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

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is a rare autosomal dominant vascular disorder involving arteriovenous malformation (AVM) due to angiodysplasia. HHT is characterized by mucocutaneous hemorrhagic telangiectasia and AVM of various different organs. The mutated genes in HHT encode proteins that mediate signaling by the transforming growth factor-beta superfamily, leading to migration and proliferation of endothelial cells to finally result in AVMs of various organs. Amongst various affected organs, pulmonary AVM is the most common. This 11-year-old female patient with a past and familial history of frequent epistaxis visited the hospital for abdominal pain and vomiting which developed on the same day. Nodular opacity was found in chest X-ray. Subsequently, AVMs in the lungs and the spleen were recognized in chest computed tomography along with detection of ENG gene mutation. Here we report a case of hereditary hemorrhagic telangiectasia diagnosed by incidental chest X-ray findings followed by genetic and radiologic studies.
Abdominal Pain ; Angiodysplasia ; Arteriovenous Malformations ; Endothelial Cells ; Epistaxis ; Female ; Humans ; Lung ; Proteins ; Spleen ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis ; Thorax ; Vomiting

Bronchiolitis obliterans organizing pneumonia (BOOP) is a pulmonary disorder that exhibits various radiographic findings. It often shows bilateral, patched, or ground glass interstitial infiltrate, but a solitary nodular pattern rarely appears. We report a case of an 8-year-old boy suffering from BOOP that showed a single nodular pattern of the lung in the chest radiography. We conclude that when there is a solitary nodule discovered in the lungs of children or adolescence, the differential diagnosis must include BOOP.
Adolescent ; Bronchiolitis ; Bronchiolitis Obliterans ; Child ; Cryptogenic Organizing Pneumonia ; Diagnosis, Differential ; Glass ; Humans ; Lung ; Solitary Pulmonary Nodule ; Stress, Psychological ; Thorax

Congenital bronchoesophageal fistula (BEF), congenital communication between esophagus and bronchus, is a rare malformation. Benign BEF shows only nonspecific symptoms that may delay a correct diagnosis and proper treatment. This is a case of a 3-year-old boy presenting congenital BEF with imperforate anus and atrial septal defect. He had recurrent pneumonia in the right lower lobe since he was 5 months old. A barium swallow examination showed a communicating fistula between the lower esophagus and the right lower lobe bronchus. Computed tomography scan supported to delineate the course of the fistula. He underwent resection surgery of the fistula and lobectomy of the right lower lobe. He recovered without any postoperative complications.
Anus, Imperforate ; Barium ; Bronchi ; Child ; Esophagus ; Fistula ; Heart Septal Defects, Atrial ; Humans ; Pneumonia ; Postoperative Complications

A 29-month-old boy presented with fever, dyspnea, and paleness. He was initially diagnosed with pneumonia and severe sepsis. Although he was treated with intravenous antibiotics and high dose methylprednisolone, dyspnea and paleness recurred two times. Under suspicion of pulmonary hemosiderosis, we performed video-assisted thoracoscopic lung biopsy and bronchoalveolar lavage on him and found hemosiderin-laden macrophages in both specimens. Despite thorough history and laboratory examination, we could not find any pathologic or serologic evidence for primary and secondary causes of pulmonary hemosiderosis except for one that indicating Heiner's syndrome. After taking oral prednisolone he showed improvement of anemia and dyspnea, which was maintained by milk avoidance. Based on the history and the existence of immunoglobulin G antibodies against milk components, we are considering it as the case of Heiner's syndrome.
Anemia ; Anti-Bacterial Agents ; Antibodies ; Biopsy ; Bronchoalveolar Lavage ; Dyspnea ; Fever ; Hemosiderosis ; Immunoglobulin G ; Lung ; Lung Diseases ; Macrophages ; Methylprednisolone ; Milk ; Milk Hypersensitivity ; Pneumonia ; Prednisolone ; Sepsis