Unmet Primary Physicians' Needs for Allergic Rhinitis Care in Korea

Allergic rhinitis (AR) is one of the most common chronic allergic respiratory diseases worldwide. Various practical guidelines for AR have been developed and updated to improve the care of AR patients; however, up to 40% patients remain symptomatic. The unmet need for AR care is one of the greatest public health problems in the world. The gaps between guideline and real-world practice, and differences according to the region, culture, and medical environments may be the causes of unmet needs for AR care. Because there is no evidence-based AR practical guideline reflecting the Korean particularity, various needs are increasing. The purpose of the study was to evaluate whether existing guidelines are sufficient for AR patient management in real practice and whether development of regional guidelines to reflect regional differences is needed in Korea. A total of 99 primary physicians comprising internists, pediatricians, and otolaryngologists (n=33 for each) were surveyed by a questionnaire relating to unmet needs for AR care between June 2 and June 16 of 2014. Among 39 question items, participants strongly agreed on 15 items that existing guidelines were highly insufficient and needed new guidelines. However, there was some disagreement according to specialties for another 24 items. In conclusion, the survey results demonstrated that many physicians did not agree with the current AR guideline, and a new guideline reflecting Korean particularity was needed.

Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.

Erratum: Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

The funding acknowledgment in this article was omitted as published.

The Effects on Treatment of Atopic Dermatitis with Oral Lactobacillus casei Supplements in Korean Children / 소아알레르기및호흡기학회지

PURPOSE: Recent studies suggest that oral probiotic administration might be useful in the management of atopic dermatitis. Probiotics are known to promote the maturation of gut- associated lymphoid tissue (GALT) and control inflammatory responses. The purpose of this study was to evaluate clinical and anti-inflammatory effects on children's atopic dermatitis with Lactobacillus casei (L. casei), a kind of probiotic, supplementations. METHODS: Forty four patients with atopic dermatitis who visited the Pediatric Allergy Clinic in Soonchunhyang University Hospital from December 2004 to April 2005 were enrolled. We evaluated the SCORAD scores. Then, fresh stools were collected and cultured to count colony numbers of L. casei, and blood were samples were taken to measure IFN-gamma, total IgE, specific IgE (house dust mites, milk, egg white, dog hair, soy bean), peripheral blood eosinophil percent, and ECP. We divided patients by two groups randomly. L. casei containing yoghurt was ingested by one group but not by the other group for 16 weeks. After that period, SCORAD scores, stool cultures and blood samples were reevaluated. RESULTS: Most patients who received L. casei experienced improvement of atopic dermatitis, but changes in SCORAD scores were not so significant compared with the other group. Just forty patients had their blood tested again (L. casei group was 21), and there were no statistical significances. There were also no significant changes of specific IgE, eosinophil percent, ECP, total IgE, and IFN-gamma levels, before and after. The colony counts of L. casei in stool which were cultured after investigation, were relatively high in the group with L. casei supplements. (P=0.03) Conclusion: The administration of L. casei in children with atopic dermatitis might be helpful to improve the colony counts of L. casei in intestines, and these increased L. casei are expected to act as a down-regulator of allergic inflammation, but more investigations should be conducted to reveal the precise mechanisms and possible complications.

Secondary Skin Infection and Their Sensitivity to Antibiotics in Children's Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Our study was designed to evaluate the prevalence of secondary skin infection in patients with atopic dermatitis and their sensitivity to antibiotics for appropriate choice of antibiotics. METHODS: We studied skin culture and their sensitivity results for 218 patients who visited to pediatric allergy clinic from June 2003 to August 2004. After determining minimal inhibitory concentrations(MICs) of antibiotics from randomly selected 40 cases of them, we compared the result with previous data. RESULTS: Age distribution was as follows; 28 cases(12.8%) were under 1 year old, 64 cases(29.4%) were 1 to 3 years old, 63 cases(28.9%) were 4 to 6 years old, and 63 cases (28.9%) were over 7 years old. 121 cases(55.5%) of 218 cases were found to have secondary skin infection. The most common organism was Staphylococcus aureus(S. aureus; 85 cases, 70.2%). The next was Staphylococcus epidermides(S. epidermidis; 22 cases, 18.2%). S. aureus were highly resistant to ampicillin and penicillin, but were relatively highly sensitive to 1st and 2nd generation cephalosporin, gentamicin, and erythromycin. To teicoplanin and vancomycin, they were entirely sensitive. On the other hand, S. epidermidis was highly resistant to 1st generation cephalosporin in addition to ampicillin and penicillin. Moreover, alpha- and beta-hemolytic streptococcus, which were co-infected with S. aureus, showed highly resistance to ampicillin, oxacillin and cephalosporin. In MIC test, methicillin-resistant S. aureus were found in 4 cases. CONCLUSION: Skin culture, sensitivity test and the appropriate choice of antibiotics might be important to control secondary skin infection and atopic dermatitis.

An Investigation into the Actual Condition of Outbreak and Treatment in Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Social concern about atopic dermatitis is increasing these days, and there is much informations from the mass media. However, we have difficulties to diagnose and treat atopic dermatitis because there is no general guideline. So these studies were done to help establish guidelines for proper diagnosis and treatment of atopic dermatitis. METHODS: The authors made up a questionnaire consisting of symptoms, environment, birth, diet, family history, previous treatment and common knowledge about atopic dermatitis. We studied moderate to severe atopic dermatitis patients, from February to August, 2003, using a survey containing 40 questions. We tested serum total IgE, specific IgE (Pharmacia, uni CAP), skin culture, complete blood counts, AST/ALT, and IgA. RESULTS: In our study results, the onset of atopic dermatitis, which was over moderate, was averaged 13 months after birth, and the earliest onset was 1 week after birth. The locations of skin lesion were lower extremities, face, buttocks, neck, and body, according to frequency. The most common type of housing was apartments. Many were getting breast milk feeding, had family members who smoke and most had no pets. Regardless of the severity of clinical manifestations, many patients did not have allergic tests and took just oriental medicine. Secondary infections were more common in patients who had fewer baths. CONCLUSION: Therefore the education of patients and their parents about etiology and progress of atopic dermatitis is needed. And for pediatricians, a general guideline of diagnosis and treatment needs to be established.

Comparison of Clinical Effect and Compliance according to Administration Route of beta2-agonist in Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: This study was performed to evaluate the efficacy and compliance of beta2- agonist according to the type of preparations in the children with asthma. METHODS: Randomly selected 30 patients, who visited to Soonchunhyang University Hospital with acute asthma attack from May to August, 2004 were enrolled. Patients were randomly divided into 3 groups. We evaluated asthma symptom score before and 1 week after treatment in each group. Also, we measured O2 saturation, peak expiratory flow rate (PEFR), heart rate, and evaluated adverse reactions during the treatment. Treatment compliance was evaluated by the face to face interview with the patients and their guardians after 1 week of treatment. RESULTS: The mean asthma symptom score before and after treatment in each group were 5.9 and 1.1 in transdermal group, 5.4 and 0.9 in inhalation group, and 5.5 and 1.3 in oral group, respectively. Mean improvement of PEFR was 23.7% predicted after treatment. There was no serious adverse reactionin each group except mild itching of patch site in one case of transdermal group. Compliance of each group was relatively good. CONCLUSION: For the treatment of acute asthma attack, there was no difference in efficacy and safety of beta-agonist among the type of preparations. Also, there was no difference in adverse reaction and compliance between the type of preparation. Therefore it will be useful to choose the preparation with better compliance in each patient for the effective treatment of childhood asthma.

A Case of Neonatal Infective Endocarditis without Cardiac Anomaly

Neonatal infective endocarditis is fatal and rare disease but recently there is a trend of an increase in incidence even without congenital heart disease when there are high risk as prematurity, central vein catheterization and neonatal cardiopulmonary resuscitation. Symchych reported that in about 3% of autopsy cases of an year, the findings of infective endocarditis were noted. In Korea, there was a case report but it was case of a premature infant who had umbilical vein catheterization and respiratory ventilator treatment. We experienced a case of neonatal infective endocarditis in a female infant who was delivered at 34 weeks gestational age without receiving central vein catheterization or neonatal cardiopulmonary resuscitation. Although she received intensive antibiotic therapy for staphylococcus cultured in blood, she died necessarily. We reported a case of neonatal infective endocarditis without cardiac anomaly with brief review of related literature.