We experienced a case of anaphylaxis by bee venom acupuncture in a 28-year old man. He had bee venom acupuncture on the right ankle due to sprain, experiencing nuchal rigidity, chest tightness and dyspnea 30 mins later. Two tablets of antihistamine prescribed by herb doctor did not improve his symptoms at all. He visited Chungbuk National University Hospital emergency room, where only wheezing was auscultated. He fully recovered after treatment with epinephrine, antihistamine and aminophylline intravenously. His sinus X-ray showed mucosal thickening at maxillary sinus and PC20-methacholine was 8.2 mg/ml. The only positive reaction to bee venom (0.1 microgram/ml) was found at skin prick test with 55 inhalant allergens and bee venom using the same agent at acupuncture. He had a history of generalized urticaria after a honey bee stung his hand 20 years earlier. This case states a very serious and important message that venom acupunctures without taking bee stinging history meticulously and without skin test for bee venom can be very dangerous.
Acupuncture* ; Adult ; Allergens ; Aminophylline ; Anaphylaxis* ; Ankle ; Bee Venoms* ; Bees* ; Bites and Stings ; Chungcheongbuk-do ; Dyspnea ; Emergency Service, Hospital ; Epinephrine ; Hand ; Honey ; Humans ; Maxillary Sinus ; Muscle Rigidity ; Respiratory Sounds ; Skin ; Skin Tests ; Sprains and Strains ; Tablets ; Thorax ; Urticaria ; Venoms

Acetaminophen is a widely used analgesic-antipyretic. Hypersensitivity reactions to acetaminophen are rare and selective sensitivity to acetaminophen without aspirin or non-steroidal antiinflammatory drug intolerance is even rarer. We experienced a case of acetaminopheninduced bronchial asthma without aspirin sensitivity. An oral challenge test upto 650mg of Tylenol demonstrated urticaria and dyspnea with greater than 20% decrease of FEV1. Both oral provocation test with 500mg of aspirin and lysine-aspirin bronchoprovocation test showed negative results. In conclusion, we report a case of acetaminophen-induced asthma without aspirin sensitivity. Cyclo-oxygenase inhibition may not be a pathogenic mechanism of acetaminophen-induced bronchial asthma. Further studies will be needed to clarify the mechanism of this reaction.
Acetaminophen* ; Aspirin* ; Asthma* ; Dyspnea ; Hypersensitivity ; Prostaglandin-Endoperoxide Synthases ; Urticaria

BACKGROUND AND OBJECTIVES: Chronic idiopathic urticaria refers to recurrent hives of more than six weeks duration and in approximately 80% of cases, the etiology is unknown. Recently, involvement of an autoimmune mechanism in the pathogenesis of chronic idiopathic urticaria has been suggested. Thyroid autoimmunity has been reported in patients with chronic idiopathic urticaria and treatment with thyroxine in selected cases induced clinical remission. MATERIALS AND METHODS: We studied 99 patients with chronic idiopathic urticaria to evaluate the clinical significance of anti-thyroid auto-antibodies including anti-thyroglobulin and antimicrosomal antibodies. Thirty-four normal volunteers were selected as controls. The prevalence of these two auto-antibodies as well as laboratory findings and clinical features between these two groups were compared. RESULTS: Thyroid auto-antibodies were positive in 24% of patients compared to 8.7% of control patients and the duration of the disease was significantly longer in the patients with thyroid auto-antibodies than in those without thyroid auto-antibodies, respectively (p<0.05). There was no significant difference in age, positive rate of ANA and total eosinophil count. Administration of thyroxine to five patients with refractory urticaria resulted in improvement in three patients. CONCLUSION: Thyroid autoimmunity is associated with chronic idiopathic urticaria in some patients. Administration of thyroxine resulted in improvement of symptoms in some of these patients. Therefore, we recommend routine testing of thyroid auto-antibodies in patients with retractable chronic idiopathic urticaria.
Antibodies ; Autoimmunity ; Eosinophils ; Healthy Volunteers ; Humans ; Prevalence ; Thyroid Gland* ; Thyroxine ; Urticaria*

BACKGROUND AND OBJECTIVES: Glucocorticoids have demonstrated excellent efficacy in decreasing airway inflammation and controlling bronchial asthma symptoms. However, exacerbations of asthma are frequently observed even during treatment with inhaled glucocorticoids, and most of these episodes occur following viral upper respiratory infections (URI). Recently, it has been suggested that transient resistance to glucocorticoid developed after URI and this resistance to glucocorticoid in asthmatics was related to the increased expression of glucocorticoid receptor beta (GCRbeta). The aim of this study is to evaluate the expression of GCRbeta in asthmatics experiencing exacerbation after an episode of URI. METHODS: Peripheral blood mononuclear cells (PBMCs) were obtained from asthmatics experiencing exacerbation after URI (n=15), stable asthmatics (n=23), and normal controls (n= 12). Exacerbated asthmatics were started on systemic glucocorticoids upto two weeks and PBMCs were obtained again after the treatment. The degree of expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA were calculated using the semi-quantitative RT-PCR. RESULTS: Compared with stable asthmatics and normal control, exacerbated asthmatics showed significantly higher expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA. However, comparing exacerbated asthmatics before and after treatment, we found no significant difference but trends of reduction in expression of GCRbeta mRNA and ratio of GCRbeta/GCRalpha mRNA after treatment. CONCLUSION: These findings suggest that transient resistance to corticosteroid in asthmatics experiencing exacerbation after an episode of URI may be related to increased expression of GCRbeta.
Asthma ; Glucocorticoids ; Inflammation ; Receptors, Glucocorticoid* ; Respiratory Tract Infections ; RNA, Messenger

BACKGROUND: Laboratory animal workers who are in regular contact with furred animals commonly develop laboratory animal allergy (LAA). LAA is one of the most common occupational allergic diseases. OBJECTIVES: This study was performed to estimate the prevalence of sensitization and symptoms of LAA, and to determine important host factors for the development of LAA. METHOD: Sixteen subjects with laboratory animal workers in one medical research center were enrolled in this study. They responded to a questionnaire about work-related symptoms and underwent allergy skin prick test to common inhalant and laboratory animal allergens. RESULTS: The prevalence of sensitization to laboratory animal allergens was 18.8%, and all sensitized workers were atopic (positive skin reactivity to one or more common inhalant allergens). Prevalence rate of allergy symptoms caused by working with laboratory animals was 31.3%. Positive skin prick responses to dog or cat allergens were highly associated with specific sensitization to laboratory animal allergens, and positive skin responses to laboratory animal allergens were associated with laboratory allergy symptoms. Among sixteen subjects, we found out one case of occupational asthma due to mouse allergy and also reported the case here. CONCLUSION: Some laboratory animal workers showed sensitization to laboratory animal allergens and had allergic symptoms attributed to contact with laboratory animals. Atopy, especially atopy to dogs or cats may be an important host factor for the development of LAA.
Allergens ; Animals ; Animals, Laboratory* ; Asthma, Occupational ; Cats ; Dogs ; Hypersensitivity* ; Mice ; Prevalence ; Skin ; Surveys and Questionnaires

BACKGROUND: Sensitization to food allergens is associated with development of food allergy. Although rates of sensitization to food allergens are different according to countries, there has not been surveyed on the sensitization rate to each food allergen in Korean population. The aim of this study was to evaluate the food allergen sensitization rate among patients who visited allergy clinics at several university hospitals in Korea. METHODS: This study was carried out on 1,425 patients who visited allergy clinics with various allergic symptoms. They had skin prick test for 62 items to evaluate sensitization to food allergens. RESULT: The food allergens of which sensitization rate was above 1% were pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flour, buckwheat, cabbage, mackerel, abalone, lobster, turban shell, arrowroot in decreasing order. The sensitization rate of pupa was highest among them by 9.4% and that of shrimp followed by 5.8%. The sensitization rates of food allergens were generally higher in males and young adults than in those of females and old people. Atopic patients for inhalant allergens showed higher sensitization rates of food allergens than non-atopic patients for inhalant allergens. CONCLUSION: Common food allergens sensitized in a Korean population were different from those in other countries. Pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flourbuckwheat, cabbage, mackerel were the 10 most common food allergens sensitized in Korean population above 10 years old.
Allergens* ; Bombyx ; Brassica ; Child ; Fagopyrum ; Female ; Flour ; Food Hypersensitivity ; Hospitals, University ; Humans ; Hypersensitivity ; Korea ; Male ; Marantaceae ; Perciformes ; Pupa ; Skin ; Solanum tuberosum ; Soybeans ; Young Adult

BACKGROUND: The presence of airway wall thickening and its relationship with pulmonary functions or airway hyperresponsiveness (AHR) have not yet been sufficiently clarified in bronchial asthma. OBJECTIVE: We investigated the relation of airway wall thickness to the pulmonary functions and AHR in patients with asthma. METHODS: After baseline measurement of pulmonary functions and PC20 in 24 patients, we measured airway wall thickness (T), internal diameter (d) using HRCT and calculated external diameter (D)[(D)=(d)+ 2x(T)]. We used the T/D ratio as a parameter for comparisons with pulmonary functions and PC20. RESULTS: We measured total 185 airways (upper;92, lower;93). The mean T/D ratio of small airways (diameter< 2mm;n=111) showed higher value than that of large airways (diameter>or=2mm;n=74) (0.324 +/- 0.028 vs 0.274 +/- 0.033, p<0.001). The mean T/D ratio of each subjects showed significant negative correlation with FEV1(% of predicted) in total (r=-0.407, p=0.048) and small airways (r=-0.468, p=0.024). PC20 showed a tendency of weak negative correlation with mean T/D ratio in small airways (r=-0.290, p=0.179). CONCLUSION: The thicker the airway wall is, the lower the FEV1 (% of predicted) in patients with bronchial asthma. Airway wall thickening occurred predominantly in the small airways.
Asthma* ; Humans

BACKGROUND AND OBJECTIVE: There are many differences in common inhalant allergens between countries and regions. We need to determine the major inhalant allergens in this country with geographical characteristics. To observe the major inhalant allergens and establish essential ones for the skin prick test in Korea, a nation-wide multicenter study was performed. METHOD: The skin prick tests were performed with the same kits of 43 allergens on 2,554 allergy patients who visited their regional hospitals for one year. RESULT: There are significant differences in the sensitization rate to common inhalant allergens among the centers. Twenty three allergens showed > or=5% sensitization rate: D. pteronyssinus, D. farinae, Tyrophagus putrescentiae, Tetranychus urticae, Panonychus citri, Alternaria alternata, Cladosporium tenuis, cat fur, dog hair, American and German cockroach, tree pollen mixture I, alder, hazel, tree pollen mixture II, birch, beech, oak, plane tree, ragweed, mugwort, hop Japanese and chrysanthemum. CONCLUSION: We suggest the major allergens such as D. pteronyssinus, D. farinae, T. putrescentiae, T. urticae, P. citri, outdoor molds, indoor molds, cat fur, dog hair, German and American cockroaches, tree pollens, mugwort, and hop Japanese pollen should be included in skin test battery in Korea.
Allergens* ; Alnus ; Alternaria ; Ambrosia ; Animals ; Artemisia ; Asian Continental Ancestry Group ; Betula ; Blattellidae ; Cats ; Chrysanthemum ; Cladosporium ; Dogs ; Fagus ; Fungi ; Hair ; Humans ; Humulus ; Hypersensitivity ; Korea* ; Periplaneta ; Pollen ; Skin ; Skin Tests

BACKGROUND AND OBJECTIVE: Ingestion and inhalation of buckwheat flour can induce IgE-mediated bronchoconstriction and anaphylaxis in sensitized individuals, especially in childhood. The aim of this study was to determine the sensitization rate of buckwheat allergen, measure the level of specific IgE to buckwheat, and identify IgE-binding components in adult patients with various allergic diseases. METHODS: 1,738 allergy patients and 40 healthy controls were enrolled. Skin prick tests were performed using homemade buckwheat extract. The specific IgE level to homemade buckwheat allergen was measured by ELISA, and results were compared to those of the CAP system. ELISA inhibition tests were done to evaluate allergenic relationships with major food allergens and IgE binding components were identified using IgE immunoblot analysis. RESULTS: Among 1,738 patients tested, 60 patients (3.5%) showed more than a 2+ response on skin prick tests to buckwheat. The prevalence of serum specific IgE to buckwheat ranged from 24% in patients with a 2+ response to buckwheat skin prick test, to 50% in patients with a 4+ response. The mean absorbance value increased with skin reactivity although it was not statistically significant. However, CAP results were significantly correlated with skin reactivity (p<0.05). A significant correlation was noted between (the) results by homemade ELISA and CAP. IgE immunoblot demonstrated 20 IgE binding components ranging from 20 to 114 kDa, and 10 components were bound to IgE in more than 50% of the patients tested. CONCLUSION: Natural buckwheat allergens should be considered as one of the causative food allergens in exposed adults. Specific IgE results by homemade ELISA were comparable with those of CAP system. Twenty IgE binding components and 10 major allergens were noted within natural buckwheat allergen. Further studies will be needed to evaluate the allergenic relationships with other food allergens.
Adult* ; Allergens ; Anaphylaxis ; Bronchoconstriction ; Eating ; Enzyme-Linked Immunosorbent Assay* ; Fagopyrum* ; Flour ; Humans ; Hypersensitivity* ; Immunoglobulin E* ; Inhalation ; Prevalence ; Skin

BACKGROUND: Infiltration of eosinophils in the nasal mucosa is a consistent feature of nasal allergic inflammation. Various cytokines, especially interleukin-5(IL-5), were identified to play important roles in the infiltration and activation of eosinophils in nasal mucosa. Our previous study found that among 4 kinds of sophoricosides extracted from Sophora japonica, named sophi, orobol, genistin, and genistein, 3 compounds except genistein known as protein tyrosine kinase(PTK) inhibitor had anti-inflammatory and anti-IL-5 effects, and sophi was the most potent. OBJECTIVE: The goal of this study was to investigate the antagonism of sophi on the nasal eosinophilia in ovalbumin(OA)-sensitized murine nasal allergy model. METHODS: Male BALB/c mice sensitized intraperitoneally and then topically with OA were treated with sophi(10 or 30mg/kg) or anti-mouse IL-5 monoclonal antibody(anti-IL-5 mAb, 1mg/Kg) intravenously 1 hour before challenge. The effect of sophi on the infiltration of eosinophils into the nasal mucosa, peripheral blood eosinophilia, nasal symptom, and OA-specific IgE antibody production were evaluated. Results: Administration of sophi(10, 30mg/kg) significantly inhibited the nasal eosinophil infiltration and nasal symptom compared to that of anti-IL-5 mAb. But eosinophil count inthe peripheral blood and the titer of OA-specific IgE were not affected by sophi. CONCLUSION: Sophi inhibited not only the tissue eosinophilia but also the acute nasal allergic symptom. These findings suggest that sophi has anti-eosinophilic cytokine activity and also plays blockade of early allergic reaction. Taken together, sophi may be a candidate for new anti-allergic medicine.
Animals ; Antibody Formation ; Cytokines ; Eosinophilia ; Eosinophils* ; Genistein ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Inflammation ; Interleukin-5 ; Male ; Mice ; Nasal Mucosa ; Sophora ; Tyrosine