Dronedarone is a new antiarrhythmic drug for the treatment of nonpermanent atrial fibrillation. Compared with amiodarone, it is regarded as a safe medication due to its structural differences. In this report, we describe a 56-year-old man who developed photosensitivity due to dronedarone. He presented with itchy skin rashes for 1 week. Maculopapular exanthema was localized on the neck, both arms, and both hands, with sparing of the other parts of the body. Dronedarone was prescribed 4 weeks ago when atrial fibrillation occurred. After development of skin rashes, dronedarone was discontinued, and systemic steroid, antihistamine, and topical corticosteroid were administered for 1 week, with improvement in skin rashes. The photopatch test was performed with antiarrhythmic drugs, including dronedarone, amiodarone, and flecainide, 4 weeks after withdrawal of dronedarone. Positive reactions were recorded only to dronedarone at the site exposed to ultraviolet A. He was diagnosed with dronedarone-induced photosensitivity and advised to change the antiarrhythmic medication to others. There have been a few case reports on photosensitivity reactions due to dronedarone, which were diagnosed only by clinical suspicion. However, we suspected photosensitivity and proved it by the photopatch test. Photosensitivity should be considered in patients having skin rashes on the exposed area and taking antiarrhythmic medication, including dronedarone.
Amiodarone ; Anti-Arrhythmia Agents ; Arm ; Atrial Fibrillation ; Exanthema ; Flecainide ; Hand ; Humans ; Middle Aged ; Neck

No abstract available.
Anaphylaxis* ; Basophils*

Seafood is one of the common causes of food allergies to adults. The sea hare Aplysia kurodai is a marine mollusk which belongs to invertebrate gastropod that has been consumed as a food in Korea. Cases of acute toxic hepatitis after ingestion of sea hares have been reported, but few cases of allergic reactions to sea hare have been reported in the literature. A 33-year-old man was referred to our Emergency Department due to urticaria and periorbital/perioral swelling after eating sea hares. Approximately 10 years ago, he experienced similar allergic reactions to it. Skin prick and intradermal tests showed strong positive responses to crude sea hare allergen extract. He was diagnosed with food allergy to sea hares. We herein report the first case of sea hare allergy after ingestion.
Adult ; Angioedema* ; Aplysia ; Drug-Induced Liver Injury ; Eating* ; Emergency Service, Hospital ; Food Hypersensitivity ; Gastropoda ; Hares* ; Humans ; Hypersensitivity ; Intradermal Tests ; Invertebrates ; Korea ; Mollusca ; Seafood ; Skin ; Urticaria*

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

OBJECTIVES: This study aimed to assess the status of Scrub typhus, Leptospirosis and HFRS(hemorrhagic fever with renal syndrome) among farmers with febrile illness. METHODS: We involved a total of 841 farmers who had febrile illness(508 and 333 village residents were, respectively, three and four district of Gyeongju city) selected during autumn of 2014 and 2015. Data were collected by survey questionnaires and blood sample examination. RESULTS: Serum response rate for Scrub typhus and Leptospirosis was 1.5% each and 1.9% for HFRS. Serum response rate for Scrub typhus was significantly higher for tick-bite cases(38.5%), while Leptospirosis was significantly higher for those who were in fruit–planting work(23.1%). Similarly, serum response rate was significantly higher for HFRS who were working in venyl green house work(25.0%). CONCLUSIONS: Government authority should develop effective and efficient preventive strategies to create awareness of infectious diseases among farmers. Extending information, education and communication be reached to farmers that could change their perception and help early diagnosis and treatment and reduce the disease burden and its complication.
Communicable Diseases ; Early Diagnosis ; Education ; Farmers ; Fever ; Gyeongsangbuk-do ; Hemorrhagic Fever with Renal Syndrome ; Leptospirosis ; Risk Factors ; Scrub Typhus

Benign submandibular gland tumor is a common disease in the head and neck region and can be completely removed by transcervical approach. Typical submandibular gland resection can lead to neurological complications. The most common complications are damage to the marginal mandibular branch of the facial nerve and weakening of the lower lip. We report a case of ipsilateral lower lip twitching occurring 3 months after surgery. There was no difficulty during the operation, and there were no neurologic complications immediate after surgery. However, in the present case, the patient experienced lower lip twitching paradoxically after surgery which has not been reported in the literature yet. Therefore, we reported this case with a review of relevant literature.

Benign submandibular gland tumor is a common disease in the head and neck region and can be completely removed by transcervical approach. Typical submandibular gland resection can lead to neurological complications. The most common complications are damage to the marginal mandibular branch of the facial nerve and weakening of the lower lip. We report a case of ipsilateral lower lip twitching occurring 3 months after surgery. There was no difficulty during the operation, and there were no neurologic complications immediate after surgery. However, in the present case, the patient experienced lower lip twitching paradoxically after surgery which has not been reported in the literature yet. Therefore, we reported this case with a review of relevant literature.

Fungal balls consist of rounded conglomerates of fungal mycelia, which can form within a preexisting cavity. They are mostly found in the paranasal sinuses in the head and neck regions. Cholesterol granuloma is a fibrotic lesion that develops as a tissue response to a foreign body such as cholesterol crystals or hemosiderin and is often associated with chronic otitis media. We present the unusual case of a 62-year-old male who was treated for chronic otitis media, which was histologically confirmed as a fungal ball and cholesterol granuloma in the middle ear cavity following tympanomastoidectomy. This is the first reported case of synchronous fungal ball and cholesterol granuloma in the middle ear cavity.

Anaphylaxis is a severe and life-threatening systemic reaction. Despite the extensive evaluation to determine the cause, 30%-60% of cases of anaphylaxis in adults remain idiopathic. Recently, omalizumab treatment has been postulated to treat refractory idiopathic anaphylaxis. We report a case of idiopathic anaphylaxis treated with omalizumab and investigated its pharmacological mechanism. A 66-year-old female presented to our clinic with recurrent anaphylaxis. She suffered from anaphylaxis 2-3 times a month for 6 months. She had past medical history of nonallergic bronchial asthma. History was carefully undertaken and anaphylaxis was not related to any specific foods, drugs, exercise, and insect bites. Serum specific IgE antibodies to common food allergens showed negative results. Oral provocation tests to food additives revealed to be negative. To screen systemic mastocytosis and mast cell activating syndrome, baseline tryptase level was checked, and it was within normal range. From comprehensive evaluation, she was diagnosed as having idiopathic anaphylaxis. She could not tolerate oral medications due to gastrointestinal discomfort, therefore, omalizumab treatment (150 mg, monthly) was started. After 6 months of treatment, anaphylaxis did not occur with complete remission status. To evaluate the pharmacological mechanism of omalizumab treatment, basophil histamine releasability test was performed. Histamine releasability induced by anti-IgE did not change after 6 months of treatment, while that induced by calcium inophore decreased. Omalizumab treatment can induce remission or favorable effects on idiopathic anaphylaxis, which may be derived from increased threshold of mast cell degranulation. Long-term studies in a larger cohort will be needed to confirm its efficacy.
Adult ; Aged ; Allergens ; Anaphylaxis* ; Antibodies ; Asthma ; Basophils ; Calcium ; Cohort Studies ; Female ; Food Additives ; Histamine ; Humans ; Immunoglobulin E ; Insect Bites and Stings ; Mast Cells ; Mastocytosis, Systemic ; Reference Values ; Tryptases ; Omalizumab

PURPOSE: The prevalence of pollinosis is increasing, and it is expected to increase further with climate change. Mugwort and ragweed pollens are well known as prevalent allergenic weed pollens in Korea. However, the clinical significance of dandelion pollen as an inhalant allergen has not yet been studied. The purpose of this study was to evaluate the clinical significance and cross-allergenicity between dandelion and major weed pollens. METHODS: Ninety-seven patients with allergic rhinitis and asthma or with allergic rhinitis alone who were sensitized to dandelion pollens on skin prick tests (allergen/histamine ratio>3) were enrolled between December, 2012 and November, 2013. Serum specific IgE levels to dandelion pollen extracts were measured by using enzyme-linked immunosorbent assay (ELISA). ELISA inhibition tests were performed to evaluate cross allergenecity with other weed pollens. RESULTS: When the positive cutoff value for serum specific IgE was set at the mean+/-3 standard deviation of absorbance values, 52 patients (53.6%) had a high serum specific IgE antibody level. ELISA inhibition tests showed significant inhibitions with serial addition of dandelion pollen extracts, and 5 different inhibition patterns were noted with addition of 4 weed pollen extracts: significant inhibitions with pollens of mugwort, ragweed, chenopodium and Hop J (25%, 13 of 52), inhibitions with pollens of mugwort, ragweed and chenopodium (17.3%, 9 of 52), inhibitions with 2 pollens of mugwort and ragweed (32.6%, 17 of 52), inhibitions with mugwort pollen (21.1%, 11 of 52), and inhibitions with dandelion pollen alone (4%, 2 of 52). CONCLUSION: These findings suggest that dandelion pollen may be a causative inhalant allergen to induce pollinosis in the autumn season. Cross-allergenicity with other weed pollens showed individual differences; most patients had cross-reactivity with mugwort, ragweed, and chenopodium pollens, while some with Hop J pollen. Few patients were sensitized to dandelion pollen alone.
Ambrosia ; Artemisia ; Asthma ; Chenopodium ; Climate Change ; Enzyme-Linked Immunosorbent Assay ; Humans ; Humulus ; Immunoglobulin E ; Individuality ; Korea ; Pollen* ; Prevalence ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Seasons ; Skin ; Taraxacum*