BACKGROUND: Although the basic cellular and molecular requirements for the induction and synthesis of whole human IgE antibody have extensively been investigated, the mechanisms involved in the regulation of allergen-specific IgE synthesis are not yet fully understood. OBJECTIVES: The aims of this study were to elucidate the differences in the total and specific IgE regulation by hydrocortisone(HC) with interleukin 4 (IL-4) between atopics and non-atopics and to determine the relationship between in vitro IgE synthesis and serum IgE levels. METHODS: Peripheral blood mononuclear cells(PBMCs) from sixteen atopic asthma patients sensitive to Dermatophagoides farinae(D.f) and seven non-atopics were cultured with IL-4 and/or HC. Total and D.f-specific IgE in culture supernatant were measured using ELISA and FAST methods respectively. RESULTS: PBMCs from 8 of 16 atopics produced D.f-specific IgE in vitro either spontaneously or by IL-4 and/or HC. HC had more profound effects than IL-4 in these patients. They also showed higher total IgE synthesis by HC, and higher specific serum IgE levels than the others. IL-4 and/or HC did not induce any D.f-specific IgE synthesis by PBMCs from non-atopics. CONCLUSION: These data suggest that atopic patients have allergen-specific B cells that have already been switched to IgE production, probably due to in vivo priming effect of IL-4.
Asthma ; B-Lymphocytes ; Dermatophagoides farinae ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hydrocortisone* ; Immunoglobulin E* ; Interleukin-4* ; Interleukins* ; Pyroglyphidae

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

Exercise-induced anaphylaxis (EIA) is a medical emergency in that it derives from a physical allergy. We reported a case of food-independent EIA based on history and laboratory data. A 40-year-old male patient was presented with generalized urticaria, angioedema, and syncope after jogging. He had suffered from allergic rhinitis for 25 years. Increased level of serum tryptase was noted. Mast cell activation might be suggested in the pathophysiologic mechanism of EIA.
Adult ; Anaphylaxis* ; Angioedema ; Emergencies ; Humans ; Hypersensitivity ; Jogging ; Male ; Mast Cells ; Rhinitis ; Syncope ; Tryptases* ; Urticaria

BACKGROUND: Most studies involving factor analysis on clinical severity of bronchial asthma are short-term and cross-sectional. OBJECTIVES: We evaluated the clinical severity of bronchial asthma according to requirement of systemic corticosteroid therapy, and analyzed the factors associated with long-term systemic corticosteroid therapy. METHODS: The records of 158 asthmatic patients (including 76 patients followed for one year) visiting the clinic of Allergy-Immunology of Ajou University Hospital between June, 1997 and May, 1999 were reviewed retrospectively. RESULTS: Among the 76 asthmatic patients who had been followed-up for one year, asthmatic patients (n=28) treated with systemic corticosteroid for more than 60 days had lower initial FEV1(% predicted) values (p=0.001), lower prevalence of concomitant allergic diseases (p= 0.04), and lower frequency of allergen-specific immunotherapy (p=0.006) than asthmatic patients treated with systemic corticosteroid for less than 60 days (n=48). Among the 158 asthmatic patients, 87 patients (55%) were atopic asthmatics and 71 patients (45%) were nonatopic asthmatics. Nonatopic asthmatics showed older age at initial visit (p<0.001), lower serum total IgE levels (p=0.02), lower prevalence of concomitant allergic diseases (p=0.004), and higher prevalence of aspirin-sensitivity (p<0.001) than atopic asthmatic patients. Among the 76 patients followed for one year, nonatopic asthmatic patients were treated with significantly higher cumulative-doses of systemic steroid than atopic asthmatic patients (p=0.04). CONCLUSION: Initial pulmonary function and nonatopy are significantly associated with clinical severity determined by requirement of systemic corticosteroid therapy in adult asthmatic patients.
Adult* ; Asthma ; Humans ; Immunoglobulin E ; Immunotherapy ; Prevalence ; Retrospective Studies

BACKGROUND AND OBJECTIVE: In patients with aspirin-sensitive asthma, anti-inflammatory treatment is a common problem in clinical practice. Nimesulide has been chosen due to weak inhibitory action on cyclooxygenase in ASA-sensitive asthma patients. In this study, we evaluated the safety of nimesulide in patients with ASA-sensitive asthma. METHODS: We performed lysine-aspirin bronchoprovocation test to confirm ASA-sensitive asthma, and nimesulide oral provocation test (up to 200 mg) to screen nimesulide sensitivity in 17 cases of bronchial asthma patients. RESULTS: Fifteen (88.2%) of 17 subjects showed positive responses to lysine-aspirin bronchoprovocation test. Six (35.3%) patients reacted to nimesulide oral provocation test. Of the six patients who reacted to nimesulide, three experienced bronchospasm, two urticaria, and one anaphylaxis. All positive reactions occurred within the 200 mg dose. One of 6 subjects showed a positive response to nimesulide oral provocation test without ASA-sensitivity. CONCLUSION: The prevalence of nimesulide sensitivity among aspirin-sensitive asthma was 33.3%, which was higher than in the previous reports. Screening oral provocation test is essential before prescribing relative COX-2 inhibitors for ASA-sensitive asthmatic patients. A case of nimesulide-sensitive asthma without ASA-sensitivity was also noted.
Anaphylaxis ; Asthma* ; Bronchial Spasm ; Cyclooxygenase 2 Inhibitors ; Humans ; Mass Screening ; Prevalence* ; Prostaglandin-Endoperoxide Synthases ; Urticaria

BACKGROUND: In a previous linkage analysis, a marker locus on chromosome 5q31-33 showed evidence of linkage to bronchial responsiveness to methacholine and atopy. The beta2-adrenoceptor (beta2AR) gene is located on chromosome 5q32 and is considered to be a candidate gene in the development of asthma phenotype. OBJECTIVE: The aim of this study was to evaluate the association between asthma phenotypes and beta2AR polymorphism at amino acids 16 and 27. METHODS: From the general population, 440 unrelated Korean subjects were randomly selected, and asthma phenotypes were determined using a questionnaire, skin prick tests, and methacholine bronchial provocation tests. Haplotypes of 16 and 27 polymorphisms on the beta2AR gene were determined using PCR-based methods. RESULTS: Frequencies of haplotypes of beta2AR gene for polymorphic positions 16 and 27 were Arg16-Gln27:53.2%, Gly16-Gln27:36.4%, Arg16-Glu27:0.1% and Gly16-Glu27:10.3%. No significant association was found between haplotype of beta2AR gene and asthma phenotypes. Among the atopic subjects, however, we observed that Arg16-Gln27 and Gly16-Gln27 haplotypes were significantly associated with nocturnal cough. There was linear association between the development of nocturnal cough and the number of Arg16-Gln27 and Gly16-Gln27 haplotypes, respectively. CONCLUSION: This study demonstrates that the linkage of a gene marker on chromosome 5q31-33 with atopy and bronchial responsiveness is not related with genetic variations in the beta2AR gene. However, beta2AR polymorphisms may play an important role in the expression of nocturnal cough in atopic subjects.
Amino Acids ; Asthma* ; Bronchial Provocation Tests ; Cough ; Genes, vif ; Genetic Variation ; Haplotypes ; Methacholine Chloride ; Phenotype* ; Skin ; Surveys and Questionnaires

Common complications in a patient with IgG subclass deficiency include recurrent respiratory infections and concomitant inflammatory lung disease. The most effective therapy in these patients is the administration of intravenous immunoglobulin. The authors report a case of severe aspirin-sensitive asthma and recurrent pneumonia with combined IgG1, and IgG3 subclass deficiency in a 19-year-old man. The patient was treated with 0.4g/kg at monthly intervals for 6 months, and is still receiving 0.2g/kg every 2 weeks at our clinic. After the replacement of intravenous immunoglobulin, the patient has clinically improved.
Aspirin* ; Asthma* ; Humans ; Immunization, Passive* ; Immunoglobulin G* ; Immunoglobulins* ; Lung Diseases ; Pneumonia ; Respiratory Tract Infections ; Young Adult

Garlic(Allium sativum) is recognized as a sensitizing agent responsible for allergic contact dermatitis with food handlers and housewives. Lymphomatoid contact dermatitis, which is a type of allergic contact dermatitis, shows similar histologic features to Mycosis Fungoides. We report a 66-year-old male, who had applied garlic extract to both lower extremities and the trunk for 8 months for relieving his symptoms of arthralgia and generalized pruritis. He had complained of variable sized multiple erythematous pruritic papules on both lower extremities and the trunk and lymphadenopathy of both inguinal and axillary area. Skin biopsy was performed and the histological exam presented microscopically abnormal lymphocyte infiltration in the upper dermis. T-cell marker studies revealed strong CD3 positivity and increased CD4/CD8 ratio. The results of PCR-heteroduplex analysis showed negative for T-cell receptor- gene rearrangement and abscence of T-cell monoclonality. We could diagnose his skin lesion and generalized lymphadenopathy as lymphomatoid contact dermatitis which represented as a T-cell pseudolymphoma histologically. He was treated with local steroid injection and phototherapy and the skin lesion were improved without recurrence.
Aged ; Arthralgia ; Biopsy ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Dermis ; Garlic* ; Gene Rearrangement ; Humans ; Lower Extremity ; Lymphatic Diseases ; Lymphocytes ; Male ; Mycosis Fungoides ; Phototherapy ; Pruritus ; Pseudolymphoma ; Recurrence ; Skin ; T-Lymphocytes

Tracheal diverticula are relatively rare disease characterized by single or multiple evaginations of the tracheal wall. The tracheal diverticulum may act as a reservoir for secretions, leading to recurrent respiratory tract infections associated with chronic cough and dyspnea. A 31-year-old man had complained of a chronic productive cough for several months. Methacholine bronchial provocation test was positive. Three-dimensional computed tomography showed an air-containing cystic structure extending right posterolateral aspect of the trachea. Fiberoptic bronchoscopy demonstrated ostium arising from the right posterolateral wall at mid-third of trachea. These findings made asthma and tracheal diverticulum the diagnosis. Medical treatment was performed and symptoms were relieved.
Adult ; Asthma* ; Bronchial Provocation Tests ; Bronchoscopy ; Cough ; Diagnosis ; Diverticulum* ; Dyspnea ; Humans ; Methacholine Chloride ; Rare Diseases ; Respiratory Tract Infections ; Trachea

Wheat is known as a causative agent of bakers' asthma, wheat-dependent exercise induced anaphylaxis and food allergies in infants and young children. However, there has been few cases of wheat-induced anaphylaxis in adult age. We report a case of wheat-induced anaphylaxis patient presented in an adult and two IgE-binding components(43 kDa and 48 kDa) were identified.
Adult* ; Anaphylaxis* ; Asthma ; Child ; Food Hypersensitivity ; Humans ; Infant ; Triticum