Overview of anaphylaxis in Korea: diagnosis and management

Anaphylaxis is a medical emergency and all healthcare professionals need to be familiar with its diagnosis, acute management, long-term management including prevention of future episodes, and plan for patient education. Correct diagnosis and management for anaphylaxis is critical, but it is not easy in clinical setting. Up to the present, several practical guidelines for anaphylaxis are available for the practitioners. Among them, World Allergy Organization guideline for the assessment and management has recently been released and widely used. In this article, we reviewed and summarized the epidemiology, risk factors, diagnosis, management, prevention, and education based on case reports and studies of anaphylaxis in Korean and other countries. Although there are many controversies, this practical overview for anaphylaxis would provide a clinical guidance for Korean healthcare professionals.

Clinical Manifestation of Necrotizing Pneumonia in Healthy Children

OBJECTIVE: Necrotizing pneumonia (NP) is a severe complication of lobar pneumonia caused by various pathogens. The immunopathogenesis and clinical characteristics of NP in children are not clearly understood. We wanted to evaluate the clinical characteristics and suggest in part the immunopathogenesis of NP. METHODS: We reviewed retrospectively the medical charts and radiographic materials of eight patients with NP, who were diagnosed by chest radiography and chest computed tomography at the Department of Pediatrics, Soonchunhyang University Hospitals at Cheonan and Bucheon from January 2002 to December 2011. RESULTS: They were previously healthy, 2.1 to 4.6 years of ages (mean, 2.8+/-1.0 years) and three boys and five girls. All of them had pleural effusion. Five patients had pneumonic consolidations in right upper lung field. Three patients had pneumatocele. They developed leukocytosis (mean, 19,400+/-6,400/mm3), higher C-reactive protein level (mean, 25.1+/-8.0 mg/dL). The etiologic agents were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. CONCLUSION: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.

The Experience of High Frequency Oscillatory Ventilation in Children with Respiratory Failure / 소아알레르기및호흡기학회지

PURPOSE: High frequency oscillatory ventillation (HFOV) is an alternative to conventional ventilation (CV) when oxygenation deteriorates. This study evaluates the efficacy and safety of HFOV in children with respiratory failure. METHODS: Ten cases with respiratory failure (age 8.7+/-7.6 mo, body weight 6.8+/-2.6 kg) that underwent HFOV for more than 3 days because of failure of oxygenation by CV were enrolled. PaO2/FiO2, oxygenation index (OI), (A-a) DO2, mean airway pressure (MAP), blood pressure, heart rate, PEediatric Logistic Organ Dysfunction (PELOD) score and complications were evaluated before and at 6, 12, 24, 48, 72 hours of HFOV. The influencing factors were compared between an HFOV success group and a failure group, and outcomes were evaluated. RESULTS: 1) Lower FiO2 was required for proper oxygenation by HFOV, although MAP was significantly increased. (P< 0.05) 2) PaO2/FiO2 was higher (P=0.002) and (A-a) DO2 was lower than baseline (P< 0.001) during HFOV. However, no significant difference was observed for OI, PaO2, PaCO2 or pH. 3) In the HFOV success group, (A-a) DO2 was significantly lower than failure group at baseline, (P=0.045) and OI was also significantly lower than in the failure group at 6 hours of HFOV. (P=0.032) PaO2/FiO2 was significantly improved in the success group at 6 hours of HFOV. (P=0.045) 4) Complications were air leak, 20% (2/10), and hypotension, 40% (4/10), which was corrected by using inotropics. PELOD scores decreased in all patients compared to at baseline throughout HFOV. (P=0.03) 5) Sixty percent patients survived for 3 months after HFOV were 60% (6/10). The success of HFOV related to survival. (P=0.048) CONCLUSION: HFOV can be used to improve oxygenation effectively and safely in children with respiratory failure who did not improve with CV.

Effect of Interleukin-9 on Cell Proliferation and Histamine Release of Cord Blood-derived Human Mast Cells / 소아알레르기및호흡기학회지

PURPOSE: Interleukin-9(IL-9), one of Th2-type cytokines, might be important in the pathophysiology of allergic diseases. We investigated the effect of IL-9 on human mast cells by assessing cell proliferation and histamine release. METHODS: Human umbilical cord blood cells were cultured in the presence of stem cell factor(SCF, 100 ng/mL) and IL-6(50 ng/mL) in liquid medium for 8 weeks. Then these cells were divided into 3 aliquots. Each aliquot was cultured for 4 more weeks in different conditions : SCF alone(100 ng/mL), IL-9 alone(50 ng/mL) and SCF+IL-9. Cell numbers were counted using hemocytometer. For evaluation of apoptosis, DNA fragmentation was determined by propidium iodide(PI) staining and flow cytometric analysis. Histamine concentration was measured by ELISA after stimulation with human IgE and anti-human IgE. RESULTS: Cell numbers increased significantly when they were cultured in the presence of SCF and IL-9 compared with SCF alone(P<0.05). Proliferation of mast cells was mediated by decreased apoptosis. Histamine release in activated mast cells was not different regardless of incubation with IL-9. CONCLUSION: IL-9 might be involved in allergic inflammation via proliferation of mast cells in target tissue.

Treatment of Childhood Idiopathic Thrombocytopenic Purpura with Anti-D (WinRho(R)) / 대한소아혈액종양학회지

PURPOSE: Anti-D immunoglobulin has recently emerged as a theraputic option for the treatment of patients with idiopathic thrombocytopenic purpura (ITP). There is no report about anti-D treatment in our country. In this report, the efficacy and adverse reactions of anti-D immunoglobulin in children with ITP were evaluated. METHPDS: From August, 1997 to September, 1998, 7 courses of anti-D treatment were applied in 4 children who had persisting thrombocytopenia and frequent bleeding episodes despite use of intravenous immunoglobulin and corticosteroid. They were Rh-positive and non-splenectomized patients. They received 43~60 mug/kg/dose of anti-D (WinRho ) twice with 7 days interval at out patient department. To evaluate the efficacy and adverse reactions of anti-D, platelet, reticulocyte, hemoglobin, bilirubin and haptoglobin counts were observed weekly. RESULTS: Median age and pretreatment duration after diagnosis were 22 months (15~77 months) and 7 months (2~46 months), respectively. Bleeding decreased significantly after anti-D treatment. Platelet count increased median 4.11 folds (1.85~13.67 folds) and response was maximal at day 7. Duration of platelet increase more than 2 folds was 5 weeks (0~10 weeks). No significant adverse reactions other than mild hemolytic anemia was present. Hemoglobin decreased to minimal 88% (79.5~95.9%) of pretreatment value. Duration of hemoglobin lower than 90% of pretreatment value was 1 week (0~4 weeks). After 10 weeks, platelet and hemoglobin returned to pretreatment value. CONCLUSION: Although anti-D is not a curative treatment for ITP, it is safe and repeated infusions of anti-D can be used to maintain the platelet count at a level of sufficient to provide adequate hemostasis and may enable children to postpone or even avoid splenectomy.