Zinc deficiency can result from acrodermatitis enteropathica, an inadequate dietary intake, malabsorption, increased body loss, or intravenous feeding. Unlike acrodermatitis enteropathica, breast feeding-induced acrodermatitis is transient and improves when nursing ends. Breast feeding-induced acrodermatitis is caused by a ZnT-2 transporter dysfunction in the mother's mammary glands. We report a case of a 6-month-old male infant who presented with erythematous patches and plaques involving the perioral, perineal, and acral areas and loose stools since 2 weeks after birth. Atopic dermatitis was considered initially, but the lesions did not respond to topical antibiotics, corticosteroids, or maternal dietary restriction from allergenic food. The patient's serum zinc concentration was low, and the mother's serum and milk had low zinc levels. The differential diagnosis for atopic dermatitis is extensive. Physicians should be alert for the possibility of zinc deficiency dermatitis in breast milk fed infants that mimics atopic dermatitis.
Acrodermatitis ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Breast ; Dermatitis ; Dermatitis, Atopic ; Diagnosis, Differential ; Humans ; Infant ; Male ; Mammary Glands, Human ; Milk ; Milk, Human ; Parenteral Nutrition ; Parturition ; Zinc

Papillary carcinoma of the thyroid is the most common thyroid cancer in children. It usually occurs in the teenage female and presents as a mass within the thyroid itself. In the great majority of cases the only presenting sign is a neck mass. In a high percentage (60-80%) there are also palpable lymph nodes. A 8 years old female patient was admitted because of palpable neck mass and miliary shadow in chest X-ray. On examination, a soft nontenter nodular mass 1x1 cm in size was palpated at supraclavicular area of left mid-neck. In chest X-ray and CT, well demarcated nodular milialy infiltration was fully distributed in both lung. After the initial treatment failure for the miliary tuberculosis, the fine needle aspiration biopsy was performed. The Papillary carcinoma of the thyroid was diagnosed. Total thyroidectomy and entire lymph node excision were performed, followed by radioiodine ablation and hormonal therapy. The patient has been improved clinically. We are reporting a case of thyroid papillary carcinoma presenting as a pulmonary miliary infiltration with brief review of the literature.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary* ; Child* ; Female* ; Humans ; Lung ; Lymph Node Excision ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Failure ; Tuberculosis, Miliary

PURPOSE: Airway hyperresponsiveness (AHR) and pulmonary inflammation with eosinophil infiltration and mucus hypersecretion are prominent features of asthma and can be reproduced in a murine model. There are some allergen challenge routes; intra-tracheal challenge and intra-nasal challenge are the main challenge routes. We examined whether these inflammatory responses varied by the routes of airway allergen challenges. METHODS: BALB/c mice after intraperitoneal (i.p.) ovalbumin (OVA) sensitization (day 0) were challenged with either intranasal (i.n.) or intratracheal (i.t.) OVA on day 8, day 15, day 18, and day 21. AHR to methacholine and lung inflammation were assessed 24 hours after the last OVA challenge on day 22. RESULTS: In bronchoalveolar lavage fluid, number of eosinophils were significantly greater in the intranasal OVA challenge group (4.8 +/- 0.9x10 (5) ) than in the intratracheal (2.0 +/- 0.3x10 (5) ) OVA challenge group (P< 0.01). Lung inflammatory cell infiltration and mucus hypersecretion were also greater in the intranasal OVA challenge group (P< 0.05). In contrast, AHR to methacholine (assessed by in vivo plethysmography) and peribronchial edema were significantly greater in the intratracheal OVA challenge group than intranasal OVA challenge group (P< 0.05). CONCLUSION: These data suggest the dissociation of eosinophilic airway inflammation from development of AHR and that peribronchial edema would contribute to the development of AHR.
Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Edema ; Eosinophils ; Inflammation* ; Lung ; Methacholine Chloride ; Mice* ; Models, Animal ; Mucus ; Ovalbumin ; Ovum ; Pneumonia

BACKGROUND: The role of food allergy in children with atopic dermatitis (AD) has been emphasized. Eggs, cow's milk, soybeans are most common food allergens. We evaluated the serum specific IgE to egg whites (EW), cow's milk (CM), soybeans, and their clinical significance. METHODS: We performed a study with 1, 321 patients (male 739, female 582) who visited Samsung Medical Center during June 1998 and March 2002. We divided them into 9 groups by age. The serum total IgE and specific IgE to EW, CM, and soybeans were measured by Pharmacia AutoCAP system RAST (R) FEIA. RESULTS: The geometric mean of serum total IgE was increased with age (P< 0.05). EW (27.4%) was the most commonly sensitized food allergen in these subjects (P< 0.05), followed by CM (16.1%), and soybeans (8.1%). 37.2% of patients who are younger than 1-year-old showed positive reactions to EW. Reaction rate for this group was higher than others (P< 0.05). The positive reactions to EW were decreased with age (P< 0.05). But, the positive reactions to CM and soybeans did not show any relations to the age. The positive reactions to EW for 4-year-olds and younger were higher than those to CM and soybeans (P< 0.05). 30.7% of patients who had positive reactions to EW, especially 44.3% in age group 1-year-olds and younger (P< 0.05), showed higher specific IgE levels than diagnostic decision points of specific IgE to EW. CONCLUSION: The children with atopic dermatitis, especially young children, have high level of positive responses to egg whites, cow's milk. Sometimes they have serum specific IgE higher than diagnostic decision point. We think that young children with atopic dermatitis are more frequently related to egg and milk allergy.
Allergens ; Child* ; Child, Preschool ; Dermatitis, Atopic* ; Egg White* ; Eggs ; Female ; Food Hypersensitivity ; Humans ; Immunoglobulin E* ; Milk Hypersensitivity ; Milk* ; Ovum* ; Soybeans*

PURPOSE: Birds' eggs have been a major source of food for mankind since the time unknown. Among them, chicken eggs have been the most important food source. We examined the allergenic properties of eggs from varying birds on patients with known allergy to chicken eggs, to find out whether they can replace the chicken eggs for the source of nutrient. METHODS: Samples were selected from patients who visited the allergy clinic of the Department of Pediatrics at Yonsei University Medical Center. The serum specific IgE for eggs were measured and allergy skin tests were performed. The serum of the patients with proven egg allergy was then tested for reactivity with eggs from wild and domestic ducks, geese, seagulls, quails, yellow-shelled and white-shelled eggs employing SDS-PAGE and IgE immunoblotting. RESULTS: All the egg protein showed similar molecular sizes ranging from 24-100 kDa. Their expressions, however, were different, with white eggs, yellow eggs, and quail eggs showing strong reaction, while ducks, geese, and mallard eggs presented with weak reaction. Immunoblotting exhibited reactivity in 35-50 kDa and 25-35 kDa groups. Quail eggs and shells from chicken eggs showed a protein banding of 75-80 kDa. Geese, wild and domestic ducks, quail did not exhibit any cross-reactivity with chicken eggs. CONCLUSION: Among patients with egg allergy, cross-reactivity between different chicken eggs was present, but no cross-reactivity was apparent between chicken eggs and other birds' eggs. Therefore, we suggest theses eggs as alternative source of food in patients with egg allergy. However further study with larger patient population is still required.
Academic Medical Centers ; Animals, Domestic ; Birds* ; Chickens ; Child* ; Ducks* ; Egg Hypersensitivity* ; Eggs ; Electrophoresis, Polyacrylamide Gel ; Geese ; Humans ; Hypersensitivity ; Immunoblotting ; Immunoglobulin E ; Ovum* ; Pediatrics ; Quail ; Skin Tests

PURPOSE: Asthma is an important worldwide pediatric public health problem and rapidly increasing prevalence has been reported. Environmental tobacco smoke (ETS) is known to be an important aggravation factor of asthma. The aim of this study was to determine whether ETS exposure is associated with exacerbations of asthma, and therefore to define the possibility of improving illness by cessation of smoking. METHODS: One hundred one (101) asthmatic children who visited and followed up at Korea university hospital pediatric allergy clinic were enrolled. Their chart was reviewed retrospectively and their family members were also interviewed. RESULTS: Sixty nine patients were exposed to ETS and thirty two patients were not exposed. Among exposed group (n=69), fourteen patients were no longer exposed due to cessation of smoking. The difference in the number of hospital admissions between exposed group and non-exposed was statistically significant (P=0.002). But the difference in the number of emergency room visits and PFT value (FEV1, PEFR, FEF25-75%) between the two groups was statistically insignificant. Statistical relationship between the duration of ETS and number of hospital admissions was significant (Pearson Correlation Coefficient=0.243, P=0.015). Comparing current smoking group and smoking cessation group, differences in out-patient clinic follow up period, number of hospital admissions, and number of emergency room visits between the two groups were statistically insignificant. CONCLUSION: We found that ETS exposure is associated with exacerbations of asthma. Possibility of improving illness by reduction of ETS exposure indicates the significance of education for cessation of smoking.
Asthma* ; Child ; Education ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Hypersensitivity ; Korea ; Outpatients ; Peak Expiratory Flow Rate ; Prevalence ; Public Health ; Retrospective Studies ; Smoke* ; Smoking ; Smoking Cessation ; Tobacco*

Laryngeal cysts can be classified into saccular (24%) or ductal (75%) cysts. In infants who have undergone intubation, ductal cysts are occasionally seen in the subglottic region. These cysts are caused by irritation and obstruction of mucous gland ducts. A 20-month-old infant admitted to our department due to inspiratory stridor, wheezing, and dyspnea. She was born prematurely and had a past history of endotracheal intubation with ventilator of 9 days because of respiratory distress syndrome. At 31 days of age, she was intubated again for 5 days because of pneumonia. She had admitted our hospital repeatedly at 7, 8, 16, and 17 months because of inspiratory stridor, wheezing, cough and dyspnea and she was diagnosed as asthmatic bronchitis. But symptoms developed again, she readmitted. A lateral X-ray film of the neck and neck spiral CT revealed a 6x5 mm sized homogeneous mass in the posterior wall of the subglottic region causing airway obstruction. A laryngoscopy was performed and showed a 4x5 mm sized cystic mass in the subglottic region. Endoscopic resection was done by Nd : Yag laser. The postoperative course was satisfactory. Histologic examination showed a ductal cyst, lined with ciliated cuboidal epithelium. This subglottic ductal cyst was believed to be a late complication of endotracheal intubation.
Airway Obstruction ; Bronchitis ; Cough ; Dyspnea ; Epithelium ; Humans ; Infant ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Larynx ; Lasers, Solid-State ; Neck ; Pneumonia ; Respiratory Sounds ; Tomography, Spiral Computed ; Ventilators, Mechanical ; X-Ray Film

PURPOSE: Rice is the main cereal produced and consumed in large quantities in Asian countries including Korea. Several reports have suggested a role of IgE-mediated hypersensitivity in asthma and eczema associated with ingestion or inhalation of rice. In Japan, hypoallergenic rices are used as substitutes for rice in some atopic patients. We performed this study to identify major the allergens of rice and the different allergenicity in cooked rice and hypoallergenic rices. METHODS: We made crude extracts from rice of various origins: polished rice, cooked rice, hypoallergenic rice from Japan and GMO rice, and performed SDS-PAGE. Based on uni, CAP test and skin prick tests we got pooled sera, then IgE immunoblots were undertaken. We performed ELISA inhibition to rule out nonspecific binding. RESULTS: There was no difference of protein distribution between the origins of the various rices, and their "polishment". After cooking, it was difficult to see any protein distribution of rice. With the results of IgE immunoblots it was impossible to differentiate between wild and hypoallergenic rices by IgE binding itself. Even in hypoallergenic rice, there was still a binding of IgE with remaining allergen. CONCLUSION: Boiling degenerates almost all protein in rice IgE binding activities remain in hypoallergenic rice produced in Japan was no difference between wild and GMO rice in SDS-PAGE and IgE immunoblot using sensitized pooled sera. Further studies with more sensitive sera are necessary for the identification of major allergens and the development of hypoallergenic rice.
Allergens ; Asian Continental Ancestry Group ; Asthma ; Edible Grain ; Complex Mixtures ; Cooking ; Eating ; Eczema ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E ; Inhalation ; Japan ; Korea ; Organisms, Genetically Modified ; Skin

PURPOSE: This study was undertaken to compare blood eosinophilic inflammatory markers between the acute period and clinical remission in children with upper respiratory infection (URI) -induced wheezing, and to assess the effects of atopy and age on these changes. METHODS: In 77 children with URI-induced wheezing, blood eosinophil count and serum eosinophil cationic protein (ECP) were measured during the acute wheezing phase and clinical remission period. The data were analyzed in the subgroups divided by atopy and age, respectively. RESULTS: Blood eosinophil count was significantly lower during acute period (181.6/microliter, 67.3-490.0) than that during clinical remission period (261.8/microliter, 120.7-567.7, P=0.001), and this significant eosinopenic response was found in non-atopic children (n=36) [92.2 (41.3-206.0) /microliter vs 204.5 (106.6-392.2) /microliter, P< 0.001], but not in atopic children (n=41). A significantly higher level of serum ECP was observed during acute period (15.1 microgram/L, 7.2-31.6) than during clinical remission (13.0 microgram/L, 6.6-25.7, P=0.05), and this difference was significant only in atopic children[24.2 (15.3-38.1) microgram/L vs 16.2 (8.3-31.6) microgram/L, P< 0.001]. A significant fall in blood eosinophil count during acute period was found only in children < or=4 years (n=37), while a significant rise in serum ECP was detected only in children > 4 years (n=40). However, these differences a due to dissimilar distribution of atopy in the two age groups. CONCLUSION: Our results showed different eosinophil responses to infection in non-atopic and atopic children with URI-induced wheezing. It appears that the blunted eosinopenic response in atopic children may be associated with the predominant Th2-like response to infection.
Child* ; Eosinophil Cationic Protein ; Eosinophils* ; Humans ; Respiratory Sounds*

No abstract available.
Respiratory Syncytial Viruses* ; Respiratory System* ; Respiratory Tract Infections*