Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods. In particular, it is rare occurrence for FDEIA to be associated with meat in Korea. A 15-year-old female had generalized urticaria, dyspnea, severe cough, headache, dizziness, and vomiting after singing and dancing for 1 hour and after ingesting grilled pork. Skin prick tests showed a strong positive reaction to pork, whereas the results of an oral food challenge and exercise provocation tests were negative. However, the exercise provocation test after pork ingestion showed a positive reaction manifested by generalized urticaria, cough, mild dyspnea, and a 23% decreased peak expiratory flow rate. Three allergens to pork (67 kDa, 90 kDa, and 15 kDa) reacted with the patient's serum on immunoglobulin E immunoblotting. We report a case of pork-dependent exercise-induced anaphylaxis in a patient who was sensitive to pork.
Adolescent ; Allergens ; Anaphylaxis ; Cough ; Dancing ; Dizziness ; Dyspnea ; Eating ; Female ; Food Hypersensitivity ; Headache ; Humans ; Immunoblotting ; Immunoglobulin E ; Immunoglobulins ; Korea ; Meat ; Motor Activity ; Peak Expiratory Flow Rate ; Singing ; Skin ; Urticaria ; Vomiting

PURPOSE: Procalcitonin (PCT), a precursor of calcitonin, has been described as a biomarker of bacterial infection and inflammation. This study was performed to evaluate the clinical usefulness of PCT levels and to reduce the unnecessary usage of antibiotics in children with lower respiratory tract infection (RTI). METHODS: Eighty-eight children, with lower RTI, under the age of 5 years, who were admitted to Chungnam National University Hospital, between May 2010 and December 2010, were enrolled. White blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and PCT were measured. Blood and sputum cultures were performed to identify the causative bacteria and reverse transcription-polymerase chain reaction for the viruses. Clinical features were reviewed, retrospectively. RESULTS: The mean participant age was 1.9+/-1.5 years. The cut-off value for serum PCT levels, which was derived from the receiver-operator characteristic curve, was 0.11 ng/mL. In 29 patients (33.0%) with low PCT levels (<0.11 ng/mL), antibiotic therapy showed no benefit for clinical and laboratory findings. However, in 59 patients (67.1%) with high PCT levels (> or =0.11 ng/mL), hospitalization (P=0.005) and fever (P=0.054) exhibited a shorter duration, after antibiotic therapy. CONCLUSION: A single initial serum PCT levels (> or =0.11 ng/mL) may be clinically useful to give a guideline for antibiotic treatment in children with lower respiratory tract infection and to reduce the unnecessary usage of antibiotics.
Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; Blood Sedimentation ; C-Reactive Protein ; Calcitonin ; Child ; Fever ; Hospitalization ; Humans ; Inflammation ; Leukocyte Count ; Protein Precursors ; Respiratory System ; Respiratory Tract Infections ; Sputum

PURPOSE: We investigated the risk factors related to the development and aggravation of allergic rhinitis, which is associated with residential environment and lifestyle habits of children residing in Incheon. METHODS: A total of 182 children diagnosed with moderate to severe allergic rhinitis and 67 healthy children were enrolled. A detailed questionnaire of the environmental characteristics and the dietary habits were completed by the parents. Further, skin prick tests with 14 common allergens were performed. RESULTS: The mean age of the children with allergic rhinitis and healthy control was 8.2+/-2.8 and 9.4+/-2.0 years, respectively. The presence of indoor mold was associated with an increased risk of development of allergic rhinitis. (adjusted odds ratio [aOR], 4.26; 95% confidence interval [CI], 1.96-9.27) Among the food groups, there was no significant difference of the daily intake of milk and yogurt between the patients and the controls. However, daily intake of vegetables, except Kimchi, and daily intake of fruits or fruit juice were associated with a decreased risk of allergic rhinitis. (aOR, 0.43; 95% CI, 0.20-0.92 / aOR, 0.43; 95% CI, 0.13-0.90, respectively) CONCLUSION: The results indicate that an indoor dampness is one of the risk factors of development and aggravation of allergic rhinitis. Control of indoor humidity and daily intake of fruits and vegetables can prevent the development and control symptoms of allergic rhinitis.
Allergens ; Child ; Diet ; Food Habits ; Fruit ; Fungi ; Humans ; Humidity ; Life Style ; Milk ; Odds Ratio ; Parents ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Skin ; Vegetables ; Yogurt

PURPOSE: The aim of this study was to longitudinally examine the correlation between the change of atopic dermatitis (AD) severity and the change of quality of life (QOL). METHODS: We assessed AD severity and QOL of patients and their families, by a prospective followed up for at least 12 months. AD severity was assessed, using the scoring of atopic dermatitis (SCORAD) index. A questionnaire based on dermatitis family impact (DFI), infants' dermatologic quality of life (IDQoL) and children's dermatology life quality index (CDLQI) were used to determine QOL. RESULTS: Seventy-nine AD patients were assessed for total and objective SCORAD and DFI. Among them, 45 patients that were less than 36 months old completed IDQoL and 13 patients that were equal to or more than 36 months old completed CDLQI. Objective SCORAD (oSCORAD) were correlated with DFI (r=0.235), IDQoL (r=0.602) and CDLQI (r=0.589) (P<0.05). At the 2nd interview, median oSCORAD (from 17.4 to 7.8), DFI (from 23.0 to 18.0) and IDQoL (from 9.0 to 6.0) were significantly decreased (P<0.01). The changes of oSCORAD were linearly related with the change of IDQoL (P<0.01), but neither with DFI (P=0.356) nor with CDLQI (P=0.267). Of the 64 patients with decreased oSCORAD, food allergy was accompanied more frequently in those with an increased DFI than those with a decreased DFI (60.7% vs. 27.8%, P<0.01). CONCLUSION: In this longitudinal study, the improvement of AD severity is correlated with the improvement of the patient's QOL, under the age of 3. To improve the family's QOL, we need to find out accompanying factors, such as food allergy, and to support the family accordingly.
Asthma ; Dermatitis ; Dermatitis, Atopic ; Dermatology ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Longitudinal Studies ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Rhinitis, Allergic, Perennial

PURPOSE: Bronchial asthma was reported to be an important risk factor of severe respiratory symptoms due to pandemic H1N1 influenza infection. In this study, we investigated if there was any difference in the clinical features of children with H1N1 pneumonia according to their atopic or asthma status. METHODS: Eighty-eight children admitted with pneumonia due to reverse transcriptase-polymerase chain reaction-confirmed H1N1 influenza infection during the period from September 2009 to January 2010 were enrolled. These patients were divided into atopic (n=42) and non-atopic (n=46) groups. The atopic group consisted of 23 asthmatic children and 19 non-asthmatic children with allergic rhinitis or atopic dermatitis. We retrospectively analyzed the medical records of the patients to investigate if there was any difference in the clinical features according to their atopic or asthma status. RESULTS: There was no age difference between atopic and non-atopic patients. Male preponderance was observed only in the atopic group.(P<0.05) The occurrence of wheezing, severity of respiratory symptoms, and number of emergency-room visits were significantly higher in atopic than non-atopic patients.(P<0.05) However, those variables showed no difference between asthmatic and non-asthmatic patients within the atopic group. Twelve patients in the atopic, non-asthmatic group were followed for 1 year after discharge, and 5 patients were diagnosed to have asthma with recurrence of wheezing and/or positive results to methacholine challenge tests. CONCLUSION: Our study shows that H1N1 influenza infection may cause more severe respiratory symptoms in atopic patients than in non-atopic patients, regardless of their asthma status. allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness.
Asthma ; Child ; Dermatitis, Atopic ; Humans ; Influenza, Human ; Male ; Medical Records ; Methacholine Chloride ; Pandemics ; Parents ; Pneumonia ; Recurrence ; Respiratory Sounds ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors

PURPOSE: The aim of this study was to examine the sensitivity and specificity of the influenza rapid antigen test, in comparison with reverse transcription polymerase chain reaction (RT-PCR), according to the time of the test from symptom onset and the clinical manifestations in the patients tested for suspected infection of the influenza A (H1N1) at a second hospital. METHODS: A total of 529 pediatric patients, aged between 6 and 12 years old, who visited the emergency department from October 1, 2009 to December 31, 2009, received the influenza rapid antigen test and RT-PCR. We examined the sensitivity and specificity of the influenza rapid antigen test in comparison with RT-PCR according to the time of the test from symptom onset (<24 hours, 24 to 48 hours, 48 to 72 hours, >72 hours) and clinical manifestations (fever, cough, rhinorrhea.nasal obstruction, sore throat, gastrointestinal symptoms, and general symptoms) in a retrospective study based on hospital charts. RESULTS: The sensitivity of the influenza rapid antigen test at elapsed times of less than 24 hours, 24 to 48 hours, and 48 to 72 hours after the onset of the symptoms was 53.9%, 61.4%, and 62.1% respectively. When the elapse time was greater than 72 hours, the sensitivity was 31.6%; thus, the sensitivity of the influenza rapid antigen test tended to decrease with elapsed time. The sensitivity of the test was 79% in patients presenting with gastrointestinal symptoms, which was the highest, but there was no statistical difference according to the clinical manifestations of the patients. CONCLUSION: Our study suggests that more accurate results might be gained when the influenza rapid antigen test is performed within 72 hours after symptom onset.
Aged ; Child ; Cough ; Emergencies ; Humans ; Influenza, Human ; Pharyngitis ; Polymerase Chain Reaction ; Retrospective Studies ; Reverse Transcription ; Sensitivity and Specificity

PURPOSE: Interleukin (IL)-33, a member of the IL-1 cytokine family, is considered to be important for innate-type mucosal immunity of the lung and also has been suggested to induce Th2-type immune responses. We aimed to investigate if IL-33 is involved in airway inflammation due to respiratory syncytial virus (RSV) infection in young children. METHODS: Thirty-eight infants (< or =24 months of age) admitted with their first episode of RSV bronchiolitis were enrolled in the study. Atopy was defined by having at least 1 allergen-specific immunoglobulin E (IgE), positive result to skin prick test, or high serum IgE levels. The patients were assessed to have severe symptoms when they had > or =2 of the following clinical findings: hypoxemia (<92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and >7 days of hospital stay. The levels of IL-33 and the IL-33 receptor (sST2) were measured using enzyme-linked immunosorbent assay in nasal secretion samples collected from the patients on admission and compared with 20 age-matched controls. We also investigated the levels of IL-33 and sST2 in relation to the atopic status and symptom severity of the patients. RESULTS: Nasal IL-33 levels in the patients with acute RSV bronchiolitis were significantly increased (P<0.05), but sST2 showed no difference compared to the controls. Neither IL-33 nor sST2 showed significant difference in relation to the atopic status or severity of symptoms. CONCLUSION: Our study showed significantly increased IL-33 in the nasal secretions of the young infants admitted with acute RSV bronchiolitis and suggests that IL-33 is involved in the pathogenesis of RSV-induced airway inflammation.
Anoxia ; Bronchiolitis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunity, Mucosal ; Immunoglobulin E ; Immunoglobulins ; Infant ; Inflammation ; Interleukin-1 ; Interleukins ; Length of Stay ; Lung ; Oxygen ; Respiration ; Respiratory Syncytial Viruses ; Skin ; Thoracic Wall

PURPOSE: The aim of this study was to evaluate the prevalence and risk factors associated with asthma and allergic rhinitis in rural elementary school children. METHODS: Children in 12 elementary schools in Jinan-gun, Jeollabuk-do, a typical rural area in Korea, were enrolled. We conducted cross-sectional survey using a Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. RESULTS: A total of 947 questionnaires out of 1,062 were completed and the response rate was 89.1%. The symptom prevalence of asthma and allergic rhinitis (AR) in the last 12 months was 7.4% and 28.1%. The prevalence of physician-diagnosed asthma and AR was 7.2% and 22.2%. Male, passive smoking, visible mold at home, and use of antibiotics during infancy more than 3 times were associated with higher prevalence of asthma diagnosis (adjusted odds ratio [aOR] 2.35, 95% confidence interval [CI] 1.30 to 4.26; aOR 2.49, 95% CI 1.38 to 4.48; aOR 2.19, 95% CI 1.23 to 3.89; and aOR 8.45, 95% CI 4.23 to 16.59). Parental history of allergic diseases, children without siblings, use of antibiotics during infancy more than 3 times were associated with higher prevalence of AR (aOR 4.89, 95% CI 3.37 to 7.10; aOR 5.20, 95% CI 2.38 to 11.35; and aOR 2.39, 95% CI 1.36 to 4.19). CONCLUSION: In Jinan-gun, the symptom prevalence of asthma and AR in the last 12 months was 7.4% and 28.1%. The environmental factors such as passive smoking, visible mold at home, use of antibiotics during infancy and number of siblings are associated with asthma and allergic rhinitis.
Anti-Bacterial Agents ; Asthma ; Child ; Cross-Sectional Studies ; Fungi ; Humans ; Hypersensitivity ; Korea ; Male ; Odds Ratio ; Parents ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Siblings ; Tobacco Smoke Pollution

PURPOSE: A significant proportion of patients with cough variant asthma (CVA) eventually develops asthma. The aim of this study was to investigate the relationship between bronchial hyperresponsiveness (BHR) and development of asthma in preschool children with CVA. METHODS: We reviewed the medical records of children aged 5 to 7 years who presented with chronic cough and had regular check-up by the school age. All children had methacholine bronchial challenge test (MBCT) at preschool age with a modified auscultation method. The end-point was defined as the appearance of wheezing and/or oxygen desaturation. Positive BHR was defined as end-point concentration (EPC)< or =8 mg/mL. MBCT was performed at the school age with spirometric method. Positive BHR was defined as PC20< or =8 mg/mL. We collected information on the development of wheezing or dyspnoea from the medical records. RESULTS: Thirty-six children with CVA were analyzed. During follow-up (2.1+/-0.9 years), 9/36 children developed wheezing or dyspnoea (group A), and 27/36 children did not (group B). EPC (geometric mean, 95% confidence interval) was significantly lower in group A than group B (1.59 mg/mL, 0.93 to 2.70 mg/mL vs. 3.43 mg/mL, 2.34 to 5.03 mg/mL; P=0.02, respectively). The prevalence of positive BHR at school age was significantly higher in group A than group B (77.8% vs. 22.2%, P<0.01). CONCLUSION: These results suggest that the increase and the persistence of BHR may have an important role in the development of asthma during the course of CVA in preschool children.
Aged ; Asthma ; Auscultation ; Bronchial Provocation Tests ; Child ; Child, Preschool ; Cough ; Follow-Up Studies ; Humans ; Medical Records ; Methacholine Chloride ; Oxygen ; Phosphorylcholine ; Prevalence ; Respiratory Sounds

PURPOSE: Development of asthma involves the interaction between genetic factors and environmental stimuli. This study aims to investigate whether major single nucleotide polymorphism (SNP)s and their haplotypes of the ADRB2 (beta2-adrenoceptor) gene are associated with children with asthma in Korea. METHODS: Children with asthma aging 5 to 15 years old were recruited as the patient group, and children without respiratory diseases or asthma of the same age were recruited as the control group. Blood samples of 5 mL were collected and DNA was extracted by standard methods. Genotyping was done for 6 SNPs known to have a frequency of more than 4%, including 1309A>G, 1342C>G, 1515G>A, 1786C>A, 2316G>C, 2502G>A. RESULTS: Overall, 438 subjects (214 patients and 224 controls) were included in this study. Minor allele homozygote frequency of 6 SNP were 22%, 1.8%, 11%, 12.3%, 21.2% and 13.0%, respectively. Differences between both groups of individual SNP frequencies were not statistically significant, although the difference of the frequency of the second SNP (1342C>G) has borderline significance (P=0.06). Overall distributions of haplotypes were not significantly different between both groups. However, analysis of specific SNPs among haplotypes revealed that haplotypes including the 2nd SNP were significantly associated with asthma (odds ratio, 1.7; 95% confidence interval, 1.1 to 2.6). Combinations of haplotypes excluding the 2nd SNP did not show significant difference between both groups. CONCLUSION: This study suggests that the ADRB2 gene polymorphism is associated with susceptibility to childhood asthma and that analysis of haplotypes rather than SNPs is more reliable in this association.
Aging ; Alleles ; Asthma ; Child ; DNA ; Haplotypes ; Homozygote ; Humans ; Polymorphism, Single Nucleotide ; Receptors, Adrenergic, beta-2