PURPOSE: Causes of acute lower respiratory tract infections (ALRI) in children are diverse. But virus is the most common cause of ALRI, so it is important to understand the etiology and epidemiology of ALRI. This study was performed to investigate the etiologic organisms, age distribution, clinical manifestations and seasonal occurrence of ALRI in hospitalized children. METHODS: We confirmed viral etiologies using nasopharyngeal aspirates in 377 patients of the ages of 15 years or younger who were hospitalized for ALRI from March, 1996 to February, 1999 at Samsung Seoul Hospital, Seoul, Korea. Viral agents were detected by virus isolation and antigen detection by indirect immunofluorescent staining. RESULTS: The viral pathogens identified were influenza A (22.2%), influenza B (9.0 %), adenovirus (21.2%), parainfluenza virus type 1 (8.8%), type 2 (3.4%), type 3 (15.1%) and respiratory syncytial virus (RSV) (20.2%). The occurrence of ALRIs was high under 2 year old. The clinical patterns of viral ALRI include pneumonia (49.9%), croup (20.2%), bronchiolitis (22.0%), tracheobronchitis (8.0%). The specific viruses are frequently associated with specific clinical syndrome of ALRI. The respiratory agents and associated syndromes frequently have characteristic seasonal patterns. CONCLUSION: This study will help us to estimate the etiologic agents of ALRI, and to avoid inappropriate antibiotic therapy. An annual nationwide survey is necessary to understand the viral epidemiology associated with respiratory illness.
Adenoviridae ; Age Distribution ; Bronchiolitis ; Child ; Child, Hospitalized* ; Child, Preschool ; Croup ; Epidemiology ; Humans ; Influenza, Human ; Korea ; Parainfluenza Virus 1, Human ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory System* ; Respiratory Tract Infections* ; Seasons ; Seoul

BACKGROUND: Our previous data suggested that IgE-mediated histamine release from basophil was elevated in the atopic asthmatic children. Basophil may play an important role in the development of the IgE-dependent, late phase response in allergen induced airway disease. So the existence of enhanced basophil histamine release in asthma could promote airway reactivity and obstruction. PURPOSE: The purpose of this study is to determine the relationship between IgE-mediated basophil histamine releasability (BHR) and airway hyperresponsiveness or markers of atopy in atopic children. METHODS: Twelve atopic asthmatics and four healthy atopics who were sensitive to D.p and D.f were selected. Their median age was 11.2 years old, their mean serum IgE level was 897+/-276 IU/mL and mean total eosinophil count was 536+/-71/mm3. Total eosinophil counts, total IgE, D.p and D.f-specific IgE, pulmonary function test, and methacholine provocation test were performed. IgE-mediated basophil histamine release by D.f allergen and goat-antihuman IgE antibody were measured by automated fluorometric assay. The relationship between histamine release and airway hyperresponsiveness or atopic markers was investigated. RESULTS: PC20 inversely correlated with anti-IgE antibody-mediated BHR (r=-0.50, P<0.05). Serum total IgE concentration correlated with anti-IgE antibody-mediated BHR (r=0.54, P<0.05). Serum concentrations of specific IgE to D.p correlated with anti-IgE antibody-mediated BHR (r=0.66, P<0.05). PC20 correlated correlated with FEF25-75% (r=0.75, P<0.05) and inversely with the total eosinophil counts (r=-0.69, P< 0.01). CONCLUSION: IgE-mediated basophil histamine releasability is inversely correlated with airway hyperresponsiveness, and correlated with total or specific-IgE in atopic children. These findings suggest that basophil histamine releasability is easy and useful method of diagnosis and monitoring response to treatment in atopic disease.
Asthma ; Basophils* ; Child* ; Diagnosis ; Eosinophils ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Respiratory Function Tests

PURPOSE: Buckwheat flour (BF) is known as a potent food allergen. Its sensitization usually occurs by ingestion, but also by inhalation due to occupational or domestic exposure. We underwent this study to identify an effect of buckwheat chaff stuffed pillow (BCP) exposure on sensitization to BF and clinical BF allergy in asthmatic children. METHOD: We obtained detailed history of BCP exposure in 36 asthmatic children (aged 0.7-14.2 years). We also performed RIA for specific IgE, BCP-elimination-provocation test. All subjects were divided into 3 groups, Group I (continuous BCP exposurers, n=13), Group II (previous exposurers, n=11), and Group III (non-exposurers to BCP, n=12) and all subjects had no history of ingestion of BF containing foods. RESULTS: In the 13 Group I cases, the durations of BCP exposure were 1-6 years, and 8 of them were users of BCP themselves, 5 were indirect exposurers by family members' BCP. The positive rates of BF specific IgE were 92.3, 36.4% and 8.3% in the Group I, II and III, respectively (Chi-square test, P<0.05). While the positive rates of house dust mites specific IgE were not significantly different among three groups. Twelve out of 13 Group I cases sensitized to BF, and 9 of those 12 were not sensitized to house dust mites. Eight out of 13 Group I cases were positive in BCP elimination-provocation test, during 6-24 month follow-up periods, 7 of them were managed effectively by BCP elimination only. CONCLUSION: Taken together, a small amount of BF attached to BCP can induce BF sensitization and BCP can be a major cause of childhood nocturnal asthma.
Asthma ; Child* ; Eating ; Fagopyrum* ; Flour ; Follow-Up Studies ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inhalation ; Pyroglyphidae

PURPOSE: Asthma is characterized by airway hyperreactivity to a variety of specific and nonspecific stimuli, by chronic airway inflammation with pulmonary eosinophilia, by mucus hypersecretion, and by increased serum IgE levels. T helper 2 (Th2) cells play a critical role in the pathogenesis of asthma, but the precise immunological mechanism that inhibit Th2 cell function in vivo are not well understood. METHODS: Using gene therapy, Th-cell lines were transferred intravenously into histocompatible SCID or OVA immunized BALB/c mice. Airway responsiveness was assessed by methacholine-induced airflow obstruction from conscious mice placed in a whole-body plethysmograph. Pulmonary airflow obstruction was measured by enhanced pause (Penh). RESULTS: We demonstrated that ovalbumin-specific (OVA-specific) Th cells engineered to express IL-10 abolished airway hyperreactivity induced by OVA-specific Th2 effector cells in SCID and BALB/c mice. The inhibitory effect of IL-10 transduced Th cells was antigen-specific and was reversed by neutralization of IL-10. CONCLUSION: Our results demonstrate that IL-10 transduced CD4+ Th cells in the respiratory mucosa can indeed regulate Th2-induced airway hyperreactivity.
Animals ; Asthma ; Genetic Therapy ; Immunoglobulin E ; Inflammation* ; Interleukin-10* ; Mice ; Mucus ; Ovum ; Pulmonary Eosinophilia ; Respiratory Mucosa ; T-Lymphocytes, Helper-Inducer* ; Th2 Cells

No abstract available.
Air Pollution* ; Asthma*

No abstract available.
Bronchial Provocation Tests*

No abstract available.
Asthma*

PURPOSE: Foreign body aspiration in the tracheobronchial tree is a common medical emergency in children and represents an important cause of morbidity and mortality. This study was aimed to analyze the clinical spectrum of tracheobronchial foreign bodies in children and to evaluate the causes of late diagnoses. METHODS: A total of 108 patients with foreign body aspiration were recruited in the last 10 years, who had a flexible or rigid bronchoscopic examination. The age, sex, symptoms, causes of aspiration, radiologic findings, and clinical courses were investigated retrospectively. Patients were divided into 2 groups according to the elapsed time from aspiration to a definite diagnosis as early (< or =24 hours after aspiration) and late diagnoses (>24 hours after aspiration). The two groups were compared for clinical courses, radiologic findings, and the duration of admission of early- and late-diagnosed foreign body aspiration. RESULTS: Approximately 80% of the patients were less than 24 months of age and the most common symptoms were the sudden onset of a cough. Hyperinflation or obstructive emphysema (52.8%) and normal chest radiographs (19.4%) were the most frequent radiologic findings. Plain chest radiographies revealed visible foreign bodies in 7.4% of all patients with foreign body aspiration. Nuts were the most common foreign bodies aspirated. Sudden onset of a persistent cough and fever were predominant in the late-diagnosed group.(P<0.05) CONCLUSION: Our results suggest that clinical suspicion upon interviewing is enough to indicate bronchoscopy. The best way to reduce the number of accidents and deaths associated with foreign body aspiration is to promote public prevention polices.
Bronchoscopy ; Child ; Cough ; Delayed Diagnosis ; Diagnosis* ; Emergencies ; Emphysema ; Fever ; Foreign Bodies* ; Humans ; Mortality ; Nuts ; Radiography, Thoracic ; Retrospective Studies ; Thorax

PURPOSE: Infantile atopic dermatitis (AD) is one of the most important risk factors for development of childhood asthma. Those with persistent wheezing with atopy had a great risk of declining lung function. Our study was designed to find out the risk factors for wheezing in infants who has AD, therefore early detection of risk factors for developing wheezing. METHODS: Three hundreds forty seven infants with AD who visited on our Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from January 2002 to December 2005 were enrolled and they were followed up till July 2006. We obtained familial allergy history and laboratory data such as serum total IgE, specific IgE and blood eosinophil count. We analyzed the factors affecting recurrent wheezing and persistent wheezing after 3 years old in children who had AD during infancy. RESULTS: One-hundred ninety-four children (55.9%) developed wheezing. Male sex (adjusted odds ratio (aOR) 1.7, 95% CI 1.1-2.7) and asthma history of parents or siblings (aOR 4.7, 95% CI 1.7-12.5) were the significant risk factors for development of wheezing. Serum total IgE (aOR 5.1 95% CI 1.1-22.5) and house dust mite sensitization (aOR 9.0, 95% CI 0.9-89.4) were significant risk factors for persistent wheezing after first three years of life. CONCLUSION: We should be alert for asthma in cases of infantile AD especially in male sex or with familial asthma history. And we propose early identification and intervention for asthma in infantile AD with increased total IgE and with house dust mite sensitization.
Asthma ; Child ; Child, Preschool ; Dermatitis, Atopic* ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant* ; Lung ; Male ; Odds Ratio ; Parents ; Pyroglyphidae ; Respiratory Center ; Respiratory Sounds* ; Risk Factors* ; Siblings

PURPOSE: This study was performed to examine the developmental changes in the innate or adaptive immune responses in serum during naturally occurring acute respiratory syncytial virus (RSV) bronchiolitis. METHODS: Forty-five children who were admitted with acute RSV bronchiolitis were enrolled. Two patient groups were defined: Group 1: young infants under 6 months of age; and Group 2: young children of less than 2 years of age. Immune responses in serum were determined in these two patient groups and compared with two age-matched control groups (Control 1 and 2), respectively. Serum samples were obtained on admission and analyzed for sCD14, a receptor for innate immune response, and the cytokines, IFN-gamma and IL-13 using ELISA. RESULTS: Serum sCD14 levels were significantly higher but IFN-gamma and IL-13 levels were lower in control 2 compared with control 1. During RSV bronchiolitis, serum sCD14 increased significantly in both patient groups comparing each age-matched control group, which was even greater in group 2. IFN-gamma significantly increased in group 2, but showed a trend to decrease in group 1. IL-13 levels were significantly higher in group 2, but showed no significant difference in group 1 compared with age-matched controls. CONCLUSION: Our study showed that innate immunity plays an important role in the pathophysiology of acute RSV bronchiolitis during early life and suggests that developmental changes in the innate and adaptive immunity may be considered in treatment of the disease.
Adaptive Immunity ; Bronchiolitis* ; Child ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunity, Innate ; Infant ; Interleukin-13 ; Respiratory Syncytial Viruses*