The effect of atopy and allergic diseases on pulmonary function of Korean adolescents

PURPOSE: Pulmonary function test (PFT) plays a key role in the diagnosis and management of asthma in adolescents. But, it is not clear whether adolescents with asthma have significantly reduced lung function when compared with adolescents without asthma. The purpose of this study was to determine the effect of atopy and allergic diseases on pulmonary function and bronchial hyperresponsiveness (BHR) in Korean adolescents. METHODS: A questionnaire survey was conducted on 647 middle school students (male, 264; female, 383) from Seoul city to determine the prevalence of symptoms and diagnosed allergic diseases. We also performed the PFT, methacholine challenge test, skin prick tests and serum total immunoglobulin E. Current atopic dermatitis was diagnosed by doctor's medical examination. RESULTS: Female showed higher values of forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) and higher numbers of BHR (PC20 less than 25 mg/dL) compared to male (P<0.01). BHR was more common in atopy group (P<0.01), but PFT was not significant difference between atopy and nonatopy. Mean values for all spirometric parameters for asthmatic adolescents were in the normal range. Adolescents with asthma symptoms had slightly lower FEV1/FVC and forced expiratory flow 25%-75% than that of adolescents with no history of wheeze ever, asthma diagnosis and current asthma, but there was no statistically significance. CONCLUSION: The majority of adolescents recruited from the general population who reported having asthma symptoms or other allergic diseases had normal lung function. Sex, atopy, and current atopic dermatitis may affect BHR in Korean adolescents.

A Case of Laryngeal Neurofibroma with Sleep Obstructive Apnea / 소아알레르기및호흡기학회지

Most patients with neurofibromas suffer from neurofibromatosis type 1 (von Recklinghausen's disease), which is characterized by cafe-au-lait spots and cutaneous neurofibromas. Neurofibromas in the laryngeal area are extremely rare. Most patients with a laryngeal neurofibroma present with dyspnea, dysphagia, stridor, or hoarseness, depending on the location and size of the tumor. We present a case of a laryngeal neurofibroma in a boy with neurofibromatosis type 1. A 30-month-old boy with neurofibromatosis presented to our hospital with respiratory difficulty and obstructive sleep apnea. Magnetic resonance imaging demonstrated a round mass over the left carotid space, and its location made surgical resection impossible. Hence, tracheostomy was performed to maintain airway patency. The patient's symptoms improved after tracheostomy. Long-term follow-up is essential owing to the possibility of recurrence. The patient has thus far shown no obstructive airway symptoms for one year after closure of the tracheostomy.

A Case of Epstein-Barr-Virus-Associated Lymphocytic Interstitial Pneumonia / 소아알레르기및호흡기학회지

Lymphocytic interstitial pneumonia (LIP) is a benign lymphoproliferative disorder characterized histologically by diffuse infiltration with predominantly mature lymphocytes, plasma cells and reticuloendothelial cells in the alveolar septae and along the lymphatic vessels. LIP is an uncommon disease frequently associated with autoimmune diseases such as Sj?gren's syndrome, systemic lupus erythematosus, chronic active hepatitis, thyroiditis, myasthenia gravis, autoimmune hemolytic anemia and Human Immunodeficiency Virus (HIV) or Epstein- Barr virus (EBV) infection. LIP can progress to pulmonary or systemic lymphoma. LIP in children has variable disease courses such as spontaneous resolution, episodic worsening or progression to frank respiratory failure. Intravenous immunoglobulin and corticosteroids yield variable results, and some children may respond to them for several years. We report herein a case of EBV-associated, HIV-negative LIP diagnosed by thoracoscopic lung biopsy and a clonality study in a 5 year-old boy who was admitted with recurrent coughing and dyspnea. The patient was treated and fully recovered with methylprednisolone and high dose acyclovir. At the 3-year follow-up, he showed no clinical symptom despite increased EBV copy in bronchoalveolar lavage and progressive bronchiectasis in the right middle lobe.

Allergen Sensitization of Severe Atopic Dermatitis in Children under 2 Years / 소아알레르기및호흡기학회지

PURPOSE: Atopic dermatitis (AD) is the allergic disease which appears during infancy. This study aimed to find associations between clinical parameters, allergen sensitization and severity of AD in chidren under 2 years. METHODS: Two hundred fifteen patients (123 boys, 92 girls) under 2 years with severe AD who visited the department of pediatrics of Hangang Sacred Heart Hospital and Asan Medical Center were enrolled. We checked the severity scoring of atopic dermatitis (SCORAD), total eosinophil count, eosinophil ratio, eosionphil cationic protein (ECP), total IgE and specific IgE to 12 allergens [egg white, milk, soybean, peanut, wheat, fish, Dermatophagoides pteronyssinus (D.p), Dermatophagoides farinae (D.f), dog, cat, cockroach, alternaria]. Atopic AD was defined as serum total IgE 200 IU/mL or specific IgE positive. RESULTS: The mean of SCORAD was 69.0. Atopic AD was 161 (75%). There were no differences in age between atopic and non-atopic AD. However, SCORAD, IgE, eosinophil, and ECP were the higher in atopic AD. Sensitization to food allergen was the highest in egg white (76.4%), followed by milk (58.4%) and aeroallergens such as D.f (49.1%) and D.p (46.6%). The more the number of sensitized food allergens, the higher the SCORAD appeared. However, it did not show any relationships with the number of sensitized aeroallergens. CONCLUSION: The percentage and severity were higher in atopic AD than non-atopic AD. The number of sensitized to food allergen affect the severity. Therefore, understanding the sensitization to food allergens may be more helpful in predicting severity than sensitization to aeroallergen. In cases of positive reaction to aeroallergens, it is necessary to observe the development of respiratory allergic disease.

Role of IL-5 and eotaxin in airway eosinophilic inflammation / 천식및알레르기

BACKGROUND: IL-5 and eotaxin are the most important cytokines/chemokines responsible for regulating eosinophil locomotion. OBJECTIVE: We investigated the role of IL-5 and eotaxin in airway eosinophilic inflammation in patients with chronic cough by analyzing sputum from patients. METHODS: Thirty-one patients who had chronic cough and seven normal control subjects were enrolled. Patients were divided into two groups, asthma group (n=15) and non-asthma group (n=16). Sputum was induced by inhalation of hypertonic saline. Total cell counts and differentials were determined. The levels of IL-5 and eotaxin were measured by ELISA, and the levels of EDN and MBP were measured by RIA. RESULTS: Patients in the asthma group showed higher percentage of eosinophils and higher levels of EDN and IL-5 (P<.001, P<.05 and P<.05, respectively) compared to subjects in the control group and higher % eosinophils, higher levels of EDN and MBP (P<.001, P<.05 and P<.05, respectively) compared to subjects in the control group. Non-asthma group patients also showed higher percentage of eosinophils and increased IL-5 levels (P<.05 and P<.05, respectively) compared to the control group. The eotaxin level correlated positively with percentage of eosinophils (Rs = 0.60, P<.001), the EDN (Rs = 0.59, P<.001) and MBP (Rs = 0.73, P<.01) levels, and correlated inversely with FEV1 % pred. (Rs = -0.71, P<.01). Unexpectedly, the IL-5 levels did not correlate significantly with any of sputum eosinophil indices or FEV1 % pred. CONCLUSION: Good correlation of eotaxin with sputum eosinophil indices or pulmonary function and no correlation of IL-5 with them suggest that eotaxin may play a more important role in the specific recruitment and degranulation of airway eosinophils, although both IL-5 and eotaxin are involved in local eosinophilic inflammation.

Congenital Heart Anomalies in Patients with Clefts of the Lip and/or Palate

PURPOSE: The prevalence of congenital heart anomalies is known to be higher in patients with clefts of the lip and/or palate(CL/P). The purpose of this study was to determine the prevalence and type of congenital heart anomalies in patients with CL/P. METHODS: We investigated congenital heart anomalies in 756 patients presented with CL/P from January 1986 to December 1997 by reviewing their clinical records. RESULTS: The prevalence rate of congenital heart anomalies in patients with CL/P was 4.2% (32 of 756). Congenital heart anomalies in those were ventricular septal defect (15 of 32), atrial septal defect (4 of 32), tetralogy of Fallot (3 of 32), patent ductus arteriosus (2 of 32), double outlet right ventricle(2 of 32), pulmonary stenosis (1 of 32), transposition of the great arteries (1 of 32), pulmonary atresia (1 of 32), coarctation of aorta (1 of 32), anomalous systemic venous drainage (1 of 32), and aortic aneurysm with patent ductus arteriosus (1 of 32). It was significant that the prevalence rate of congenital heart anomalies in cleft palate with or without cleft lip (CP+/-L) was 6.8% (30 of 442), because the prevalence rate of congenital heart anomalies in cleft lip alone was not higher than in normal population (0.6%; 2 of 314). Of the 30 patients with congenital heart anomalies, 12 patients (40 %) had conotruncal defects. CONCLUSION: The prevalence of congenital heart anomalies in patients with CP+/-L was much higher than normal population. Cardiac defects were predominantly conotruncal. Predominance of conotruncal defects among congenital heart anomalies in those was associated with abnormalities of neural crest cell proliferation and migration developing into conotruncus and palate.

A Case of Congenital Rubella Syndrome / 감염

Congenital rubella syndrome is a transplacental fetal infection with rubella virus and shows a wide spectrum of clinical expression from severe malformation to asymptomatic in the neonatal period. For the confirmation of congenital rubella, one of the following laboratory criteria should be present: isolation of rubella virus, demonstration of rubella-specific IgM antibody, or a rubella IgG antibody that persists and fails to drop at a rate of twofold dilution per month. Recently a reverse transcription-nested polymerase chain reaction (RT-nPCR) method for the prenatal diagnosis of rubella virus infection has been used. We experienced a case of congenital rubella in a 15- month old male who had suffered from respiratory difficulty. He had low birth weight. Thrombocytopenia was noticed shortly after his birth. He was transferred to our hospital because persistent respiratory difficulty had been developing since the age of one month. His growth and development were delayed. Physical examination revealed micrognathia, hepatosplenomegly, lymphadenopathy, and petechiae. Laboratory examination revealed a rubella specific IgM antibody. Chest X-ray suggested a chronic lung change. Rubella virus RNA was detected in the serum by RT-nPCR. This is the first case of congenital rubella, which was confirmed by the detection of rubella virus RNA, in Korea.

A Case of Congenital Rubella Syndrome / 감염

Congenital rubella syndrome is a transplacental fetal infection with rubella virus and shows a wide spectrum of clinical expression from severe malformation to asymptomatic in the neonatal period. For the confirmation of congenital rubella, one of the following laboratory criteria should be present: isolation of rubella virus, demonstration of rubella-specific IgM antibody, or a rubella IgG antibody that persists and fails to drop at a rate of twofold dilution per month. Recently a reverse transcription-nested polymerase chain reaction (RT-nPCR) method for the prenatal diagnosis of rubella virus infection has been used. We experienced a case of congenital rubella in a 15- month old male who had suffered from respiratory difficulty. He had low birth weight. Thrombocytopenia was noticed shortly after his birth. He was transferred to our hospital because persistent respiratory difficulty had been developing since the age of one month. His growth and development were delayed. Physical examination revealed micrognathia, hepatosplenomegly, lymphadenopathy, and petechiae. Laboratory examination revealed a rubella specific IgM antibody. Chest X-ray suggested a chronic lung change. Rubella virus RNA was detected in the serum by RT-nPCR. This is the first case of congenital rubella, which was confirmed by the detection of rubella virus RNA, in Korea.