Monosensitization differs both immunologically and clinically from polysensitization, and specific immunotherapy is more effective in patients sensitized only to a single pollen than in multiple-pollen sensitized patients. To further examine the differences between monosensitized and polysensitized allergies, allergic indices were examined in 68 monosensitized and 62 polysensitized patients with childhood asthma. Measurements included symptom scores, eosinophil counts, skin prick tests, serum total and specific IgE levels, and IL-10 levels, and were used to compare allergic indices between the two groups. Patients were followed for 18 months following immunotherapy to examine the effectiveness of the treatment. Symptom scores and total IgE levels were significantly higher in the polysensitized group than those in the monosensitized group (p<0.05). The levels of skin test response decreased significantly in both groups following immunotherapy. In the monosensitized group, symptom scores and specific IgE levels were significantly reduced after immunotherapy (p<0.05). In the polysensitized group, symptom scores were reduced after immunotherapy (p<0.05), but the degree of reduction was less than that of the monosensitized group (p<0.05). Moreover, in the polysensitized group, specific IgE levels after immunotherapy did not differ from that before immunotherapy. Serum IL-10 levels were not significantly increased after immunotherapy in either group. In conclusion, polysensitized patients tend to show higher allergic indices and immunotherapy might be less effective for these patients.
Skin Tests/*methods ; Sensitivity and Specificity ; Reproducibility of Results ; Male ; Hypersensitivity/*classification/*diagnosis ; Humans ; *Health Status Indicators ; Female ; Child ; Asthma/*classification/*diagnosis

Monosensitization differs both immunologically and clinically from polysensitization, and specific immunotherapy is more effective in patients sensitized only to a single pollen than in multiple-pollen sensitized patients. To further examine the differences between monosensitized and polysensitized allergies, allergic indices were examined in 68 monosensitized and 62 polysensitized patients with childhood asthma. Measurements included symptom scores, eosinophil counts, skin prick tests, serum total and specific IgE levels, and IL-10 levels, and were used to compare allergic indices between the two groups. Patients were followed for 18 months following immunotherapy to examine the effectiveness of the treatment. Symptom scores and total IgE levels were significantly higher in the polysensitized group than those in the monosensitized group (p<0.05). The levels of skin test response decreased significantly in both groups following immunotherapy. In the monosensitized group, symptom scores and specific IgE levels were significantly reduced after immunotherapy (p<0.05). In the polysensitized group, symptom scores were reduced after immunotherapy (p<0.05), but the degree of reduction was less than that of the monosensitized group (p<0.05). Moreover, in the polysensitized group, specific IgE levels after immunotherapy did not differ from that before immunotherapy. Serum IL-10 levels were not significantly increased after immunotherapy in either group. In conclusion, polysensitized patients tend to show higher allergic indices and immunotherapy might be less effective for these patients.
Skin Tests/*methods ; Sensitivity and Specificity ; Reproducibility of Results ; Male ; Hypersensitivity/*classification/*diagnosis ; Humans ; *Health Status Indicators ; Female ; Child ; Asthma/*classification/*diagnosis

The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma.
Adult* ; Asthma* ; Biomarkers* ; Classification ; Diagnosis ; Humans ; Precision Medicine* ; Patient Selection ; Phenotype ; Prescriptions ; Prognosis ; Research Personnel

PURPOSE: Cough is a frequent symptom in bronchial asthma. Acoustic digital analysis of cough has been reported using digital signal processing techniques. Differences between asthmatic and control cough sounds are presented. The main purpose of this study was to examine whether overall spectral energy and the visual observation of the fine details of the cough spectrographs, explain the differences in cough between normal subjects and asthmatic patients. METHODS: We presented data from 7 asthmatic patients and 8 non-asthmatic subjects using a new method of acoustic analysis. Cough sound was digitalized at a sampling rate of 5 kHz. Individual coughs were divided into two or three phases, presents the data of RMS (Root Mean Square), duration, RMS in the frequency band. Factor analysis and iogistic regression analysis were performed to identify groups of variables. RESULTS: Duration of cough was longer in asthmatics cough. The number of additional cough sounds showed no difference. RMS of cough in total cough and 2nd phase cough was stronger for asthmatics cough. Energy of frequency band is significantly different in 1,000-1,500 Hz, 1,500-2,000 Hz, 5,000-5,500 Hz, 5,500-6,000 Hz, 6,000-6,500 Hz, 9,000-9,500 Hz at total phase, 0-500 Hz, 1,000-1,500 Hz, 2,000-2,500 Hz, 5,000-5,500 Hz, 6,000-6,500 Hz, 9,000-9,500 Hz at 1st phase. Factor analysis and logistic regression analysis for the two groups provoded a classification table of 96.3% of sensitivity and 86.0% of specificity. CONCLUSION: We provided a new approach to the analysis of cough sounds. Significant differences were found between asthmatic and non-asthmatic cough sounds. It has potential as a tool with which to study the pathophysiology of cough and diagnosis the respiratory disease.
Acoustics ; Asthma ; Classification ; Cough* ; Diagnosis ; Humans ; Logistic Models ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted

diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.]]>
Angioedema ; Asthma ; Classification ; Diagnosis ; Drug Hypersensitivity ; Humans ; Hypersensitivity ; Phenotype ; Rhinitis ; Urticaria

Churg-Strauss syndrome(CSS) or allergic angiitis and granulomatosis is a disorder characterized by pulmonary and systemic small-vessel vasculitis, extravascular granulomas, and hypereosinophilia. It occurs in individuals with asthma and allergic rhinitis. The diagnosis of CSS is made on the basis of clinical and pathologic features. According to 1990 American College of Rheumatology(ACR) criteria for the classification of CSS, 6 criteria were developed. The presence of 4 or more of these criteria yielded a sensitivity of 85% and a specificity of 99. 7%. We describe a case of CSS in a 62-year-old female who met all of 1990 ACR criteria, but presented as like a as rheumatoid arthritis initially. Clinical symptoms, laboratory and roentgenographic findings gradually responded to high dose prednisolone treatment and resolved 3 weeks later. After discharge, she has been treated with oral prednisolone in a tapering course. Although polyarthritis with eosinophilia, vasculitis, and neuropathy are clinical manifestations of rheumatoid arthritis, those maniestations frequently occur during the vasculitic phase of the CSS. This case suggests that thorough differentiation of extra-articular manifestations of RA from clinical manifestations of CSS is considered when we meet a patient who have polyarthritis and vasculitis.
Arthritis ; Arthritis, Rheumatoid* ; Asthma ; Churg-Strauss Syndrome ; Classification ; Diagnosis ; Eosinophilia ; Female ; Granuloma ; Humans ; Middle Aged ; Prednisolone ; Rhinitis ; Sensitivity and Specificity ; Vasculitis

PURPOSE: Atopic Dermatitis (AD) is a chronically relapsing inflammatory skin disease. Generally, aeroallergens and food allergens can exacerbate symptoms in AD. Currently they are divided into two groups: one is an IgE mediated form and the other is a non-IgE mediated form. This study focused upon clinical manifestations of two distinct forms of AD. METHODS: We evaluated 110 patients (male: 58, female: 52) with AD. All patients had visited Masan Samsung Hospital from June 2002 to February 2005. The patients were divided into 2 sub-groups according to their serum total IgE and specific IgE levels. The serum total IgE and specific IgE to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Egg white, Cow's milk and Soybean were measured by the Pharmacia CAP-FEIA system. Metacholine provocation tests were conducted to reveal bronchial hyper-responsiveness and ARIA guidelines for diagnosis of AR were applied. RESULTS: Our study showed more female predominance in non IgE-mediated atopic dermatitis patients and showed higher total eosinophil count in IgE-mediated atopic dermatitis. (P< 0.05) There was no difference in frequency of asthma between two groups (P> 0.05), but allergic rhinitis was significantly predominant in non IgE-mediated atopic dermatitis patients. (P< 0.05) CONCLUSION: Female was more predominant in non IgE-mediated atopic dermatitis patients and IgE-mediated atopic dermatitis patients showed higher total eosinophil count and more frequency of allergic rhinitis.
Allergens ; Asthma ; Child* ; Classification* ; Dermatitis, Atopic* ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Diagnosis ; Egg White ; Eosinophils ; Female ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Milk ; Rhinitis ; Skin Diseases ; Soybeans

OBJECTIVES: The aim of this study was to compare the prescription patterns according to characteristics of physicians using a survey distributed amongst physicians in Korea. METHODS: We surveyed the prescription patterns for allergic rhinitis (AR) of the members of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and the Korean Association of Otorhinolaryngologists (KAO). Questionnaire contained 4 categories with 28 queries. 448 physicians including 98 internal medicine (IM), 113 pediatrics (PED), and 237 otorhinolaryngology (ENT) were responded. RESULTS: Although the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines are most frequently used in all specialties, seasonal or perennial AR is the most frequent classification system. For the definitive diagnosis of AR, ENT physicians reported using multiple allergen simultaneous test (MAST)/radio allergy sorbent test (RAST) more than others (IM, 10.9%; PED, 20.6%; ENT, 44.2%; P < 0.001). In treatment, most physicians reported that antihistamine medication is the initial treatment for AR. PED physicians prescribed fewer intranasal steroid to combinations with an antihistamine than other specialists (IM, 65.3%; PED, 42.5%; ENT, 63.3%), but preferred leukotriene antagonists (IM, 4.1%; PED, 23.0%; ENT, 3.9%; P=0.041). Overall, 53% (235/448) of the physicians performed allergen immunotherapy (AIT), and IM administers the most AIT (IM, 71.6%; PED, 42.0%; ENT, 39.5%; P=0.019). Furthermore, university and general hospital physicians prescribed more AIT than doctors at other hospital types (university hospital, 76.4%; general hospital, 64.3%; local hospital, 21.4%; private clinic, 20.2%; P < 0.001). CONCLUSION: The prescription patterns for AR were different according to the physicians’ characteristics and general rate of prescribing AIT is just about 53% in Korea. Thus, the development of complementary Korean-specific guidelines is needed and proper clinical instruction of AIT would be necessary.
Allergy and Immunology ; Asthma ; Classification ; Desensitization, Immunologic ; Diagnosis ; Drug Prescriptions ; Hospitals, General ; Hypersensitivity ; Internal Medicine ; Korea ; Leukotriene Antagonists ; Otolaryngology ; Pediatrics ; Prescriptions* ; Rhinitis, Allergic* ; Seasons ; Specialization ; Surveys and Questionnaires

OBJECTIVETo explore the relationship between latex allergen and clinical presentation as well as allergenic cross-reactivity between latex and other allergens, to know the incidence of latex allergy in Chinese children and elucidate the allergenic cross-reactivity of latex with other allergens.

METHODSTotally 265 children with allergic disorders were assayed with 13 international standard allergen agents by means of SPT.

RESULTSIn 79 children with latex allergenic SPT position, 53 were boys and 26 were girls with an average age of 5.6 years, and 14 cases had episodes occurred in winter, 14 cases in spring, 24 cases in summer, and 27 cases in autumn. Of them, 66 cases presented as asthma, 5 cases atopic skin disorders, 1 case anaphylactoid purpura, 1 case hives and 6 cases only had mild cough. Statistical analysis showed that the positive percentage of the latex SPT had no obvious relation with sex and age, but was higher in summers and autumns than in winters and springs (P < 0.01). Children with allergic symptoms had higher positive rate in latex allergenic SPT than those without them, that is, the positive percentage of the latex SPT significantly increased among children presenting with some allergic symptoms, such as asthma, hives and atopic skin disorders (P < 0.01). All the children with latex allergenic SPT position had cross-reactivity with acarid allergen, 62.0% approximately 43.0% with animal protein allergens including milk, cats, shrimp, dogs, eggs in the order of decreasing cross-reaction rate, and 10.1% - 3.8% with mold and plant farina allergens. But the cross-reactivity between latex and mold or tree farina I were not statistically significant.

CONCLUSIONThirty percent of the children with allergic disorders were latex allergenic SPT positive. Latex allergenic SPT positive results were significantly correlative to allergic clinical presentation and season, while were not relative to sex and age. The cross-reactivity of latex with acarid was most common, followed by animal protein allergens, while the cross-reactivity with mold and plant farina allergen was rare.

Allergens ; immunology ; Animals ; Asthma ; immunology ; Child ; Child, Preschool ; Cross Reactions ; Female ; Humans ; Infant ; Latex Hypersensitivity ; classification ; diagnosis ; immunology ; Male ; Predictive Value of Tests ; Seasons ; Skin Tests

Allergic rhinitis is defined as an immunologic response moderated by IgE and is characterized by sneezing, rhinorrhea, nasal congestion, and nasal itching. Allergic rhinitis represents a global health problem. It is an extremely common disease worldwide affecting 10 to 25% of the population. Because of its increasing prevalence over the last decades, allergic rhinitis has been identified as one of the top ten reasons for visits to primary care clinics. Although allergic rhinitis is not a severe disease usually, it significantly affects the social life of patients and compromises school performance as well as work productivity. In addition, allergic rhinitis is associated with asthma, sinusitis, otitis media, nasal polyposis, lower respiratory tract infection and dental occlusion. Therefore, the cost incurred by rhinitis is substantial. Allergic rhinitis was previously classified into seasonal, perennial, and occupational. From a therapeutic point of view, however, it is often difficult to differentiate between seasonal and perennial symptoms. In 2001, therefore, a new classification has been proposed by the ARIA as 'ntermittent' or 'persistent' rhinitis. The severity of allergic rhinitis can be classified as 'mild' or 'moderate-severe' on the basis of symptoms as well as the quality of life of the patient. Treatment of allergic rhinitis involves allergen avoidance, pharmacotherapy, and in selected cases, immunotherapy. Surgical procedures can be performed in refractory cases. This article reviews the predisposing factors to allergic rhinitis, clinical presentation, diagnosis, and the recommended treatment options.
Asthma ; Causality ; Classification ; Dental Occlusion ; Diagnosis ; Drug Therapy ; Efficiency ; Estrogens, Conjugated (USP) ; Humans ; Immunoglobulin E ; Immunotherapy ; Otitis Media ; Prevalence ; Primary Health Care ; Pruritus ; Quality of Life ; Respiratory Tract Infections ; Rhinitis* ; Seasons ; Sinusitis ; Sneezing