A case of latex fruit syndrome caused by spinach and eggplant / 대한내과학회지

Spinach (Spinacia oleracea) is a widely consumed vegetable, but rarely causes allergic reactions. Spinach contains plenty of histamine derivatives, so it is sometimes difficult to distinguish food allergy from pharmacologic effect of histamine itself in susceptible individuals. Latex exhibits strong cross reactivity with proteins from different fruits, vegetables, and grains, which is called as latex fruit syndrome. A 27 year old female visited emergency room with hives, facial swelling, dyspnea and palpitation immediately after meal. She had been suffering from latex allergy and had experienced an episode of anaphylaxis after eating eggplant 5 months earlier. Skin prick test with spinach extract was positive. Specific IgE to spinach antigens was detected by ELISA. ELISA inhibition test revealed that there is cross reactivity between latex and spinach. Two IgE binding components were detected between 22kD and 36kD, and another two between 16kD and 22kD on IgE-immunoblot analysis.

A case of lymphomatoid contact dermatitis caused by garlic / 천식및알레르기

Garlic(Allium sativum) is recognized as a sensitizing agent responsible for allergic contact dermatitis with food handlers and housewives. Lymphomatoid contact dermatitis, which is a type of allergic contact dermatitis, shows similar histologic features to Mycosis Fungoides. We report a 66-year-old male, who had applied garlic extract to both lower extremities and the trunk for 8 months for relieving his symptoms of arthralgia and generalized pruritis. He had complained of variable sized multiple erythematous pruritic papules on both lower extremities and the trunk and lymphadenopathy of both inguinal and axillary area. Skin biopsy was performed and the histological exam presented microscopically abnormal lymphocyte infiltration in the upper dermis. T-cell marker studies revealed strong CD3 positivity and increased CD4/CD8 ratio. The results of PCR-heteroduplex analysis showed negative for T-cell receptor- gene rearrangement and abscence of T-cell monoclonality. We could diagnose his skin lesion and generalized lymphadenopathy as lymphomatoid contact dermatitis which represented as a T-cell pseudolymphoma histologically. He was treated with local steroid injection and phototherapy and the skin lesion were improved without recurrence.

Evaluation of the inhalation performance in patients with asthma / 천식및알레르기

BACKGROUND: The proper use of inhaler drugs is critical in the management of chronic asthma. In this study, we investigated the inhalation performance of asthmatic patients and effectiveness of the regular education of inhalation technique. METHODS: The 145 asthmatic patients who had been educated the inhaler technique for more than 3 times were enrolled. The inhalation performance of each patient was scored using a checklist form (9 items for metered dose inhaler [MDI], 4 items for dry powder inhaler [DPI]) whenever they visited the clinic. Clinical characteristics affecting inhalation performance were evaluated in the groups using each type of inhaler. RESULT: In MDI, the mean initial performance score was significantly low when the patients were female sex, aged patients (>65 years old), or had lower educational backgrounds. Some items of the checklist, which include tilting head back, placing the mouthpiece with a distance from lips, continuing deep inspiration, and holding breath after inhalation for 10 seconds, were improperly performed in about 25% of the MDI users. No significant change was observed in the final performance scores assessed after intensive repeated education for proper inhalation technique of MDI. In DPI, the mean initial performance score was significantly low in the patients with old age (>65 years old) or lower educational backgrounds. The final performance scores were significantly improved after the repeated education for proper use of DPI inhalation in contrast to MDI. CONCLUSION: For the effective management of asthma, it may be important to choose proper type of inhaler with consideration of individual characteristics of the patients. The evaluation of inhalation performance and regular education of inhalation technique could be useful to maintain and improve the effective use of inhaler, especially in DPI.

Dyspnea and Palpitation during Pregnancy

OBJECTIVES: Dyspnea and palpitation are common features of pregnancy. While several theories have been put forward to explain the etiology of gestational dyspnea and palpitation, there have been few systemic studies of its incidence, severity and time-course in a group of normal women. METHODS: We interviewed postpartum women, within 3 days after delivery, about dyspnea and palpitation. Separately from this interview, we performed 24-hour ECG monitoring for obstetric patients with palpitation before delivery. RESULTS: The subjects interviewed were 261 women, of whom 37.5 percent and 11.5 percent experienced dyspnea and palpitation, respectively. These symptoms had a tendency to increase to term. The presence of arrhythmias could be documented in only 22% of patients having 24-hour Holter monitoring. CONCLUSION: Dyspnea and palpitation were common among normal pregnant women and had a tendency to increase to term.

The Regulation of OPG/OCIF mRNA Epression by IL-1beta in Peripheral Blood Mononuclear Cells / 대한내분비학회지

BACKGROUND: Osteoprotegerin(OPG) is a soluble member of the tumor necrosis factor(TNF) receptor family and inhibits osteoclastogenesis by interrupting the cell-to-cell interaction between osteoblastic/stromal cells and osteoclast progenitors. OPG is expressed in many tissues including osteoblasts and may act on bone tissues in a paracrine and/or autocrine fashion. Futhermore, many cytokines and growth factors are known to influence the regulation of OPG expression in osteoblastic/stromal cells. The aims of the present study were to examine whether or not OPG was expressed in human peripheral blood mononuclear cells(PBMCs) and to investigate the effects of IL-1beta, which were known as potent osteotropic agents, on the regulation of OPG mRNA in PBMCs. METHODS: PBMCs were isolated by centrifugation over Ficoll-Hypaque density gradients from postmenopausal women and cultured in 6-well plates containing alpha-MEM supplemented with 5% FBS. The expression of OPG mRNA in PBMCs was observed by RT-PCR in adherent and nonadherent cells on culture plates. To observe the effect of OPG expression by IL-1beta, we measured the concentration of OPG mRNA by altering the concentration and incubation time of IL-1beta. The measurement of OPG mRNA was done by semi-quantitative PCR and indicated as OPG/GAPDH. RESULTS: OPG was expressed both in cells attached to the surface of culture plates and in non-adherent cells for the incubation of peripheral blood mononuclear cells. The effect of OPG mRNA by IL-1beta tend to increase in accordance with the length of incubation time and maximizes at 12 hours of incubation time and shows 1.2-3.5 times higher than the standard level at the concentration of 0.5ng/ml. However, the increased quantity in concentration varies according to individuals.] CONCLUSION: OPG mRNA is expressed in peripheral blood mononuclear cells and known to be increased by IL-1beta.

A Case of the McCune: Albright Syndrome Associated with Activating Mutations of Stimulatory G Protein / 대한내분비학회지

McCune-Albright syndrome (MAS) is a sporadic disease classically including polyostotic fibrous dysplasia, cafe -au-lait spots, sexual precocity, and other hyperfunctional endocrinopathies. Recent investigations suggest an etiological role for activating embryonic somatic missense mutations in the gene for the a subunit of Gs (Gsa), the G protein that stimulates adenylyl cyclase. DNA from bone, ovary, and blood was analyzed by using polymerase chain reaction and sequenced. A embryological somatic mutation of Gsa gene encoding substitution of a Cys for Arg at amino acid 201 from cells of dysplastic bone and ovary was observed, and the distribution of mutant gene reveals mosaic pattern. We report a case of McCune-Albright syndrome with an activating mutation at codon 201 of Gsa subunit on ovary and bone tissue that was experienced recently.