking history, and forced expiratory volume in 1 second according to blood basophil count. Blood basophil count was positively correlated with interleukin-33 (IL-33) (r=0.651, P=0.016) and IL-17 (r=0.732, P=0.004) in EBC. @*Conclusion@#Blood basophils may be associated with frequent asthma exacerbations and lower quality of life due to asthma. IL-33 and IL-17 may be the key mediators that stimulate basophils to participate in the pathogenesis of asthma.

Inhaled Corticosteroids in Asthma and the Risk of Pneumonia

PURPOSE: Asthma is a common disease that is expensive and burdensome for patients. Inhaled corticosteroids (ICS) are the most important drugs for asthma treatment and are often prescribed long-term. However, the use of ICS has been reported to increase pneumonia, though this remains controversial. We evaluated whether the use of ICS increases the risk of pneumonia in asthmatic patients using the Health Insurance Review and Assessment Service (HIRA) database in Korea. METHODS: The Asthma Management Adequacy Assessment was performed by the HIRA in Korea. Patients with claimed insurance benefits for asthma disease codes and who were prescribed asthma medications more than 2 times were enrolled. Patient demographics, asthma medications, healthcare use, and complications were analyzed. RESULTS: The total number of asthma patients was 831,613. Patients using ICS were older and had more comorbidities than those not using ICS; they also visited outpatient clinics and emergency departments, and were more often hospitalized. Pneumonia and other complications occurred more often in patients using ICS, and they used more respiratory medications, except for theophylline. Multiple logistic regression analysis showed that ICS prescription was associated with pneumonia (odds ratio, 1.38; 95% confidence interval, 1.36-1.41). Age, sex, medical care, use of secondary and tertiary hospitals, and hospitalization due to asthma in the previous year were also associated with pneumonia. CONCLUSIONS: ICS use was associated with increasing pneumonia in asthmatic patients in Korea. Therefore, it is critical to acknowledge that the use of ICS may increase the risk of pneumonia and should be meticulously monitored in asthmatics.

Concurrent bilateral juvenile temporal arteritis and hypereosinophilic syndrome: a case report and review of the literature

Most of temporal arteritis occurs in the older patient over 50 years old, and the histopathologic finding shows a granulomatous inflammation, so this called giant cell arteritis. However, the young patients also present with a nodular lesion in their temple, and juvenile temporal arteritis (JTA) should be considered as one of the differential diagnosis, although it is very rare. For both diagnosis and treatment of JTA, excisional biopsy is essential. The pathologic finding of the temporal artery shows panarteritis with lymphoeosinophilic infiltrates, but no giant cell or granulomatous lesion. JTA is a localized disease with low level of systemic inflammatory marker, so the symptom is usually relieved by excision of affected lesion. Peripheral blood eosinophilia present in some cases of JTA, but its relation with clinical course and prognosis is not yet been known. Herein, we report the case of a 24-year-old man diagnosed with concurrent JTA and hypereosinophilic syndrome. We also reviewed the literature of JTA focusing on the impact of combined peripheral eosinophilia on the course of the disease. Combined peripheral eosinophilia may increase the risk of recurrence of JTA after local treatment such as excision only.

Bullous hemorrhagic dermatosis due to enoxaparin use in a bullous pemphigoid patient

Adverse reactions of subcutaneous low molecular weight heparin or unfractionated heparin could be complications by bleeding, heparin-induced thrombocytopenia, drug-induced liver injury, osteoporosis, and cutaneous reactions. Heparin-induced skin lesions vary from allergic reactions like erythema, urticaria, eczema to intradermal microvascular thrombosis associated with heparin-induced thrombocytopenia. There is a rare cutaneous complication, called bullous hemorrhagic dermatosis. We experienced this rare case of the cutaneous complication caused by enoxaparin. Several tense bullous hemorrhagic lesions occurred after 3 days of enoxaparin in a known bullous pemphigoid patient who had aortic valve replacement surgery with a mechanical prosthesis. The bullous hemorrhagic lesions were regressed after the discontinuation of enoxaparin but recurred after re-administration. The lesions were controlled by the administration of systemic corticosteroid and alternative anticoagulant. To date, less than 20 cases have been reported worldwide. This is the first case of bullous hemorrhagic dermatosis induced by enoxaparin, a low-molecular-weight heparin in Korea. This is also the first case of bullous hemorrhagic dermatosis in a known bullous pemphigoid patient.

Successful rapid desensitization for cetuximab-induced anaphylaxis

Cetuximab, a chimeric mouse-human immunoglobulin, is an antiepidermal growth factor receptor monoclonal antibody. It has been approved by the U.S. Food and Drug Administration for the treatment of metastatic colorectal and head/neck cancer, but can cause fatal hypersensitivity reactions in some patients. A 66-year-old male with metastatic sigmoid cancer had cetuximab-induced anaphylaxis when the first dose of cetuximab was administered. Cetuximab was safely readministered for another 15 cycles based on the rapid desensitization protocol. We experienced a case of cetuximab-induced anaphylaxis on the first exposure which was successfully managed by rapid desensitization.