Clinical manifestations patterns of allergic disease in Korean children under the age of 6: multi-center study / 소아과

PURPOSE: It is widely known that allergic diseases progress through an allergic march. However, there have not been any recent reports in Korea on how the diseases progress. METHODS: Parents who visited one of the Pediatric Allergy Clinics of four university hospitals in Seoul with a child under the age of 6 years during the period from May 1-30, 2006 were asked to complete a questionnaire. RESULTS: A total of 229 parents answered the questionnaire about their children, of which 122 were male and 107 were female. The most common allergic disease before 2 years of age was atopic dermatitis (79%). Meanwhile, in 2- to 4-year age group, allergic rhinitis (38%) and asthma (37%) were predominant. The most common allergic disease in the 4- to 6-year age group was asthma (72%), followed by allergic rhinitis (64%). Seventy-three percent of the children had a family history of allergic disease, most often in the fathers (39%). Among patients with allergic rhinitis, 50% had experienced asthma in their earlier days and 30% had experienced atopic dermatitis. In addition, 57% of the children with asthma had suffered from atopic dermatitis. Parents believed that asthma was the most serious allergic disease. CONCLUSION: In the present study, allergic disease showed a tendency to march from atopic dermatitis to asthma and then to allergic rhinitis. Early diagnosis and treatment of atopic dermatitis is, therefore, considered important for prevention of the allergic march.

A Nationwide Clinical Study of Acute Respiratory Distress Syndrome in Children

PURPOSE: Acute respiratory distress syndrome(ARDS) is the final course of acute lung injury. It results from various etiological origins and pathophysiologic mechanisms, and has a mortality rate of approximately 60-70%. Although the confirmative incidence of ARDS in children is yet unknown, the increasing incidence of ARDS has been reported in Korea. In the present study, we report ARDS diagnosed at the Clinic for Pediatric Allergy and Respiratory Disease in eleven medical centers nationwide. METHODS: The study was conducted on 42 patients diagnosed with ARDS in Pediatric Allergy and Respiratory Clinics from January, 1995 to August, 1997. We analyzed the clinical course and treatment modalities of the 42 cases of ARDS retrospectively. RESULTS: The total number of patients recruited was 42, including seventeen(40.4%) below 1-year-old. The mean age was 2.0+/-2.3(mean+/-standard deviation) years with a range of 2 months to 10 years, and there was no sex predominance(male/female : 27/15). Twenty-one cases(50.0%) occured during the spring(March, April and May). The major triggering factors of ARDS were viral pneumonia(59.5%) and bacterial pneumonia (19.1%). Mechanical ventilation was used in 37 cases(88.1%). Major complications included pneumothorax, DIC, and gastrointestinal bleeding. The mortality rate was 61.9% of which 16 case (61.5%) occurred before 2 years of age. CONCLUSION: We conducted this study to make a rapid diagnosis and appropriate treatment of ARDS in children, who have major risk factors, to reduce its mortality rate.

A Nationwide Clinical Study of Acute Respiratory Distress Syndrome in Children

PURPOSE: Acute respiratory distress syndrome(ARDS) is the final course of acute lung injury. It results from various etiological origins and pathophysiologic mechanisms, and has a mortality rate of approximately 60-70%. Although the confirmative incidence of ARDS in children is yet unknown, the increasing incidence of ARDS has been reported in Korea. In the present study, we report ARDS diagnosed at the Clinic for Pediatric Allergy and Respiratory Disease in eleven medical centers nationwide. METHODS: The study was conducted on 42 patients diagnosed with ARDS in Pediatric Allergy and Respiratory Clinics from January, 1995 to August, 1997. We analyzed the clinical course and treatment modalities of the 42 cases of ARDS retrospectively. RESULTS: The total number of patients recruited was 42, including seventeen(40.4%) below 1-year-old. The mean age was 2.0+/-2.3(mean+/-standard deviation) years with a range of 2 months to 10 years, and there was no sex predominance(male/female : 27/15). Twenty-one cases(50.0%) occured during the spring(March, April and May). The major triggering factors of ARDS were viral pneumonia(59.5%) and bacterial pneumonia (19.1%). Mechanical ventilation was used in 37 cases(88.1%). Major complications included pneumothorax, DIC, and gastrointestinal bleeding. The mortality rate was 61.9% of which 16 case (61.5%) occurred before 2 years of age. CONCLUSION: We conducted this study to make a rapid diagnosis and appropriate treatment of ARDS in children, who have major risk factors, to reduce its mortality rate.

Comparison of Measles Specific IgG in the Sera of Infants and Children after Vaccination of Measles

PURPOSE: After recent epidemics of measles in Korea, Korean Pediatric Society recommended 2 dose measles vaccination schedule instead of 1 dose since 1991. However, the studies that supported the modification of vaccination schedule were insufficient yet. This study was performed to evaluate the vaccination efficacy of 1 dose and 2 dose vaccination. METHODS: One dose vaccination group consisted of 19 infants(mean: 13.5 months of age) and two dose vaccination group consisted of 17 infants(mean: 20.4 months of age). We measured the serum level of measles specific IgG antibody in vaccinated infants during 2 to 8month after vaccination using enzyme linked immunosorbent assay(ELISA). RESULTS: 1) There was no significant difference between one dose and two dose vaccination group in measles specific IgG antibody level(479+/-203AU/ml vs. 442+/-119AU/ml). 2) There was no significant difference between one dose and two dose vaccination in seropositivity of measles specific IgG antibody(94.7% vs. 88.2%). 3) Seropositivity of measles specific IgG antibody in all subjects has gradually decreased after vaccination and it was not related to the dose of vaccination. CONCLUSIONS: These results suggest that two dose vaccination of measles is not effective than one dose. Therefore, to confirm the current vaccination schedule of measles in Korea, more studies about effective method of vaccination should be performed.

Changes of Measles Specific IgG after Active Immunization of Measles in Korean Children

PURPOSE: Despite preventive measures, measles outbreaks ocurred in 1989, 1990 and 1994 in Korea. Especially, the proportion of immunized school aged children and adolescents was increased, and the reason was, in our opinion, primary and secondary vaccine failure after measles immunization. In this context, we attempted to evaluate the changes of measles specific IgG levels in various age groups of immunized children. METHODS: From Jun. 1. 1994 to Mar. 31. 1995, the sera were collected from immunized children aged 1.5 to 12 years who had no history of natural measles. We measured the measles specific IgG using enzyme linked immunosorbent assay (ELISA: SIATM Measles IgG Kit, SIGMA Co. St Louis, Mo). RESULTS: The seropositivity of immunized children aged 1.5 to 12 years was 86.1% and 11 year old age group showed lowest level, 66.0%. As children were getting older, the measles antibody level decreased significantly( r=-0.2264, p<0.001 ). CONCLUSIONS: Above results partially explain the reasons for recent measles occurrences in immunized children and suggest that it is necessary to modify the current immunization schedule of measles in Korea.