Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis.
Adult ; Asthma, Occupational/*chemically induced/*diagnosis ; Breath Tests ; Bronchial Provocation Tests ; Environmental Exposure ; Eosinophilia/*diagnosis ; Exhalation ; Humans ; Leukocyte Count ; Male ; Nickel ; Nitric Oxide/metabolism ; Occupational Exposure ; Plasticizers ; Polyvinyl Chloride

The aged population is increasing worldwide, and it is therefore essential to identify the specific features of diseases in aged groups. The diagnosis of allergic diseases in the elderly is more difficult than in younger patients, because the differential diagnosis of other diseases must be excluded. The treatment of elderly allergic diseases is also challenging because most elderly patients have co-morbidities that affect the disease outcome. Co-morbidity is one of the most important factors to be considered when elderly allergic patients are treated. Co-morbidity and medications for co-morbidity affect allergic disease treatment in terms of drug-drug interaction, medication adherence, adverse drug reactions, and so on. Many studies of allergic diseases are focused on the younger population, while few studies have dealt with elderly allergic diseases. Further studies including diagnosis and treatment guidelines for elderly allergic disease are needed.
Aged* ; Comorbidity ; Diagnosis ; Diagnosis, Differential ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Medication Adherence

An association between drug treatment for viral infections and severe cutaneous adverse reactions has been noted. We investigated six patients diagnosed with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) after being prescribed acetaminophen for suspected viral illnesses. Multiplex analysis was performed to measure cytokine levels in sera before and after treatment. IL-2Rα levels significantly decreased during the convalescence phase. Although acetaminophen is relatively safe, the drug can trigger SJS/TEN in patients with suspected viral infections. T-cells and monocytes may be key components of the link between viral infection and acetaminophen-induced SJS/TEN.
Acetaminophen* ; Convalescence ; Humans ; Monocytes ; Stevens-Johnson Syndrome* ; T-Lymphocytes

No abstract available.
Asthma* ; Hypersensitivity* ; Phenotype* ; Urticaria*

No abstract available.
Anaphylaxis* ; Basophils*

Toluene diisocyanate (TDI) exposure can directly activate and damage airway epithelium. Folliculin (FLCN) is a protein expressed by human airway epithelial cells (HAECs) to maintain airway epithelial integrity and survival. This study investigated the involvement of FLCN in the pathogenesis of TDI-induced occupational asthma (OA). Enzyme-linked immunosorbent assay was used to measure serum levels of FLCN in TDI-exposed subjects (93 TDI-OA patients and 119 asymptomatic exposed controls (AEC)), 200 non-occupational asthma (NOA) patients and 71 unexposed healthy normal controls (NCs). Significantly more subjects in the TDI-OA and AEC groups had high serum levels of FLCN compared to those in the NOA group (P=0.002 and P=0.001, respectively), all of which were higher than the NC group (all P<0.001). The serum level of FLCN was positively correlated with TDI exposure duration (r=0.251, P=0.027), but was negatively correlated with asthma duration of TDI-OA patients (r=−0.329, P=0.029). TDI-exposed subjects with high FLCN levels had higher serum levels of total IgE than those with lower levels. The effects of TDI exposure on FLCN production was investigated by treating HAECs (A549 cells) with TDI-human serum albumin conjugate, which showed increased expression and release of FLCN and interleukin-8 from HAECs. Co-culture with peripheral blood neutrophils also induced FLCN expression and release from HAECs. In conclusion, TDI exposure and TDI-induced neutrophil recruitment into the airways can activate and stimulate HAECs to produce FLCN, which could be involved in airway inflammation in workers exposed to TDI.
Asthma ; Asthma, Occupational ; Coculture Techniques ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Epithelium ; Estrone* ; Humans ; Immunoglobulin E ; Inflammation* ; Interleukin-8 ; Neutrophil Infiltration ; Neutrophils ; Serum Albumin ; Toluene 2,4-Diisocyanate* ; Toluene*

Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy. The aim of this study was to evaluate the prevalence and clinical characteristics of LAR in Korean rhinitis patients compared to allergic rhinitis (AR) and non-allergic rhinitis (NAR). A total of 304 rhinitis patients were enrolled from November 2014 to March 2016. A skin prick test, serum total and specific immunoglobulin E, and a nasal provocation test (NPT) with house dust mite (HDM) were performed on all patients. Subjects also documented changes in rhinitis symptoms before and after NPT. Seventy-four patients with nasal hyper-reactivity and 80 patients with subclinical allergy were excluded. AR was diagnosed in 69 (46.0%) patients, NAR in 75 (50.0%) patients, and LAR to HDM in 6 (4.0%) patients. The average medication score and disease duration of each group were 14.5 points and 77.6 months in AR, 12.1 point and 51.1 months in NAR, and 17.7 point and 106.0 months in LAR, respectively. There were no significant differences in the baseline nasal symptom score of the three groups. However, after NPT with HDM, the score of rhinitis, itching, and obstructive were 4.83±1.47 vs. 1.95±2.53, 3.00±2.10 vs. 1.45±2.06, and 5.50±1.38 vs. 2.57±2.84 in LAR and NAR, respectively (p<0.05). LAR patients had longer duration of disease and tended to be older and have higher medication score than other rhinitis patients.
Dust* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Nasal Provocation Tests ; Prevalence* ; Pruritus ; Pyroglyphidae* ; Rhinitis ; Rhinitis, Allergic* ; Skin

Purpose: Cysteinyl leukotrienes (CysLTs) have been recognized as key mediators associated with type 2 inflammation in the airways of asthmatic patients. CysLTs are associated with airway constriction, eosinophil recruitment/activation, and airway remodeling. The study aimed to understand the role of CysLTs in adult asthmatics in a real-world clinical setting. Methods: One hundred five adult asthmatics who had maintained antiasthmatic medications were enrolled. Asthmatic subjects were classified into 2 groups according to urinary leukotriene E4 (uLTE4) levels, and their clinical parameters and inflammatory mediators, including forced expiratory volume in 1 second (FEV1) %, fractional exhaled nitric oxide (FeNO), blood eosinophil count, serum periostin (sPON), and urinary eosinophil derived neurotoxin (uEDN) were compared between the high-uLTE4 and low-uLTE4 groups. Results: The prevalence of chronic rhinosinusitis (CRS), severe asthma, and aspirin-exacerbated respiratory disease (AERD) were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The high-uLTE4 group had lower FEV1% and maximal midexpiratory flow %, but higher FeNO levels than the low-uLTE4 group. In addition, blood eosinophil count, sPON, and uEDN levels were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The presence of AERD and levels of FeNO, sPON, and uEDN were significantly associated with higher uLTE4 levels in asthmatics. Conclusion CysLTs are associated with type 2 inflammation in the airways of asthmatic patients, contributing to the development of AERD, CRS, and asthma severity. The stratification of clinical phenotypes according to the uLTE4 level could support optimizing anti-inflammatory therapy for better control of asthma.

This erratum is being published to correct of author name.

Various foods can induce anaphylaxis. However, mushrooms-induced anaphylaxis has not been reported in Korea. We report a patient with past anaphylactic episode caused by mushroom ingestion, confirmed by the skin test and specific IgE antibody to mushrooms. A 17-year-old girl with asthma was referred to our department due to itchy throat, dyspnea, and urticaria within 10 minutes after ingestion of a soup containing Oyster mushrooms. She presented an itching throat after ingestion of cooked mushrooms 3 years before the visit. She had an elevated serum IgE level (205 kU/L) and was sensitized to house dust mites. Skin prick tests with mushroom extracts showed a strong positive on Oyster and King Oyster mushrooms as well as Pyogo mushroom. The specific IgE antibody to each mushroom measured by enzyme-linked immunosorbent assay showed significant positive results to Oyster and Pyogo mushroom extracts, but was negative on King Oyster mushroom. We educated her to avoid eating Oyster and Pyogo mushrooms for preventing recurrence, whereas we couldn't perform oral challenge tests.
Adolescent ; Agaricales* ; Anaphylaxis* ; Asthma ; Dyspnea ; Eating* ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E ; Korea ; Ostreidae ; Pharynx ; Pleurotus ; Pruritus ; Pyroglyphidae ; Recurrence ; Skin ; Skin Tests ; Urticaria