Chronic cough is one of the most common reasons for referral to a respiratory physician. Although fatal complications are rare, it may cause considerable distress in the patient's daily life. Western and local data shows that in patients with a normal chest radiograph, the most common causes are postnasal drip syndrome, postinfectious cough, gastro-oesophageal reflux disease and cough variant asthma. Less common causes are the use of angiotensin-converting enzyme inhibitors, smoker's cough and nonasthmatic eosinophilic bronchitis. A detailed history-taking and physical examination will provide a diagnosis in most patients, even at the primary care level. Some cases may need further investigations or specialist referral for diagnosis.
Asthma ; complications ; diagnosis ; Chronic Disease ; Cough ; diagnosis ; etiology ; Diagnosis, Differential ; Gastroesophageal Reflux ; complications ; diagnosis ; Humans

To characterize the patients whose asthma may be caused by Artemisia pollen extracts, we studied the bronchoprovocation test with Korean Artemisia pollen extracts (1:20 w/v), methacholine bronchial challenge test and wormwood-RAST in 32 asthmatic patients sensitized to Artemisia pollen. Twenty-six(81%) developed a 15% or greater decrease in FEVI after the inhalation of Artemisia pollen extracts and 13 patients showed early responses, 8 dual, and 5 late only. Thirteen(50%) out of 26 positive responders complained of seasonal aggravation of their asthmatic symptoms. Seven(53.8%) of the 13 seasonal type patients, 10(76.9%) of the 13 perennial type and 5(100%) of the 5 negative responders showed concurrent positive responses in the house dust bronchoprovocation test. The bronchial responsiveness to allergen(PD15) was more dependent upon the specific IgE level(bound radioactivity on wormwood-RAST) and multiple regression analysis revealed that the specific IgE level and methacholine PC20 may be contributory to allergen PD15. These results suggested that specific IgE to Artemisia pollen appears to be the major contributor to susceptibility to Artemisia bronchial challenges and this pollen may be considered as one of the important allergenic etiologies of atopic asthma in this country.
Allergens ; Asthma/diagnosis/*etiology ; Bronchial Provocation Tests ; Human ; *Pollen ; Radioallergosorbent Test ; Skin Tests

The association between allergic rhinitis and bronchial asthma, that is, whether it is a seqential process or independent diseases, has not been established. We confirmed that a 25 year-old woman with allergic rhinitis sensitized to Artemisia spp. pollens and house dust mites developed bronchial asthma during a 2 year follow-up period. Severe broncho-constriction was noted after inhalation of methacholine, and the bronchoprovocation test with extract of Korean Artemisia spp. pollen showed early bronchoconstiction. Total IgE and specific IgE antibodies to Artemisia absinthium increased, compared to the initial levels. It is suggested that some patients with allergic rhinitis progress to bronchial ashtma.
Adult ; Angiosperms ; Asthma/diagnosis/*etiology ; Bronchial Provocation Tests ; Case Report ; Female ; Hay Fever/*complications/diagnosis ; Human ; Korea ; *Pollen ; Skin Tests

Adult ; Allergens ; immunology ; Animals ; Asthma, Occupational ; diagnosis ; etiology ; Bee Venoms ; immunology ; Bees ; immunology ; Cross Reactions ; Fatty Acids ; immunology ; Female ; Humans

Adult ; Aspergillosis, Allergic Bronchopulmonary ; etiology ; Aspirin ; adverse effects ; Asthma ; chemically induced ; diagnosis ; Humans ; Male ; Radiography, Thoracic ; Tomography, X-Ray Computed

Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.
Anti-Ulcer Agents/administration & dosage ; Asthma/diagnosis/etiology ; Cough/diagnosis/etiology ; Esophageal pH Monitoring ; Gastric Acidity Determination ; Gastroesophageal Reflux/*diagnosis/etiology/therapy ; Hoarseness/diagnosis/etiology ; Humans ; Laryngitis/diagnosis/etiology ; Omeprazole/administration & dosage ; Prognosis ; Proton Pump Inhibitors/therapeutic use ; Tooth Erosion/diagnosis/etiology

Porcine pancreatic extracts (PPE), which are widely used as a digestive drug in Korea, are composed of alpha-amylase and lipase. Such enzymes are commonly described as occupational allergens. This is the first report of occupational rhinitis caused by PPE developing into occupational asthma in a hospital nurse. She showed strong positive response in the skin prick test (SPT) (5+, wheal ratio of allergen to histamine) and had a high serum-specific IgE level to PPE, but showed a negative response in the methacholine bronchial challenge test (MBT). She had been exposed to PPE intermittently with intermittent medications for rhinitis. Two years later, she presented with rhinitis and additional asthmatic symptoms. In contrast to her first visit, she showed a positive response in the MBT, and developed bronchoconstriction in the PPE-bronchial provocation test (BPT). These findings suggest that inhalation of PPE powder can induce IgE-mediated occupational rhinitis in a hospital setting, which will develop into occupational asthma if avoidance is not complete.
Adult ; Animals ; Asthma/*diagnosis/etiology ; Bronchial Provocation Tests ; Female ; Gastrointestinal Agents/adverse effects ; Humans ; Immunoglobulin E/metabolism ; Methacholine Chloride/pharmacology ; Occupational Diseases/*diagnosis/etiology ; Pancreatic Extracts/*adverse effects ; Powders ; Rhinitis/*diagnosis/etiology ; Skin Tests ; Swine

OBJECTIVETo study the characteristics of allergic reactions to common aeroallergens in young children with wheezing or allergic diseases by examining the results of skin prick test in children under 5 years old.

METHODSA total of 196 children under 5 years old, from a district of Changsha City sampled between September 1 to December 31, 2010, were assigned into two groups according to the presence of wheezing or allergic diseases: allergen screening (n=102) and control (n=94). Skin prick tests were performed on both groups.

RESULTSThe positive rate of skin prick test in the allergen screening group was 61.8% (63/102), and this was significantly higher than in the control group (9.6%, 9/94; P<0.05). In the allergen screening group, the positive rate of skin prick test in children with both recurrent wheezing and allergic rhinitis was significantly higher than in children with wheezing alone (P<0.05). The frequency of wheezing was positively correlated with a positive skin prick test (r=0.91; P<0.05). The positive rate of skin prick test for mites was significantly higher than for other aeroallergens (24.2% vs 3.5%; P<0.05) in the allergen screening group. Skin prick testing of the children for dermatophagoides farinae showed a higher positive rate than for dermatophagoides pteronyssinus (50.0% vs 14.7%; P<0.05).

CONCLUSIONSWheezing in early childhood may be associated with the occurrence of asthma. Skin prick testing contributes to the diagnosis of allergic diseases and assessment of allergic reactions to aeroallergens in children with wheezing.

Asthma ; etiology ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Respiratory Sounds ; diagnosis ; immunology ; Rhinitis, Allergic, Perennial ; diagnosis ; immunology ; Rhinitis, Allergic, Seasonal ; diagnosis ; immunology ; Skin Tests

Asthma ; diagnosis ; drug therapy ; physiopathology ; Child, Preschool ; Diagnosis, Differential ; Glucocorticoids ; therapeutic use ; Humans ; Infant ; Recurrence ; Respiratory Sounds ; diagnosis ; drug effects ; etiology ; Treatment Outcome

A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzymelinked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism.
Animals ; Asthma/diagnosis/*etiology/*immunology ; Bronchi/metabolism ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay/methods ; Flour ; Flowers ; Humans ; Hypersensitivity/*diagnosis ; Immunoglobulin E/analysis/*chemistry ; Korea ; Occupational Diseases/diagnosis/*etiology/*immunology ; Panax/*adverse effects ; Pyroglyphidae/metabolism ; *Skin Tests