Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.
Adrenal Cortex Hormones ; Allergens ; Asthma ; Drainage ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Immunoglobulin E ; Immunotherapy ; Inflammation ; Leukotrienes ; Nasal Decongestants ; Nasal Mucosa ; Prevalence ; Pruritus ; Quality of Life ; Rhinitis* ; Rhinitis, Allergic, Perennial ; Sneezing

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.
Adrenal Cortex Hormones ; Allergens ; Asthma ; Drainage ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Immunoglobulin E ; Immunotherapy ; Inflammation ; Leukotrienes ; Nasal Decongestants ; Nasal Mucosa ; Prevalence ; Pruritus ; Quality of Life ; Rhinitis* ; Rhinitis, Allergic, Perennial ; Sneezing

Asthma is a common disorder of the airways characterized by airway inflammation and by decline in lung function and airway remodeling in a subset of asthmatics. Airway remodeling is characterized by structural changes which include airway smooth muscle hypertrophy/hyperplasia, subepithelial fibrosis due to thickening of the reticular basement membrane, mucus metaplasia of the epithelium, and angiogenesis. Epidemiologic studies suggest that both genetic and environmental factors may contribute to decline in lung function and airway remodeling in a subset of asthmatics. Environmental factors include respiratory viral infection-triggered asthma exacerbations, and tobacco smoke. There is also evidence that several asthma candidate genes may contribute to decline in lung function, including ADAM33, PLAUR, VEGF, IL13, CHI3L1, TSLP, GSDMB, TGFB1, POSTN, ESR1 and ARG2. In addition, mediators or cytokines, including cysteinyl leukotrienes, matrix metallopeptidase-9, interleukin-33 and eosinophil expression of transforming growth factor-β, may contribute to airway remodeling in asthma. Although increased airway smooth muscle is associated with reduced lung function (i.e. forced expiratory volume in 1 second) in asthma, there have been few long-term studies to determine how individual pathologic features of airway remodeling contribute to decline in lung function in asthma. Clinical studies with inhibitors of individual gene products, cytokines or mediators are needed in asthmatic patients to identify their individual role in decline in lung function and/or airway remodeling.
Airway Remodeling ; Asthma ; Basement Membrane ; Cytokines ; Eosinophils ; Epidemiologic Studies ; Epithelium ; Fibrosis ; Forced Expiratory Volume ; Humans ; Inflammation ; Interleukin-13 ; Interleukin-33 ; Leukotrienes ; Lung ; Metaplasia ; Mucus ; Muscle, Smooth ; Respiratory Function Tests ; Smoke ; Tobacco ; Vascular Endothelial Growth Factor A

Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)
Actinomycosis ; Biopsy ; Endoscopy ; Female ; Follow-Up Studies ; Gastrectomy* ; Humans ; Middle Aged ; Neutrophils ; Rare Diseases ; Stomach Neoplasms* ; Sulfur ; Tetracycline

Background/Aims: Asthma is not a single disease but, rather, a heterogeneous inf lammatory disorder with various pathogenic mechanisms. We analyzed the associations between the cellular profile of sputum and the serum levels of inflammatory mediators/cytokines in a cohort of adult asthmatics. Methods: We recruited 421 adult asthmatic patients. All subjects were classified into four groups according to their sputum cellular profiles: G1, eosinophilic; G2, mixed granulocytic; G3, neutrophilic; and G4, paucigranulocytic. Serum levels of cytokines and mediators including periostin, eosinophil-derived neurotoxin (EDN), S100A9, and folliculin were quantified. Results: Among 421 patients, G1 accounted for 149 (35.4%), G2 for 71 (16.9%), G3 for 155 (36.8%), and G4 for 46 (10.9%). Serum periostin and EDN levels were significantly higher in G1 (p = 0.004, and p = 0.031) than in the others. Serum S100A9 levels were elevated in G2 and G3 (p = 0.008). Serum folliculin levels differed significantly among the four groups, with the highest level in G4 (p = 0.042). To identify G1 from G1 plus G2 groups, the optimal serum cut-off levels were 1.71 ng/mL for periostin, and 1.61 ng/mL for EDN. When these two parameters were combined, the sensitivity was 76.0% and the specificity was 64.3% (area under the curve, 0.701; p = 0.004). Conclusions The serum periostin and EDN levels may be used as predictors to discriminate the eosinophilic asthma group from patients having eosinophilic or mixed granulocytic asthma, and the serum folliculin level is significantly elevated in patients with paucigranulocytic asthma compared to those with different inflammatory cell profile.

PURPOSE: A possible involvement of autoimmune mechanism in the pathogenesis of bronchial asthma has been proposed. Recently, alpha-enolase protein was identified as a major autoantigen recognized by circulating IgG autoantibodies in patients with severe asthma. To evaluate a possible pathogenetic significance of these autoantibodies in severe asthma, isotype (IgG, IgA, IgM, and IgE) and IgG subclass (IgG1, IgG2, IgG3, and IgG4) distributions of autoantibodies to recombinant human alpha-enolase protein were analyzed. PATIENTS AND METHODS: We examined serum samples from 10 patients with severe asthma and 7 patients with mild-to-moderate asthma, and 5 healthy controls by immunoblot analysis. Severe asthma was defined as patients having at least 1 severe asthmatic exacerbation requiring an emergency department visit or admission in the last year despite continuous typical therapies. RESULTS: IgG1 was the predominant IgG subclass antibody response to alpha-enolase protein in patients with severe asthma. IgG1 autoantibody to alpha-enolase protein was detected in 7 of 10 patients with severe asthma (70%), 1 of 7 patients with mild-to-moderate asthma (14.3%), and none of 5 healthy controls (0%) (chi-square test; p < 0.05). IgA, IgM, and IgE autoantibodies to alpha-enolase protein could not be detected in patients with severe asthma. CONCLUSION: IgG1 subclass was the predominant type of autoantibody response to alpha-enolase protein in patients with severe asthma, suggests a possibility of IgG1 autoantibody- mediated complement activation in the pathogenesis of severe asthma.
Adult ; Aged ; Asthma/*enzymology/*immunology ; Autoantibodies/*blood/classification ; Autoantigens ; Case-Control Studies ; Complement Activation ; Female ; Humans ; Immunoglobulin G/blood/classification ; Immunoglobulin Isotypes/blood ; Male ; Middle Aged ; Phosphopyruvate Hydratase/*immunology ; Recombinant Proteins/immunology ; Young Adult

BACKGROUND: Recently, it has been reported that gamma-glumyltransferase (GGT) is associated with various cardiovascular risk factors including overweight in adults. However, there are few studies on the relationship between GGT and cardiovascular risk factors in children. The aim of this study was to assess the relationship between serum GGT level and overweight in Korean urban children. METHODS: This study was a cross-sectional study using data on 390 4th grade students of elementary schools in Gunpo, Korea. Children were divided into 4 groups according to gender-specific quartiles of serum GGT level. Body mass index, waist circumference and body fat percentage were quantified as adiposity indices. RESULTS: All adiposity indices in children of the highest GGT level quartile were higher than those in children of the lowest quartile. Adjusted odd ratios on overweight of the highest quartile of GGT level compared to the lowest quartile were 14.40 (95% confidence interval [CI], 4.43 to 46.83) in boys and 2.94 (95% CI, 1.06 to 8.16) in girls. CONCLUSION: This study shows that high serum GGT level is related with overweight in Korean urban children and this relationship is stronger in boys compared to girls.
Adipose Tissue ; Adiposity ; Adult ; Body Mass Index ; Child ; Cross-Sectional Studies ; gamma-Glutamyltransferase ; Humans ; Korea ; Overweight ; Oxidative Stress ; Risk Factors ; Waist Circumference

Lower respiratory symptoms in bakery workers may be induced by wheat flour and endotoxins. We hypothesized that endotoxins from wheat flour may stimulate innate immunity and that interleukin-18 (IL-18) gene polymorphisms may affect their regulatory role in innate immune responses to endotoxins. To investigate the genetic contribution of IL-18 to sensitization to wheat flour, we performed a genetic association study of IL-18 in Korean bakery workers. A total of 373 bakery workers undertook a questionnaire regarding work-related symptoms. Skin prick tests with common and occupational allergens were performed and specific antibodies to wheat flour were measured by ELISA. Three polymorphisms of the IL-18 gene (-607A/C, -137G/C, 8674C/G) were genotyped, and the functional effects of the polymorphisms were analyzed using the luciferase reporter assay. Genotypes of -137G/C (GC or CC) and haplotype ht3 [ACC] showed a significant association with the rate of sensitization to wheat flour. Luciferase activity assay indicated ht3 [AC] as a low transcript haplotype. In conclusion, the regulatory role of IL-18 in lipopolysaccharide-induced responses in bakery workers may be affected by this polymorphism, thus contributing to the development of sensitization to wheat flour and work-related respiratory symptoms.
Adult ; Alleles ; Allergens/immunology ; Antibodies/analysis/immunology ; Female ; Genes, Reporter ; Genotype ; Haplotypes ; Humans ; Interleukin-18/*genetics ; Male ; Middle Aged ; Occupational Diseases/*genetics/immunology ; *Polymorphism, Single Nucleotide ; Questionnaires ; Respiratory Hypersensitivity/*genetics/immunology ; Skin Tests ; Triticum/*immunology

PURPOSE: Allergen immunotherapy (AIT) has been used as a curative and specific treatment of allergic diseases. However, no data on the prescription patterns of AIT in Korea is available. Therefore, we surveyed the prescription patterns of AIT by allergy specialists in Korea. METHODS: We emailed a questionnaire on AIT prescription patterns to the 690 members of the Korean Academy of Asthma, Allergy and Clinical Immunology with clinical practice experience. All returned answers were evaluated. RESULTS: The response rate was 21.0%. Only 69.0% of the respondents performed AIT in practice. Hindrance factors for performing AIT in the practice included a lack of facilities (21%), lack of practical experience during their subspecialty or postgraduate educational training programs (15.8%), no need for AIT because of sufficient pharmacotherapy (14.5%), insufficient economic profits (14.5%), and risks for adverse reactions (13.2%). Ninety-two allergy specialists (82%) performed AIT subcutaneously subcutaneous immunotherapy (SCIT) and 20 allergy specialists (18%) performed it sublingually sublingual immunotherapy (SLIT). Only 8 specialists performed both SCIT and SLIT. The allergens used for SCIT were house dust mites (98.9%), pollens (72.8%), and animal dander (23.9%). SLIT was prescribed only for house dust mites. Twenty-eight physicians (30.4%) observed anaphylactic reactions during SCIT. Eight physicians (40.0%) who prescribed SLIT observed adverse reactions, including local reactions, but none of them observed anaphylactic reactions. CONCLUSIONS: In this survey, 69.0% of the respondents performed AIT in clinical practice. SCIT prescription is more popular than SLIT. The Lack of facilities and clinical education is a critical barrier to performing AIT. Therefore, proper clinical education of AIT is necessary for Korean allergists.
Allergens ; Anaphylaxis ; Animals ; Asthma ; Surveys and Questionnaires ; Desensitization, Immunologic ; Electronic Mail ; Hypersensitivity ; Immunotherapy ; Korea ; Pollen ; Prescriptions ; Pyroglyphidae ; Rhinitis, Allergic, Perennial ; Specialization ; Surveys and Questionnaires