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

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: Assessment of the severity and clinical course of asthma is important for effective disease control. Cognitive and physical impairments occur due to the aging process, which may impact on asthma control. We aimed to evaluate the impact of cognitive function on the assessment of asthma control in older asthmatics as a prospective interventional trial. METHODS: A total of 50 mild to moderate asthmatics over 60 years of age were enrolled. Three questionnaires were used: the asthma control test (ACT), the asthma-specific quality of life, and the Korean version of the Short Form of the Geriatric Depression Scale. The Seoul neuropsychological screening battery-dementia version (SNSB-D), Korean version of the Mini-Mental Status Examination, and the Seoul instrumental activities of daily living scale were applied for neuropsychological assessment. RESULTS: The mean patient age was 67.0±4.9 years, and 30 patients (60.0%) were female. The sensitivity and specificity of the ACT for determining well-controlled asthma were 91.7% and 39.5%, respectively. Regarding neuropsychological assessment, 22 patients (44%) had mild cognitive impairment, 4 (8.7%) had dementia, and 17 (34%) had depression. Total SNSB-D score was significantly higher in patients with an ACT score of ≥20 (P=0.015). The ACT scores were significantly associated with SNSB-D results in analyses adjusted for age, sex, education duration, lung function, and depression (P=0.004). CONCLUSION: We found significant positive correlations between cognitive functions, as measured by SNSB-D, and asthma control status, as measured by ACT scores, in older patients with asthma. Therefore, cognitive impairment may be associated with poor asthma control in older asthmatics.
Activities of Daily Living ; Aging ; Asthma* ; Cognition ; Cognition Disorders* ; Dementia ; Depression ; Education ; Female ; Humans ; Lung ; Mass Screening ; Mild Cognitive Impairment ; Prospective Studies ; Quality of Life ; Sensitivity and Specificity ; Seoul

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

Dioscorea batatas is widely used in Asia as a herbal medicine or food product with potential health benefits. There have been several reports of occupational asthma caused by inhalation of D. batatas dust. However, there has been no report of systemic allergic reactions after oral administration of D. batatas. Two patients with D. batatas allergy were enrolled. One had experienced severe urticaria and angioedema after indigestion, and the other had been exposed to D. batatas dust and was diagnosed as having occupational asthma. Both patients had high serum-specific IgE and IgG4 antibodies to D. batatas. And IgE immunoblot demonstrated that both sera bound to a 27-kDa protein with an IgE-binding motif, which was revealed by 2-D-electrophoresis to have the sequence Asn-Val-Glu-Asp-Glu-Phe-Ser-X-Ile- Glu-Gly-Asn-Pro-X-X-Pro-Glu-Asn-X-Gly (pI 6.40, 6.04). In conclusion, discorin from D. batatas (DB3S) was identified as the major allergen of D. batatas in patients sensitized via an oral or inhalant route.
Administration, Inhalation ; Administration, Oral ; Adult ; Allergens/*immunology ; Amino Acid Sequence ; Dioscorea/*immunology ; Electrophoresis, Gel, Two-Dimensional ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoblotting ; Immunoglobulin E/blood ; Immunoglobulin G/blood ; Molecular Sequence Data

PURPOSE: The IL-4 and IL-4 receptor alpha (IL-4Ralpha) genes are the key candidate genes for atopy and asthma susceptibility. Exposure to wheat flour can cause IgE sensitization and respiratory symptoms in bakery workers. Therefore, we hypothesized that IL-4 and IL-4Ralpha single nucleotide polymorphisms (SNPs) may be involved in the pathogenic mechanism of baker's asthma. METHODS: Clinical and genetic data from 373 bakery workers were analyzed. A survey questionnaire, spirometry, and skin prick tests with wheat flour were performed. Serum-specific IgE, IgG1, and IgG4 to wheat flour were determined using ELISA. Five candidate IL-4 (-729 T>G, 589 T>C, and 33 T>C) and IL-4Ralpha (Ile75Val A>G and Gln576Arg A>G) SNPs were genotyped and analyzed. RESULTS: Workers with the G allele of IL-4Ralpha Ile75Val A>G had a significantly higher prevalence of work-related lower respiratory symptoms than those with the AA genotype (P=0.004, 16.0% vs. 2.9%). In the skin prick test, workers with the AA genotype of IL-4Ralpha Gln576Arg A>G had a significantly higher positive rate to wheat flour (P=0.015, 8.2% vs. 1.1%) than those with AG/GG genotype. No significant associations were found in the three genetic polymorphisms of IL-4. For the predicted probabilities, workers with the AA genotype of Gln576Arg A>G had a higher prevalence of IgG1 and IgG4 in response to wheat flour, according to increased exposure intensity (P=0.001 for IgG1 and P=0.003 for IgG4). CONCLUSIONS: These findings suggest that the IL-4Ralpha Ile75Val and Gln576Arg polymorphisms may be associated with work-related respiratory symptom development.
Alleles ; Asthma ; Enzyme-Linked Immunosorbent Assay ; Flour ; Genotype ; Immunoglobulin E ; Immunoglobulin G ; Interleukin-4 ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prevalence ; Receptors, Interleukin-4 ; Skin ; Spirometry ; Triticum ; Surveys and Questionnaires

PURPOSE: The IL-4 and IL-4 receptor alpha (IL-4Ralpha) genes are the key candidate genes for atopy and asthma susceptibility. Exposure to wheat flour can cause IgE sensitization and respiratory symptoms in bakery workers. Therefore, we hypothesized that IL-4 and IL-4Ralpha single nucleotide polymorphisms (SNPs) may be involved in the pathogenic mechanism of baker's asthma. METHODS: Clinical and genetic data from 373 bakery workers were analyzed. A survey questionnaire, spirometry, and skin prick tests with wheat flour were performed. Serum-specific IgE, IgG1, and IgG4 to wheat flour were determined using ELISA. Five candidate IL-4 (-729 T>G, 589 T>C, and 33 T>C) and IL-4Ralpha (Ile75Val A>G and Gln576Arg A>G) SNPs were genotyped and analyzed. RESULTS: Workers with the G allele of IL-4Ralpha Ile75Val A>G had a significantly higher prevalence of work-related lower respiratory symptoms than those with the AA genotype (P=0.004, 16.0% vs. 2.9%). In the skin prick test, workers with the AA genotype of IL-4Ralpha Gln576Arg A>G had a significantly higher positive rate to wheat flour (P=0.015, 8.2% vs. 1.1%) than those with AG/GG genotype. No significant associations were found in the three genetic polymorphisms of IL-4. For the predicted probabilities, workers with the AA genotype of Gln576Arg A>G had a higher prevalence of IgG1 and IgG4 in response to wheat flour, according to increased exposure intensity (P=0.001 for IgG1 and P=0.003 for IgG4). CONCLUSIONS: These findings suggest that the IL-4Ralpha Ile75Val and Gln576Arg polymorphisms may be associated with work-related respiratory symptom development.
Alleles ; Asthma ; Enzyme-Linked Immunosorbent Assay ; Flour ; Genotype ; Immunoglobulin E ; Immunoglobulin G ; Interleukin-4 ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prevalence ; Receptors, Interleukin-4 ; Skin ; Spirometry ; Triticum ; Surveys and Questionnaires