Eosinophilia accompanied by eosinophilic invasion and organ dysfunction may develope idiopathic hypereosinophilic syndrome. Any organ can be involved including bone marrow, lung, skin, heart, gastrointestinal tract and nervous system. Cough, dyspnea, pleural effusion or chest pain are common pulmonary manifestation, and they may be attributed to parenchymal infiltration, pulmonary embolism or heart failure. We report a 43-year-old woman with idiopathic hypereosinophilic syndrome involving bone marrow, skin, and lung. The patient developed acute dyspnea and chest pain. High resolution CT demonstrated multiple wedge-shaped segmental involvement with pleural effusion thought to be a pulmonary infarction or heart failure. Echocardiography could not find any abnormality. Lung biopsy showed interstitial eosinophilic infiltration with increased eosinophils in BAL fluid. She was treated with high dose corticosteroid and hydroxyurea. Within few days, most of her symptoms disappeared and chest radiography nearly cleared up.
Adult ; Biopsy ; Bone Marrow ; Chest Pain ; Cough ; Dyspnea ; Echocardiography ; Eosinophilia ; Eosinophils ; Female ; Gastrointestinal Tract ; Heart ; Heart Failure ; Humans ; Hydroxyurea ; Hypereosinophilic Syndrome* ; Lung ; Nervous System ; Pleural Effusion ; Pulmonary Embolism ; Pulmonary Infarction ; Radiography ; Skin ; Thorax

Exercise-induced anaphylaxis can be associated with ingestion of a specific food. We experienced a case of exercise-induced anaphylaxis followed by ingestion of parsely. A 22- year old female patient was presented with angioedema of the face and chest tightness induced by running after ingestion of parsley within 15 minutes. She had suffered from allergic rhinitis. She had positive reactions to mugwort pollen and parsely extract on skin prick test in a dose dependent manner. Although the oral provocation test with parsely could not induce bronchoconstriction, we could diagnosed as parsely dependent exercise induced anaphylaxis based upon skin prick test and history.
Anaphylaxis ; Angioedema ; Artemisia ; Bronchoconstriction ; Eating ; Female ; Humans ; Petroselinum ; Pollen ; Rhinitis ; Running ; Skin ; Thorax

BACKGROUND: It is known that immunotherapy promotes the development of allergen-specific Thl-like lymphocytes whose products are effective in inhibiting clinical response of sensitized atopic patients to allergen exposure. At the single cell level in short term culture, however, IL-4 and IL-5 are co-expressed, while IL-4 and IFN-y are exclusively expressed. OBJECTIVE: IL-4, IL-5, and IFN-y mRNA were measured in Der pI-specific T-cell clones (TCCs) to evaluate whether expression of cytokine in allergen-specific TCC is fixed regardless of stimuli. METHOD: Seven Der pI-specific TCCs were made from two asthmatics sensitive to D. pteronyssinus. IL-4, IL-5, and IFN-y mRNA were measured by RT-PCR in these TCCs after antigen-specific (Der pI) and nonspecific (PHA + TPA) stimuli. RESULTS: IL-4 and IL-5 mRNA were expressed in four and six of seven TCCs, but IFN-y mRNA was not expressed in any TCCs after Der pI-specific stimuli. Meanwhile, after the stimulus of TPA plus PHA, IFN-y mRNA as well as IL-4 and IL-5 mRNA were expressed in four of seven TCCs, and in one TCC, only IFN-y mRNA was expressed without expression of IL-4 mRNA. CONCLUSION: The expression of cytokine may be variable in allergen-specific TCC according to the type and amount of stimuli.
Asthma ; Clone Cells* ; Humans ; Immunotherapy ; Interleukin-4* ; Interleukin-5* ; Lymphocytes ; RNA, Messenger* ; T-Lymphocytes*

BACKGROUND AND OBJECTIVE: The knowledge about the effects of the nebulized B2-agonist on serum potassium is limited. We aimed to assess the possible hypokalemia following nebulization of salbutamol. METHOD: Seven patients(mean age 60 +- 7.1years) with acute exacerbated asthma were treated with salbutamol nebulization(5mg nebulization at 1 hour interval, 3 times) without concomitant use of steroid or other bronchodilator such as theophylline. RESULTS: There was a significant increase in FEV1, from 46.41+-25.91% at baseline to 62.86+-22.38% at 3 hours after treatment. Serum potassium concentration was significantly decreased, from 3.93+-0.58mEq/L at baseline to 3.41+-0.62mEq/L and 3.46+-0.53mEq/L at 1 hour and 3 hours after third nebulization, repectively. There was a significant prolongation of the QTc interval in EKG from 454.36+-27.07msec at baseline to 479.41+-35.64msec and 505.09+-58. 69msec at 1 hour and 3 hours after third nebulization, respectively. Serum salbutamol concentration was 4.18+-3.39ng/ml at baseline, and increased to 7.69+-6.94ng/ml and 9.84+10.34ng/ ml at 1 hour and 3 hours after treatment, respectively. Magnitude of the hypokalemia and the degree of prolongation of the electrocardiographic QTc interval were significantly correlated with the level of serum salbutamol concenturation. CONCLUSION: The results suggest that cardiac complication could develop due to hypokalemia during repeated salbutamol nebulization. Caution should be done in monitoring of serum potassium concentration when using nebulized salbutamol repeatedly for the treatment of acute exacerbated bronchial asthma.
Albuterol* ; Asthma ; Electrocardiography ; Hypokalemia ; Potassium* ; Theophylline

BACKGROUND: Bronchial asthma is classically defined as a reversible obstruction and hypsrresponsiveness of the airway attributed to an inflammatory process. However, some individuals with asthma show an irreversible component of airflow obstruction. It may be associated with structural changes in the airway resulting from severe or long standing air- way inflammation and remodelling. OBJECTIVE: The study was undertaken to compare the clinical characteristics of patient and airway remodelling as shown in bronchial wall thickness in HRCT according to the duration of asthma. MATERIALS AND METHODS: A retrospective clinical study was done on 119 patients with bronchial asthma, who had been admitted to Ewha Womans University Mokdong Hospital. Patients were divided to three groups according to disease duration and, clinical characteristics, pulmonary function test and HRCT were done. RESULTS: Basal FEV, and FVC was significantly lower in patient with longer duration. (p<0. 05) However pulmonary function was improved regardless of disease duration after 2 weeks steroid and bronchodilator therapy, and there was no significant difference in level changes according to the disease duration. The inner diameter of the bronchi and thickness of the bronchial wall at segmental and subsegmental bronchi increased significantly in patient with longer duration of asthma(p<0.05). Conclusion: These findings showed that airway remodelling was more extensive in patients with longer duration of disease resulting in decreased pulmonary function. These facts suggested that early anti-inflammatory therapy would be helpful for prevention of airway remodelling.
Airway Remodeling* ; Asthma* ; Bronchi ; Female ; Humans ; Inflammation ; Respiratory Function Tests ; Retrospective Studies

BACKGROUND: Increased IgE antibody responses to inhalant allergens and bronchial hyperresponsiveness are important phenotypes in development of asthma. Although heredity reported to be important in expression of these phenotypes in twin and family studies, genetic factor(s) controlling these phenotypes is unknown. OBJECTIVE: To evaluate whether genetic factor in chromosome 11q13 may control the expression of IgE responses to common inhalant allergens and bronchial hyperresponsiveness, linkage analysis between these phenotypes and gene marker of chromosome 11q13 was investigated. MATERIALS AND METHODS: The phenotyping and genotyping using microsatellite marker (D11S97) were performed in 77 probands with bronchial asthma and 80 their sibs. The linkage analysis between these phenotypes and the genotype was evaluated by affected or quantitative trait locus (QTL) sib-pair analysis. RESULTS: Positive skin test responses to inhalant allergens were 55/77(71.4%) in probands and 44/79(55.6%) in sibs, respectively. Positive bronchial provocation test responses to methacholine were 27/61(44.3%) in sibs, geometric mean of PC20-methacholine were 5.2 mg/ ml in probands and 39.4 mg/ml in sibs, respectively, and slope of dose response curve(mean+- SE, %/mg/ml) were 11.3 +- 3.22 in probands and 1.97 +- 0.5 in sibs, respectively. Of 34 sib-pairs with positive skin test responses to allergens, two D11S97 alleles were shared by 21(61.8% ) sib -pairs, one allele by 11(32.3% ) sib-pairs, and no identical allele by two(5.9% ) sib-pairs. In affected sib-pairs, sharing rate of the alleles was 77.9%, which indicates linkage of the phenotype and genotype(p<0.001). Of 25 sib-pairs with bronchial hyperresponsiveness to methacholine, two D11S97 alleles were shared by seven(28%) sib-pairs, one allele by 11(44%) sib-pairs, and no identical allele by seven(28% ) sib-pairs. In affected sib-pairs, sharing rate of the alleles was 50%, which indicates no linkage between the phenotype and genotype(p) 0.05). Differences of geometric value(mean +- SE) of PC-methacholine and slope of dose response curve(mean +- SE, %/mg/ml) were 1.11+- 0.17 and 8.33+- 3.35 in sib-pairs sharing two alleles, respectively, 0.99 +- 0.14 and 14.27+-5.75 in sib-pairs sharing one allele, respectively, and 0.57+-0.13 and 3.64+-1.62 in sib-pairs sharing no allele, respectively. There was no difference of the above values among the three groups. CONCLUSION: The expression of skin reactivity to common inhalant allergens was linked to gene marker of chromosome 11q13, not with bronchial responsiveness to methacholine.
Alleles ; Allergens* ; Antibody Formation ; Asthma ; Bronchial Provocation Tests ; Child* ; Genotype ; Heredity ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Microsatellite Repeats ; Phenotype ; Quantitative Trait Loci ; Skin Tests ; Skin*

OBJECTIVE: The aim of this study was to investigate the usefulness of serum ECP as a marker of the severity of asthma and extent of airway inflammation. METHOD: We investigated 108 patients suffering from bronchial asthma, who were classified as mild intermittent(n=19), mild persistent(n=27), moderate persistent(n=42), and severe persistent(n=20) and 10 healthy controls. Atopy was defined as those who showed >2+ responses on skin prick test. Serum ECP, peripheral blood eosinophil, sputum eosinophil, and PEFR were measured on the same date and meth~acholine PC20 were determined within 2 weeks. RESULTS: Serum ECP levels were 10.1+- 2.0 ug/L in controls, and 29.1+- 23.6 ug/L in asthmatic patients. According to symptom severity, serum ECP levels were 22.9 +- 15.6 ug/L, 28. 6 +- 24.1 ug/L, 29.5 +- 22.2 ug/L, and 34.6 +- 31.2 ug/L in mild intermittent, mild persistent, moderate persistent and severe persistent asthmatic patients, respectively and there were no significant differences among four groups(p>0.05). Serum ECP levels correlated with peripheral blood eosinophil counts(r=0.48, p<0.01), but not with sputum eosinophil, PEFR, and methacholine PC20 levels. There was no significant difference in serum ECP level between atopic and non-atopic asthma(p>0.05). CONCLUSION: Single measurevment of ECP level at clinic could not represent the severity of asthma.
Asthma* ; Eosinophil Cationic Protein* ; Eosinophils* ; Humans ; Inflammation ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Skin ; Sputum

BACKGROUND AND OBJECTIVE: The clinical manifestation of Henoch-Schonlein purpura and existance of renal involvement may influence on its course and prognosis. To verify prevention with early administration of steroid, we studied the efficacy of corticosteroid treatment. MATERIAL AND METHOD: We analysed 65 children under 15 years of age with Henoch-Scho nlein purpura according to their age, sex, and seasonal incidence. Forty children showed typical skin lesions, arthralgia and abdominal pain. We have divided them two groups. Group A consisted of 20 children who received 1 mg/kg of prednisolone/perday for 2 weeks and group B did not. We carried out their physical examination and urinalysis monthly for a year. RESULT: The main clinical manifestations were skin rash(100% ), abdominal symptoms(41.5 %), joint symptoms (49.2%), and renal involvement(34%). As for gastrointestinal symptoms, abdominal pain(66.7% ) was most commonly observed one and others were nausea or vomiting (44.7%) and melena(25.9%). The joint involvement was observed mostly in knee(56.3%) and ankle joint(31.3% ), Hematuria was observed in all cases with renal involvement and proteinuria, in 28% of them. The improvement of renal manifestations were noted in 84.2% of them within 4 months. Mild elevation of IgA was more frequently observed in renal involvement group than non-involved group (p< 0.01). There were no significant differences in immonologic parameters such as IgG, IgM, IgE, duration of the acute phase and severity of cutaneous symptoms between two growps. None of steroid treated growp showed progression of nephropathy. Of the 20 non-steroid treated growp, 2(10%) developed nephropathy. Conclusion We may suggest that existance of renal involvement in Henoch-Schonlein purpura influences its course and prognosis.
Abdominal Pain ; Ankle ; Arthralgia ; Child ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Joints ; Nausea ; Physical Examination ; Prognosis ; Proteinuria ; Purpura* ; Purpura, Schoenlein-Henoch ; Seasons ; Skin ; Urinalysis ; Vomiting

Objective and METHOD: In order to identify the aggravating agents for intrinsic asthma, we performed ASA- and food additive-challenge tests on 182 subjects diagnosed as having intrinsic asthma. The following tests were performed: Lysine-aspirin bronchoprovocation test to confirm aspirin-sensitivity, sodium bi-sulfite (40-200mg) oral provocation test for sulfite sensitivity, tartrazine oral provocation test (50mg) for tartrazine sensitivity, and sodium benzoate (400mg) oral provocation test for sodium benzoate sensitivity. Positive reaction was defined as decrease in FEV, by more than 20% from the baseline value after the provocation. RESULT: Seventy-five (41.2%) of 182 subjects showed positive responses to more than one agent among the aspirin and three food additives challenged. The prevalence of aspirin-sensitivity was the highest (22.5%), followed by sulfite-sensitivity (8.8%), and then concurrent sensitivity to both aspirin and sulfite (6.0% ), to both aspirin and tartrazine (1.6% ), to aspirin, sulfite and tartrazine (1.1%) and to aspirin, sulfite and sodium benzoate (0.5%). Rhino-sinusitis was noted in 62.5% of aspirin-sensitive asthmatic subjects, 60% of sulfite-sensitive ones, and 80% of tartrazine-sensitive ones. Urticaria was noted in 21.4% of aspirin-sensitive asthmatic subjects, 16.6% of sulfite-sensitive ones and 6.3% of tartrazine-sensitive ones. Thirty-seven to 83% of positive responders had no adverse reaction history. CONCLUSION: These findings suggest that ASA and food additive challenge tests should be considered as a screening test to evaluate any aggravating factors in subjects with intrinsic asthma, even though they may not have experienced any adverse reactions.
Aspirin* ; Asthma* ; Food Additives* ; Mass Screening ; Prevalence ; Sodium ; Sodium Benzoate ; Tartrazine ; Urticaria

Thymic carcinoid tumors are very rare and grow slowly with low grade of malignancy. It can manifest flushing, diarrhea, and bronchial constriction with secretion of serotonins, histamines or neuropeptides. We experienced a case of thymic carcinoid tumor, which aggravated asthma. A 59-year-old male had been in a well-controlled state, until he was admitted for status asthmaticus 2 years ago. Since then, he had suffered from frequent dyspnea and had severe asthma attack leading to ICU care twice in spite of full optimal anti-asthma therapy. Nine months ago, anterior mediastinal tumor was found incidentally, which was diagnosed as carcinoid tumor. After resection, his asthmatic symptoms and signs were improved and controlled in a persistent mild state. Taken together, this case indicates that asthma might be aggravated by carcinoid syndrome caused by thymic carcinoid tumors.
Asthma* ; Bronchoconstriction ; Carcinoid Tumor* ; Diarrhea ; Dyspnea ; Flushing ; Humans ; Male ; Middle Aged ; Neuropeptides ; Serotonin ; Status Asthmaticus ; Thymus Gland