Development of Airway Allergic Diseases and Immunotherapy in Children / 대한이비인후과학회지

Allergic march is a part of a phase that occurs in a series of continuous steps in disease of pediatric patients, which proceeds from atopic dermatitis to asthma, and from asthma to allergic rhinitis. Recently, several hypotheses have been raised to explain the allergic march. Among them, the study of the hygiene theory related to microbiota, and the study on the role of innate cytokines which occurs in skin barrier damage are attracting attentions. If the interaction between the microbiota and the immune system occurs improperly, the activity of the regulatory T cell becomes insufficient and the immune-regulatory function is reduced, resulting in allergic diseases. Because of the skin barrier disruption, the innate cytokines are activated, thus resulting in Th2 inflammation reaction being increased. Considering this pathogenesis, blocking the linkage to pathogens is regarded to play an important role in preventing and treating allergic march.

Development of Airway Allergic Diseases and Immunotherapy in Children / 대한이비인후과학회지

Allergic march is a part of a phase that occurs in a series of continuous steps in disease of pediatric patients, which proceeds from atopic dermatitis to asthma, and from asthma to allergic rhinitis. Recently, several hypotheses have been raised to explain the allergic march. Among them, the study of the hygiene theory related to microbiota, and the study on the role of innate cytokines which occurs in skin barrier damage are attracting attentions. If the interaction between the microbiota and the immune system occurs improperly, the activity of the regulatory T cell becomes insufficient and the immune-regulatory function is reduced, resulting in allergic diseases. Because of the skin barrier disruption, the innate cytokines are activated, thus resulting in Th2 inflammation reaction being increased. Considering this pathogenesis, blocking the linkage to pathogens is regarded to play an important role in preventing and treating allergic march.

Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis

PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option.

Superior Semicircular Canal Dehiscence Syndrome Presenting with Sudden Deafness and Vertigo after Trauma / 대한평형의학회지

Superior semicircular canal dehiscence syndrome (SCDS) is characterized by cochleovestibular hyper-responsiveness symptoms including sound- and pressure-evoked vertigo and oscillopsia, autophony, hyperacusis and ear fullness. The typical audiometric feature of SCDS is known as conductive hearing loss at low frequency. A 43-year-old man presented with unilateral sudden deafness after several events of heading during soccer game. High-resolution temporal bone computed tomography revealed a dehiscence of superior canal encased by superior petrous sinus. We reviewed audio-vestibular findings in this patient and speculated potential pathogenic mechanisms of sudden deafness in SCDS with literature review.

A Case of Ramsay Hunt Syndrome with Cranial Polyneuropathy

Ramsay Hunt syndrome is an infectious disease caused by the varicella zoster virus. It is characterized by the symptoms of facial paralysis, otalgia, and erythematous vesicular rash on the auricle and/or oral cavity. We present a case of a patient with clinical evidence of Ramsay Hunt syndrome involving the cranial nerves VI, VII, and VIII. The patient, a 66-year-old woman, showed left facial palsy associated with vesicular eruptions on her left auricle, impaired gaze to left side, and left hearing loss. Four months after the treatment with systemic steroid and antiviral agents, her all symptoms and signs including facial paralysis and diplopia disappeared.