No abstract available.
Anaphylaxis* ; Basophils*

PURPOSE: Allergic rhinitis (AR) is a common and increasing disease in which Dermatophagoides (D.) farinae is one of the most common causative allergens. The aims of this study were to confirm the presence of locally produced antibodies to D. farinae in nasal secretions between nasal provocation test (NPT)-positive and -negative groups of AR patients, to evaluate their relationships with the levels of inflammatory mediators, and to determine adaptive and innate immune responses in nasal mucosa. METHODS: Sixty AR patients sensitive to house dust mites confirmed by skin prick test or serum specific IgE to D. farinae underwent NPT for D. farinae. Nasal packs were placed in both nasal cavities of the patients for 5 minutes to obtain nasal secretions after NPT. The levels of total IgE, specific IgE to D. farinae, eosinophil cationic protein (ECP), and tryptase in nasal secretions were detected by using ImmunoCAP. The levels of specific IgE, IgA, and secretory IgA antibodies to D. farinae in nasal secretions were measured by using ELISA. The levels of IL-8, VEGF, IL-25, and IL-33 were also measured by using ELISA. RESULTS: High levels of total IgE, specific IgE, specific IgA, and secretory IgA to D. farinae, as well as inflammatory mediators, such as ECP, IL-8, VEGF and tryptase, were detected in nasal secretions, although the differences were not statistically significant between the NPT-positive and NPT-negative groups. Levels of all immunoglobulins measured in this study significantly correlated with ECP, IL-8, and VEGF (P<0.05), but not with tryptase (P>0.05). IL-33 and IL-25 were also detected, and IL-25 level significantly correlated with IL-8 (r=0.625, P<0.001). CONCLUSIONS: These findings confirmed the presence of locally produced specific antibodies, including D. farinae-specific IgE and IgA, in nasal secretions collected from D. farinae-sensitive AR patients in both the NPT-positive and NPT-negative groups, and close correlations were noted between antibodies and nasal inflammatory mediators, including such as ECP, IL-8 and VEGF, indicating that locally produced antibodies may be involved in the nasal inflammation of AR.
Allergens ; Antibodies* ; Enzyme-Linked Immunosorbent Assay ; Eosinophil Cationic Protein ; Humans ; Immunity, Innate ; Immunoglobulin A ; Immunoglobulin A, Secretory ; Immunoglobulin E ; Immunoglobulins ; Inflammation ; Interleukin-8 ; Nasal Cavity ; Nasal Mucosa ; Nasal Provocation Tests ; Pyroglyphidae ; Rhinitis* ; Skin ; Tryptases ; Vascular Endothelial Growth Factor A

This erratum is being published to correct of author name.

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*

PURPOSE: Chronic urticaria (CU) has a substantial impact on the quality of life. Little clinical data on the prognosis of CU has been reported. This study aimed to investigate the control status and remission rate of CU and to explore potential predictors of good responses to the treatment during a 6-month treatment period. METHODS: A total of 75 patients with chronic spontaneous urticaria (CSU) were enrolled from 3 university hospitals in Korea. Urticaria control state was classified into 2 groups: group I (remission and well-controlled) and group II (partly and uncontrolled). CU-specific quality of life (CU-QoL) and the urticaria activity score (UAS) were measured before and after the treatment. Autologous serum skin test (ASST), and anti-nuclear and anti-thyroid antibodies were measured at the enrollment into the study. Aspirin intolerance was confirmed by an oral provocation test. RESULTS: Of 59 patients completing the study, 21 (35.6%) arrived at well-controlled status and only 2 (3.4%) achieved remission, whereas 26 (44.1%) remained at partly controlled status and 10 (16.9%) were at uncontrolled status. Mean changes in CU-QoL (36.5+/-2.7 vs 20.6+/-4.3, P=0.017) and UAS (-7.9+/-0.8 vs -3.0+/-1.0, P=0.001) were significantly different between groups I and II. The presence of serum autoantibodies and aspirin intolerance had no influence on the control of urticaria in this study. However, ASST positivity was identified as a significant predictor of CU control in multivariate analysis (OR=6.106, P=0.017). CONCLUSIONS: The proportion of CSU patients that achieved remission or a well-controlled state was 39% for the 6 months of stepwise treatment. Longer observations are necessary to assess the exact prognosis of CSU. ASST results may be a useful parameter for predicting a better response to treatment and both UAS and CU-QoL are helpful to monitor therapeutic response.
Antibodies ; Aspirin ; Autoantibodies ; Hospitals, University ; Humans ; Korea ; Multivariate Analysis ; Observational Study* ; Prognosis ; Prospective Studies* ; Quality of Life ; Skin Tests ; Urticaria*

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

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is performed to provide enteral nutrition to patients who require tube-feeding support due to impaired oral intake. As life expectancy increases, the need for, and use of PEG also tend to increase. We aimed to evaluate the indications and complications of PEG insertion, and to investigate any differences in the complication group. MATERIALS AND METHODS: We conducted a retrospective analysis of 109 patients who received a PEG procedure between April 2011 and April 2016 in the Korea University Ansan Hospital. We reviewed the indications and complications related to PEG insertion and time interval of tube change. RESULTS: Among 109 patients who underwent a PEG procedure, 71.6% were male, and the mean age was 68.2 years. The most common indications for PEG were central nervous system diseases, including stroke (33.9%), cerebral hemorrhage (29.4%), and hypoxic brain damage (8.3%). The overall complication rate was 14.7%, and the most common complication was peristomal infection (7.3%). Most of the complications occurred within 10 days in 14 of 16 patients (87.5%). The patients with complications were older than those without complications (74.6±11.1 vs. 67.1±14.0 years, P=0.043). The mean time interval for gastrostomy tube change was 7.3 months. CONCLUSIONS: The most common indication of PEG was brain disease, and the complication rate cannot be ignored. Careful attention is needed after a PEG procedure especially in elderly patients.
Aged ; Brain Diseases ; Central Nervous System Diseases ; Cerebral Hemorrhage ; Endoscopy ; Enteral Nutrition ; Gastrostomy* ; Gyeonggi-do ; Humans ; Hypoxia, Brain ; Korea ; Life Expectancy ; Male ; Retrospective Studies* ; Stroke

Allergen-specific immunotherapy is the only causal treatment for allergic diseases. However, the efficacy of immunotherapy may vary around the world due to differences in climate, the nature of aero-allergens and their distribution. The aim of this study was to describe the effects of subcutaneous immunotherapy (SCIT) in Korean adults with allergic asthma (AA). As a retrospective cohort study, we reviewed medical records for 627 patients with AA in Korea who were sensitized to house dust mite (HDM) and/or pollens and who underwent SCIT with aluminum hydroxide adsorbed allergen extract from 2000 to 2012. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Herein, 627 asthmatic patients achieved remission within a mean of 4.7 ± 0.2 years. The cumulative incidence rates of remission from AA were 86.9% upon treatment with SCIT. Baseline forced expiratory volume in the first second (FEV1) ≥ 80% (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.79–5.39; P < 0.001), and maintenance of immunotherapy for more than 3 years (HR, 1.82; 95% CI, 1.21–2.72; P = 0.004) were significant predictors of asthma remission during SCIT. In 284 patients on SCIT with HDM alone, initial specific immunoglobulin E (IgE) levels to Dermatophagoides pteronyssinus and Dermatophagoides farinae did not show significant difference between remission and non-remission group after adjusting demographic variables. In conclusion, SCIT was effective and safe treatment modality for patients with AA. Initial FEV1 ≥ 80% and immunotherapy more than 3 years were found to be associated with favorable clinical responses to SCIT.
Adult ; Aluminum Hydroxide ; Asthma* ; Climate ; Cohort Studies ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Immunoglobulins ; Immunotherapy* ; Incidence ; Korea* ; Life Tables ; Medical Records ; Pollen ; Pyroglyphidae ; Retrospective Studies

PURPOSE: Anaphylaxis is a rapidly progressive allergic reaction that requires precise recognition and immediate management. However, health care providers, awareness of anaphylaxis has not been acknowledged. The aim of this study is to investigate the extent of knowledge and principal management skills on anaphylaxis among medical personnel and students. METHODS: We performed a questionnaire survey on knowledge, education, and managing skills for anaphylaxis to physicians, nurses, health personnel, and medical students in Ajou University Medical Center, from 26 June to 31 October, 2014. The survey contained 2 main sections: questions about demographic data and 2 types of questionnaire (type I for all participants and type II for only medical staffs) for self-assessment on anaphylaxis. RESULTS: A total of 1,615 participants (128 doctors, 828 nurses, 436 students, and 223 health personnel) completed the survey. For questionnaire I, the percentages of correct answers in doctors, nurses, medical students, and health personnel were 77.5%, 56.4%, 47.8%, and 28.0% respectively, showing significant differences between groups (P<0.001). For questionnaire II, 93% of doctors and 75.6% of nurses indicated epinephrine as the drug of choice, and 79.7% of doctors and 71.3% of nurses selected the correct intramuscular route. More than 3 quarters of the doctors (80.5%) selected epinephrine within the first 5 steps of treatment, but only 48% included epinephrine within the first 3 steps. CONCLUSION: Our study showed considerable lack of knowledge on anaphylaxis among health care providers, especially on the specific management steps of anaphylaxis. As significant gaps on overall knowledge of anaphylaxis were observed between different groups of medical personnel, regular education should be implemented for each department in the health care setting.
Academic Medical Centers ; Anaphylaxis* ; Delivery of Health Care* ; Education ; Epinephrine ; Health Personnel* ; Humans ; Hypersensitivity ; Self-Assessment ; Students, Medical*