Dihydrocodeine is an effective antitussive agent that inhibits the cough reflex by interacting with opioid receptors in the brain. It is easily available in pharmacies without a prescription, which may contribute to a lack of awareness about potential drug hypersensitivity reactions. In the first reported case in Korea, a 29-year-old man developed acute generalized exanthematous pustulosis (AGEP) after consuming an over-the-counter cold medicine containing dihydrocodeine. He was admitted to the Emergency Department with high fever and full-body skin rashes that appeared 3 hours after taking the medicine. His EuroSCAR AGEP score was 9, with symptoms improving upon discontinuation of dihydrocodeine and the application of topical steroids. AGEP caused by dihydrocodeine, including codeine, is very rare, with 3 cases reported worldwide. By analyzing AGEP cases due to dihydrocodeine or codeine, we identified that risk factors for the development of AGEP from dihydrocodeine include a history of psoriasis and the presence of an IL36RN mutation, which result in the activation of Th17 in the blood or the skin. In cases of AGEP caused by dihydrocodeine, it is also recommended to discontinue codeine due to cross-reactivity with dihydrocodeine. Additionally, patients with AGEP due to dihydrocodeine may be able to use other opioid classes, such as morphine or tramadol, due to low cross-reactivity.

Dihydrocodeine is an effective antitussive agent that inhibits the cough reflex by interacting with opioid receptors in the brain. It is easily available in pharmacies without a prescription, which may contribute to a lack of awareness about potential drug hypersensitivity reactions. In the first reported case in Korea, a 29-year-old man developed acute generalized exanthematous pustulosis (AGEP) after consuming an over-the-counter cold medicine containing dihydrocodeine. He was admitted to the Emergency Department with high fever and full-body skin rashes that appeared 3 hours after taking the medicine. His EuroSCAR AGEP score was 9, with symptoms improving upon discontinuation of dihydrocodeine and the application of topical steroids. AGEP caused by dihydrocodeine, including codeine, is very rare, with 3 cases reported worldwide. By analyzing AGEP cases due to dihydrocodeine or codeine, we identified that risk factors for the development of AGEP from dihydrocodeine include a history of psoriasis and the presence of an IL36RN mutation, which result in the activation of Th17 in the blood or the skin. In cases of AGEP caused by dihydrocodeine, it is also recommended to discontinue codeine due to cross-reactivity with dihydrocodeine. Additionally, patients with AGEP due to dihydrocodeine may be able to use other opioid classes, such as morphine or tramadol, due to low cross-reactivity.

Dihydrocodeine is an effective antitussive agent that inhibits the cough reflex by interacting with opioid receptors in the brain. It is easily available in pharmacies without a prescription, which may contribute to a lack of awareness about potential drug hypersensitivity reactions. In the first reported case in Korea, a 29-year-old man developed acute generalized exanthematous pustulosis (AGEP) after consuming an over-the-counter cold medicine containing dihydrocodeine. He was admitted to the Emergency Department with high fever and full-body skin rashes that appeared 3 hours after taking the medicine. His EuroSCAR AGEP score was 9, with symptoms improving upon discontinuation of dihydrocodeine and the application of topical steroids. AGEP caused by dihydrocodeine, including codeine, is very rare, with 3 cases reported worldwide. By analyzing AGEP cases due to dihydrocodeine or codeine, we identified that risk factors for the development of AGEP from dihydrocodeine include a history of psoriasis and the presence of an IL36RN mutation, which result in the activation of Th17 in the blood or the skin. In cases of AGEP caused by dihydrocodeine, it is also recommended to discontinue codeine due to cross-reactivity with dihydrocodeine. Additionally, patients with AGEP due to dihydrocodeine may be able to use other opioid classes, such as morphine or tramadol, due to low cross-reactivity.

Dihydrocodeine is an effective antitussive agent that inhibits the cough reflex by interacting with opioid receptors in the brain. It is easily available in pharmacies without a prescription, which may contribute to a lack of awareness about potential drug hypersensitivity reactions. In the first reported case in Korea, a 29-year-old man developed acute generalized exanthematous pustulosis (AGEP) after consuming an over-the-counter cold medicine containing dihydrocodeine. He was admitted to the Emergency Department with high fever and full-body skin rashes that appeared 3 hours after taking the medicine. His EuroSCAR AGEP score was 9, with symptoms improving upon discontinuation of dihydrocodeine and the application of topical steroids. AGEP caused by dihydrocodeine, including codeine, is very rare, with 3 cases reported worldwide. By analyzing AGEP cases due to dihydrocodeine or codeine, we identified that risk factors for the development of AGEP from dihydrocodeine include a history of psoriasis and the presence of an IL36RN mutation, which result in the activation of Th17 in the blood or the skin. In cases of AGEP caused by dihydrocodeine, it is also recommended to discontinue codeine due to cross-reactivity with dihydrocodeine. Additionally, patients with AGEP due to dihydrocodeine may be able to use other opioid classes, such as morphine or tramadol, due to low cross-reactivity.

Dihydrocodeine is an effective antitussive agent that inhibits the cough reflex by interacting with opioid receptors in the brain. It is easily available in pharmacies without a prescription, which may contribute to a lack of awareness about potential drug hypersensitivity reactions. In the first reported case in Korea, a 29-year-old man developed acute generalized exanthematous pustulosis (AGEP) after consuming an over-the-counter cold medicine containing dihydrocodeine. He was admitted to the Emergency Department with high fever and full-body skin rashes that appeared 3 hours after taking the medicine. His EuroSCAR AGEP score was 9, with symptoms improving upon discontinuation of dihydrocodeine and the application of topical steroids. AGEP caused by dihydrocodeine, including codeine, is very rare, with 3 cases reported worldwide. By analyzing AGEP cases due to dihydrocodeine or codeine, we identified that risk factors for the development of AGEP from dihydrocodeine include a history of psoriasis and the presence of an IL36RN mutation, which result in the activation of Th17 in the blood or the skin. In cases of AGEP caused by dihydrocodeine, it is also recommended to discontinue codeine due to cross-reactivity with dihydrocodeine. Additionally, patients with AGEP due to dihydrocodeine may be able to use other opioid classes, such as morphine or tramadol, due to low cross-reactivity.

As imaging technologies have become essential for diagnosing various diseases, the use of contrast agents is rapidly expanding. As a result, hypersensitivity reactions (HSRs) to contrast agents have also increased. However, protocols for managing, diagnosing, and preventing these reactions are not fully established yet. Since the guidelines for contrast agent hypersensitivity suggested by domestic and international academic societies are not standardized and sometimes difficult to follow in medical facilities, there is a need for practical recommendations in a real-world setting. This review introduces the strategy to manage, diagnose, and prevent HSRs to contrast agents, which have been successfully implemented at Seoul National University Hospital for a decade. First, every single HSRs should be documented in the medical records because a previous history of hypersensitivity to contrast agents is the most significant risk factor for developing HSR to iodinated contrast media. Secondly, avoidance of culprit agents is the main strategy for preventing recurrences of HSRs to contrast agents. Thirdly, it is important to identify nonsensitized contrast agents using skin tests for future exposure to contrast media. In addition to skin testing, side chains of iodinated contrast media may provide a clue to reactive contrast agents. Fourthly, provocation tests can be performed in selected cases with a nonreactive agent based on the skin testing and side chain commonness. Prior to performing imaging studies, premedication can be applied stratified to the severity of the index HSR. All of these procedures are safe and prove to be executable in the medical facilities.

Drug desensitization is a treatment strategy for patients with hypersensitivity to essential drugs without alternatives. The gradual increase in the drug dosage from low doses to therapeutic levels induces a transient immune tolerance to the culprit drug. Although desensitization has traditionally been recommended for IgE-mediated immediate hypersensitivity, this indication has recently been expanded to include non-IgE-mediated immediate responses, nonimmunological responses, and T-cell-mediated delayed hypersensitivity reactions. Although the exact mechanism behind desensitization remains unclear, the process is thought to attenuate various intracellular signals in target cells through Fcɛ receptor 1 internalization, alteration in signaling pathways in mast cells and basophils, reduction in Ca 2+ influx, and production of anti-drug IgG4 blocking antibody. Desensitization can be used for the safe administration of anti-neoplastic agents, antibiotics, aspirin, and nonsteroidal anti-inflammatory drugs. Various desensitization protocols have been proposed for each drug. The optimization of drug concentration, target dosage, administration interval, and route of administration is key to successful desensitization. In addition, the desensitization protocol should be individualized for each patient with consideration of the severity of the initial hypersensitivity response, the characteristics of the culprit drug, and the nature of the breakthrough reactions.

Many child actors have appeared in various movies as the Korean film industry continues to evolve. As more children appear in violent and raunchy scenes, there are more concerns about the movie's effect on child actors. In some Western countries, many strategies have been developed for child actors, but for the Korean movie industry, the conditions are still poor for them. Although children who enter the concrete operational period are able to think logically and systematically, they are yet limited by their experiences. Adolescents in the formal operational period try to deal with all of the possibilities and assumptions logically and systematically with freedom from realistic contents and experiences. This period is very important because adolescents become more sensitive to others' feelings and they should develop their ego identity. Several studies have reported the indirect experiences through media including how the movie affected children and adolescents negatively. Depending on the individual's morality, judgment and emotional status, these effects were variable and inconsistent and could be relieved by several interventions. We could anticipate much bigger emotional effect on child actors who are acting directly and then are confronting themselves in the scene. Therefore, we suggest that the emotional effects of the movies on child actors can be managed properly by considering children's cognitive ability and emotional status, and establishing protective strategies before they are exposed to problematic scenes. Of course, it should be followed by evaluating them after the exposure and with follow-up management, if necessary.
Adolescent ; Child ; Ego ; Freedom ; Humans ; Judgment ; Logic ; Morals

Methods: We enrolled 40 patients who underwent either MISS (M group, 20 patients) or open posterior instrumentation surgery (O group, 20 patients) for the treatment of traumatic unstable burst fractures. Clinical outcomes were evaluated based on postoperative back pain, operation time, blood loss, hospital stay duration, and perioperative complications. For radiologic evaluation, preoperative magnetic resonance imaging and plain radiography were performed before and after the surgery to evaluate the changes in the kyphotic angle and fracture union. Results: The change in the kyphotic angle was −8.2°±5.8° in the M group and −8.0°±7.8° in the O group. No significant difference was noted in terms of the change in the kyphotic angle (p=0.94, t-test) after 12 months of surgery. The Visual Analog Scale score was 1.5±0.7 points in the M group, while it was 5.2±1.4 points in the O group. In the M group, back pain has significantly decreased (p<0.01, t-test). The estimated blood loss was 195.5 mL in the M group and 1,077.5 mL in the O group; the operation time was significantly decreased in the O group from 290.7 to 120.7 minutes in the M group (p<0.05, t-test) (p=0.36, t-test). The average duration of hospital stay was 36.0 days in the M group and 41.9 days in the O group (p=0.36, t-test). Conclusions For the treatment of unstable burst fractures, MISS showed significant differences in terms of postoperative back pain, operation time, and blood loss as compared to open posterior instrumentation surgery.

Chronic urticaria may often be associated with interleukin (IL)-1-mediated autoinflammatory disease, which should be suspected if systemic inflammation signs are present. Here, we report a case of Schnitzler's syndrome without monoclonal gammopathy treated successfully with the IL-1 receptor antagonist anakinra. A 69-year-old man suffered from a pruritic urticarial rash for 12 years. It became aggravated episodically and was accompanied by high fever, arthralgia, leukocytosis, and an elevated C-reactive protein and erythrocyte sedimentation rate. The episodes each lasted for over one week. Neutrophilic and eosinophilic inflammation was found on skin biopsy. However, serum and urine electrophoresis showed no evidence of monoclonal gammopathy. The cutaneous lesions were unresponsive to various kinds of anti-histamines, systemic glucocorticoids, colchicine, cyclosporine, dapsone, and methotrexate, which were administered over a span of 3 years immediately preceding successful treatment. A dramatic response, however, was observed after a daily administration of anakinra. This observation suggests that the correct diagnosis of this case is Schnitzler's syndrome without monoclonal gammopathy. For an adult patient with refractory chronic urticaria and systemic inflammation, Schnitzler's syndrome could be considered as a possible differential diagnosis. Although the typical form of Schnitzler's syndrome exhibits the presence of monoclonal gammopathy as a diagnostic criterion, monoclonal gammopathy may be absent in an atypical form. In such a situation, an IL-1 antagonist should be effective for the management of chronic urticaria.
Aged ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Chronic Disease ; Humans ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Leukocytes/metabolism ; Male ; Paraproteinemias/complications ; Schnitzler Syndrome/blood ; Schnitzler Syndrome/drug therapy ; Urticaria/complications