PURPOSE: Infantile atopic dermatitis (AD) is one of the most important risk factors for development of childhood asthma. Those with persistent wheezing with atopy had a great risk of declining lung function. Our study was designed to find out the risk factors for wheezing in infants who has AD, therefore early detection of risk factors for developing wheezing. METHODS: Three hundreds forty seven infants with AD who visited on our Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from January 2002 to December 2005 were enrolled and they were followed up till July 2006. We obtained familial allergy history and laboratory data such as serum total IgE, specific IgE and blood eosinophil count. We analyzed the factors affecting recurrent wheezing and persistent wheezing after 3 years old in children who had AD during infancy. RESULTS: One-hundred ninety-four children (55.9%) developed wheezing. Male sex (adjusted odds ratio (aOR) 1.7, 95% CI 1.1-2.7) and asthma history of parents or siblings (aOR 4.7, 95% CI 1.7-12.5) were the significant risk factors for development of wheezing. Serum total IgE (aOR 5.1 95% CI 1.1-22.5) and house dust mite sensitization (aOR 9.0, 95% CI 0.9-89.4) were significant risk factors for persistent wheezing after first three years of life. CONCLUSION: We should be alert for asthma in cases of infantile AD especially in male sex or with familial asthma history. And we propose early identification and intervention for asthma in infantile AD with increased total IgE and with house dust mite sensitization.
Asthma ; Child ; Child, Preschool ; Dermatitis, Atopic* ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant* ; Lung ; Male ; Odds Ratio ; Parents ; Pyroglyphidae ; Respiratory Center ; Respiratory Sounds* ; Risk Factors* ; Siblings

BACKGROUND/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.
Alanine Transaminase ; DNA ; Drug Resistance ; Guanine ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies

Tricyclic antidepressant (TCA) is a useful drug for treating neuropathic pain. However, tremors are one of the relatively frequent side effects of TCA. A female patient, who was suffering from postherpetic neuralgia, was treated with amitriptyline starting with 10 mg/day. She developed resting tremors on the second day after increasing the dose to 30 mg/day. This case highlights the need for the careful use of amitriptyline in the treatment of neuropathic pain in elderly patients.
Aged ; Amitriptyline ; Female ; Humans ; Neuralgia ; Neuralgia, Postherpetic ; Tremor*

PURPOSE: Recently, an increase in the number of patients sensitized to rice allergen with or without clinical symptoms has been reported. This study was designed to determine the major allergens in rice and their clinical significance. METHODS: Twenty-four children (15 boys and 9 girls; mean age, 16.3 months) with allergic disease, who were sensitized to rice antigen (by UniCAP) in the Pediatric Allergy Respiratory Center at Soonchunhyang University Hospital, were enrolled in this study. The allergenicity of various types of rice (raw, cooked, and heat-treated, simulated gastric fluid [SGF], and simulated intestinal fluid [SIF]) was investigated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoglobulin E (IgE) immunoblots. The patients' medical records, including laboratory data and allergy symptoms after ingestion of rice were reviewed. RESULTS: Patients were sensitized to an average of 13.5 food antigens and their mean total IgE was 6,888.7 kU/L. In SDS-PAGE, more than 16 protein bands were observed in the raw rice, whereas only 14-16 kDa and 31-35 kDa protein bands were observed in cooked rice. The common SDS-PAGE protein bands observed in SGF-, SIF-, and heat-treated rice were 9, 14, and 31 kDa. In a heated-rice IgE immunoblot, protein bands of 9, 14, and 31-33 kDa were found in 27.8%, 38.9%, and 38.9% of all sera, respectively, and in 50%, 50%, and 75%, of ser a from the 4 symptomatic patients, respectively. CONCLUSION: The 9-, 14-, and 31-kDa protein bands appeared to be the major allergens responsible for rice allergy symptoms.
Allergens ; Child ; Eating ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Medical Records ; Respiratory Center ; Sodium

PURPOSE: We aim to compare clinical severity of atopic and non-atopic eczema in children and examine the relationship between total-IgE, eosinophil counts, Eosinophil, Eosinophil cationic protein (ECP) and clinical severity of atopic dermatitis (AD). METHODS: A total of 271 children diagnosed with AD at the Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from October 2005 to March 2008 were enrolled for this study and divided into 2 groups: atopic and non-atopic eczema. Serum concentrations of total- and specific-IgE, eosinophil counts and ECP were measured. Allergy skin tests were also performed and the SCORAD index was used to evaluate clinical severity. Comparisons the SCORAD index and serum total-IgE, eosinophil count and ECP between the 2 groups were made. RESULTS: Of the 271 patients, 162 (59.8%) were included in the atopic eczema group, while 109 (40.2%) were included in the non-atopic group according to the laboratory results. Serum total- IgE, eosinophil counts, ECP, the SCORAD index and the frequency of a family history of eczema were relatively higher in the atopic group. In the atopic group, serum total-IgE, eosinophil counts and ECP each had a statistically significant correlation with the SCORAD index with eosinophil counts showing the highest correlation. However, only eosinophil counts had a statistically significant correlation with the SCORAD index in the non-atopic group. CONCLUSION: Serum total-IgE, eosinophil counts, and ECP can be used as markers for clinical severity in patients with atopic eczema, while eosinophil counts be used as marker for clinical severity in those with non-atopic eczema.
Child ; Dermatitis, Atopic ; Eczema ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Respiratory Center ; Skin Tests

Gender differences in asthma have been observed with a preponderance of boys affected before puberty and girls during and after puberty. The known influences of the menstrual cycle on asthma support a role for female sex hormones on the changing expression of asthma during adolescence. The purpose of this study was to investigate obesity, the menstrual cycle and lung function in adolescent girls. One hundred and three female high school girls (mean age: 15.9+/-0.8 yr) were enrolled. The investigation was performed using a questionnaire that included history of asthma, the menstrual cycle, other combined allergic disease and obesity. The skin prick and pulmonary function test during menstruation period and non-menstruation period. Analyses of these factors were compared. The forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) was significantly lower in the obese group compared to the non-obese group (99.8+/-13.8 vs. 107.1+/-10.2, p=0.03). The FEV(1) was significantly lower in the girls during menstruation period than in the girls who were not on menstruation (77.5+/-10.2 vs. 80.4+/-8.6, p=0.03). Our results showed that changes of pulmonary function were related to menstrual cycle and obesity in Korean adolescent girls.
Adolescent ; Asthma/diagnosis/*etiology ; Body Mass Index ; Female ; *Forced Expiratory Volume ; Humans ; Korea ; Menstrual Cycle/*physiology ; Obesity/*complications ; Puberty ; Questionnaires ; *Vital Capacity

PURPOSE: Some studies report a role of leukotrienes in the pathogenesis of atopic dermatitis and suggest a rationale for the use of leukotriene receptor antagonist (LTRA) in the treatment of atopic dermatitis. This study aimed to evaluate the treatment effectiveness of montelukast in children with atopic dermatitis. METHODS: Fifty-four children between the ages of 2 and 6 years with moderate to severe atopic dermatitis were enrolled. Group A received montelukast for 8 weeks, followed by a crossover to 8 weeks of placebo after a 2-week washout period. Group B reversed the administration according to a randomized, double-blind, placebo-controlled, crossover design. The SCORing atopic dermatitis (SCORAD) index, urinary leukotriene E4 (LTE4), and eosinophil-derived neurotoxin (EDN) were assessed at every visit. RESULTS: Forty-three patients (21 males) completed the study. Although the SCORAD index was decreased in both groups, there was no statistically significant difference between montelukast and placebo (-3.0±11.2 vs -5.7±11.3, P=0.43). The level of urinary LTE4 was decreased after taking montelukast when compared to placebo, but there was no statistically significant difference (-65.9±556.2 vs 87.7±618.3, P=0.26). The changes in urinary EDN after taking montelukast and placebo had no significant difference (37.0±1,008.6 vs -195.8±916.7, P=0.10). When analyzing SCORAD indices, urinary LTE4, and EDN, we could not prove the effectiveness of montelukast in the atopic, non-atopic or high ECP (ECP ≥15 µg/L) subgroups. CONCLUSIONS: There was no statistically significant difference in clinical improvement or biomarkers between montelukast and placebo treatment. Therefore, conventional treatments with skin care and infection control might be more important strategies in the treatment of atopic dermatitis.
Biological Markers ; Child* ; Cross-Over Studies* ; Dermatitis, Atopic* ; Eosinophil-Derived Neurotoxin ; Humans ; Infection Control ; Leukotriene E4 ; Leukotrienes ; Receptors, Leukotriene ; Skin Care ; Treatment Outcome

PURPOSE: Egg (egg white) allergies are among the most common food allergies in infants and young children. Serum egg white-specific IgE (sIgE) levels have been shown to be correlated with clinical symptoms, and the predictive decision point of sIgE levels has been proposed and used widely in the clinical setting. However, some patients whose sIgE levels to egg white are higher than the predictive decision point value show no clinical symptoms, and vice versa. This study was conducted to evaluate the clinical usefulness of sIgE antibodies to egg white and its components in the diagnosis of egg allergies. METHODS: Forty-one patients younger than 2 years of age with no experience of egg intake due to concerns regarding allergies or a non-specific clinical response to eggs were enrolled. Total IgE levels and the levels of IgE antibodies specific for egg white and its components (ovomucoid, ovalbumin, and conalbumin) were measured by ImmunoCAP testing. The clinical response of the subjects was confirmed by an open oral food challenge (OFC). RESULTS: Fifteen (71.4%) out of 21 patients in the egg white-sIgE > or =2 kU/L group showed a positive response, while 10 (50.0%) out of 20 patients in the egg white-sIgE <2 kU/L group showed a negative response to the OFC. There were no statistically significant differences in the levels of sIgE antibodies against egg white and its components between the positive and negative open OFC groups. In addition, there were no statistically significant differences in the levels of sIgE antibodies against egg white and its components based on an intra-group analysis. CONCLUSIONS: Our results show that the sensitivity and specificity of the predictive decision point values for egg white-sIgE antibodies by ImmunoCAP were relatively low in Korean children. In addition, no egg white component predicted the clinical reactivity of the subjects. We suggest that the predictive decision point value for a positive egg oral challenge test by ImmunoCAP should be re-evaluated. Moreover, we suggest that careful personal history recording and challenge tests are necessary for the correct diagnosis of an egg allergy.
Antibodies ; Child ; Egg Hypersensitivity ; Egg Proteins ; Egg White ; Eggs ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant ; Ovalbumin ; Ovum

PURPOSE: The purpose of our study was to investigate the risk factors in developing persistent wheezing in infants with recurrent wheezing. METHODS: Two hundred thirty two infants with recurrent wheezing under two years old visited to Pediatric Allergy and Respiratory Center in Soonchunhyang University Hospital from August 1998 to May 2002 were enrolled and investigated until May 2006, retrospectively. The patients were divided into two groups; persistent wheezer group (PW) who had recurrent wheezing until six years old and transient wheezer group (TW) who didn't have wheezing after three years old. The patients' demographics and laboratory data such as serum total IgE, specific IgE (Dp, Df, dog hair, egg white, milk, soy) and peripheral blood eosinophil count at the first visit were analysed to investigate the risk factors for developing persistent wheezing. RESULTS: PW was 115 (49.5%) and TW was 117 (50.5%) out of 232 infants with recurrent wheezing. In comparison analysis between PW and TW, there were no significant differences in age (months), serum total IgE, peripheral blood eosinophil (P=0.319), birth weight, and gestational age. However, increased serum total IgE (OR 1.72; 95% CI 1.01-2.90), sensitization to Dp (3.6, 1.14-11.39) and egg white (2.96, 1.49-5.89), family history of allergic diseases (2.35, 1.33-4.13), personal history of atopic dermatitis (2.08, 1.11-3.89), and not having older siblings (2.93, 1.64-5.24) had statistic significance. Among these results, not having older sibling (adjusted OR 2.74, 1.46-5.13) and having family history of allergic diseases (adjusted OR 2.69, 1.39-5.18) had strong significance by regnession a nalysis. CONCLUSION: Early intervention of infants with high risk factors for developing persistent wheezing may improve their outcome. Therefore early intervention of infants with high risk factors will be necessary for preventing develop childhood asthma.
Animals ; Asthma ; Birth Weight ; Demography ; Dermatitis, Atopic ; Dogs ; Early Intervention (Education) ; Egg White ; Eosinophils ; Gestational Age ; Hair ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant* ; Milk ; Respiratory Center ; Respiratory Sounds* ; Retrospective Studies ; Risk Factors* ; Siblings

PURPOSE: We aimed to evaluate the frequency and characteristics of minor clinical manifestations of atopic dermatitis (AD) in Korean children to aid the diagnosis and treatment of AD. METHODS: From April 2007 to December 2007, we enrolled 106 children (aged 1 month [infants] to 15 years) diagnosed with AD at the Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital. Clinical manifestations were examined and laboratory findings (total and specific immunoglobulin E [IgE] levels and peripheral blood eosinophil count) were analyzed and compared. RESULTS: Minor symptoms, in order of frequency, included xerosis (78.3%), aggravation due to environmental or emotional stress (43.4%), lichenification (35.8%), orbital darkening (34.0%), periauricular eczema (33.0%), and cutaneous infection (31.1%). Older children (> or =2 years) showed more orbital darkening (P=0.01), horizontal crease (P=0.01), and lichenification (P=0.001) than infants. Patients with severe AD (scoring atopic dermatitis [SCORAD] score, > or =40) showed higher frequencies of xerosis (P=0.04), cutaneous infection (P=0.03), ichthyosis (P=0.18), keratosis pilaris (P=0.02), pityriasis alba (P=0.07), recurrent conjunctivitis (P=0.02), orbital darkening (P=0.001), aggravation due to environmental or emotional stress (P=0.05), facial eczema (P=0.001), lichenification (P=0.001), and hand/foot eczema (P=0.04) than those with mild-to-moderate AD. Children with atopic eczema showed more facial eczema (P=0.01) and lichenification (P=0.04) than those with non-atopic eczema. CONCLUSION: The clinical manifestations of AD were similar to those established by Hanifin and Rajka. However, we need to develop our own diagnostic criteria for AD, because the frequencies shown by our subjects differed from those observed in other countries.
Abnormalities, Multiple ; Child ; Conjunctivitis ; Darier Disease ; Dermatitis, Atopic ; Eczema ; Eosinophils ; Eyebrows ; Humans ; Hypersensitivity ; Ichthyosis ; Immunoglobulin E ; Immunoglobulins ; Infant ; Keratosis ; Orbit ; Pityriasis ; Respiratory Center ; Stress, Psychological