A 52-year-old woman suffering from recurrent orogenital ulcerations with superficial candidiasis and chronic mucocutaneous herpes simplex infection was admitted for headache and productive cough. She had undergone a thymectomy due to thymoma of an epithelial cell type several years ago. Radiologic and immunologic examinations revealed bronchiectasis in the left lower lobe, severe deficiency in all isotypes of immunoglobulin and an abnormal delayed hypersensitivity to ubiquitous antigens on skin test. Analysis of lymphocyte subsets in peripheral blood and bone marrow showed marked decreases in the proportion of cells bearing B cell markers. Her symptoms and signs were improved with antibiotics, antifungal and antiviral agents, and monthly administration of high dose intravenous immunoglobulin (IVIG, 400mg/kg). This is a rare case of Good's syndrome presenting, a humoral and cellular immune deficiency syndrome related with thymoma. The pathogenic mechanism of hypogammaglobulinemia in this case might be caused by a block in the early stage of B cell differentiation.
Agammaglobulinemia ; Antifungal Agents ; Antiviral Agents ; Bone Marrow ; Bronchiectasis ; Candidiasis ; Cell Differentiation ; Cough ; Epithelial Cells ; Female ; Headache ; Herpes Simplex ; Humans ; Hypersensitivity, Delayed ; Immunoglobulins ; Lymphocyte Subsets ; Middle Aged ; Skin Tests ; Thymectomy ; Thymoma ; Ulcer

There are few reports on aggravation of asthma by mint flavor although it is a common ingredient of many products. A 40-year-old male patient with aspirin-sensitive asthma experienced anaphylaxis after using a gargle that contained mint flavor. Skin prick tests and ELISA for serum specific IgE to mint showed negative responses. Challenge tests with mint oil and menthol were positive and the immediate bronchoconstriction was completely inhibited by premedication with cromolyn sodium. These findings suggest that mast cells may be involved in the pathogenesis of mint-induced asthma or anaphylaxis. To our knowledge, this is the first case of mint-induced anaphylaxis. It is important to alert physicians to the possibility of aggravation of asthmatic symptoms or the development of anaphylaxis by mint flavor.
Adult ; Anaphylaxis* ; Asthma ; Bronchoconstriction ; Cromolyn Sodium ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E ; Male ; Mast Cells ; Mentha* ; Menthol ; Premedication ; Skin

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.
Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Eosinophils ; Granuloma ; Korea ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Vasculitis

Anticonvulsant hypersensitivity syndrome is a potentially fatal drug reaction with cutaneous and systemic reactions to the arene oxide-producing anticonvulsants: phenytoin, carbamazepine, and phenobarbital. In most cases, the hallmark features of fever, rash, and lymphadenopathy are accompanied by multiorgan-system abnormalities. We experienced a 41-year-old man with a carbamazepine-induced reaction, presenting with fever, rash, eosinophilia, hepatitis, and eosinophilic pneumonia. Because symptoms persisted in spite of discontinuation of carbamazepine, we administered a systemic steroid. After use of the steroid, symptoms were relieved and liver and pulmonary functions improved gradually.
Adult ; Anticonvulsants ; Carbamazepine ; Eosinophilia ; Eosinophils* ; Exanthema ; Fever ; Hepatitis ; Humans ; Hypersensitivity* ; Liver ; Lymphatic Diseases ; Phenobarbital ; Phenytoin ; Pulmonary Eosinophilia*

Adverse reactions to drugs are more common in HIV infected patients. Hypersensitivity to trimethoprim-sulfamethoxazole (TMP/SMZ) during treatment or prophylaxis of Pneumocystis carinii pneumonia (PCP) is the most frequent drug reaction of HIV infection. Although less extensively documented than sulphonamides, other drugs also seem to induce drug reactions in HIV-seropositive patients more than in other groups. Rifampin is an essential anti-tuberculosis medication; thus, desensitization of rifampin is especially necessary in our country in which mycobacterial infection is common. We report two cases of AIDS patients with pulmonary tuberculosis who have rifampin hypersensitivity whose rifampin treatment will end successfully through rifampin desensitization.
HIV ; HIV Infections ; Humans ; Hypersensitivity* ; Pneumonia, Pneumocystis ; Rifampin* ; Trimethoprim, Sulfamethoxazole Drug Combination ; Tuberculosis, Pulmonary

OBJECTIVES: This study was performed to investigate the relationship between cell counts, supernatant and lysate ECP levels in sputum, and physiologic markers in adult asthmatics. METHODS: Twenty-two patients with mild to moderate persistent asthma, ten patients with acute exacerbated asthma and nine healthy subjects were enrolled. Sputum was induced by inhalation of hypertonic saline, and homogenized with 0.1% dithiothreitol. A total and differential cell was measured. The remnant cell suspension was centrifuged, and ECP (supernatant ECP) was measured in supernatant fluid. Cell pellet was reacted with a cellular lysis buffer to release cell-associated ECP, and ECP (lysate ECP) was measured again in supernatant fluid. The ratio of supernatant to lysate ECP was calculated as an index of eosinophil degranulation. Spirometry and methacholine bronchial challenge tests were also performed as physiological markers of asthma. RESULTS: The patients with acute exacerbated asthma showed significantly higher percentage of sputum neutrophil, eosinophil count, concentration of sputum supernatant ECP and ratio of supernatant to lysate ECP than those of normal controls and stable asthmatic patients(p < 0.05, respectively). The level of sputum supernatant ECP, supernatant/lysate ECP ratio, and percentage of neutrophil showed negative correlations with pulmonary functions, but no correlations with a degree of bronchial hyperresponsiveness. There was no significant correlations between of serum ECP level and physiological parameters. CONCLUSION: These results suggest that both neutrophils and eosinophils play roles in the exacerbation of asthma. The sputum supernatant/lysate ECP ratio might be valuable in assessment of activation status of eosinophils in various hypereosinophilic conditions or diseases.
Adult* ; Asthma* ; Bronchial Provocation Tests ; Cell Count ; Dithiothreitol ; Eosinophils ; Humans ; Inflammation* ; Inhalation ; Methacholine Chloride ; Neutrophils ; Spirometry ; Sputum*

BACKGROUND: While aspirin sensitivity has been known to be common among patients with severe asthma, its frequency among asthmatics with mild to moderate severity remains to be learned. OBJECTIVES: To elucidate the frequency of aspirin sensitivity and its clinical characteristics among asthma patients with mild to moderate severity. MATERIAL AND METHODS: A total of 96 asthmatics with mild to moderate severity were enrolled. They underwent lysine-aspirin and methacholine bronchial provocation tests, and gave their induced sputum after the lysine-aspirin challenge. RESULTS: FEV1 declined greater than 20% compared with baseline FEV1 in 11 of 96 patients on the lysine-aspirin challenge. The frequency of aspirin sensitivity was higher among patients with enhanced bronchial hyperresponsiveness to methacholine (PC20 < 1 mg/ml) than among those without it (27.3% vs. 6.8%). The frequency was also higher in those with induced sputum eosinophil count higher than 3% than among those without it (38.9% vs. 0%). However, it was not associated with other risk factors such as age, sex, atopy, nasal polyps, and rhinosinusitis. CONCLUSION: More than 10% of mild to moderate asthmatics have aspirin sensitivity even though they have experienced no history of aspirin sensitivity which may be related with bronchial hyperresponsiveness to methacholine and eosinophil activation.
Aspirin* ; Asthma ; Asthma, Aspirin-Induced ; Bronchial Provocation Tests ; Eosinophils ; Humans ; Methacholine Chloride ; Nasal Polyps ; Prevalence* ; Risk Factors ; Sputum

BACKGROUND: A recent investigation has demonstrated that citrus red mite (Panonychus citri) is the most important allergen in citrus-cultivating farmers with asthma or rhinitis. METHODS: A total of 2,005 adolescents (aged 16 to 18 years) living in rural areas were enrolled in this study. Each subject was evaluated by a questionnaire developed by the International Study of Allergy and Asthma in Childhood(ISSAC), and a skin prick test with 11 common inhalant allergens including citrus red mite. RESULTS: Prevalence of recent wheezing, recent rhinoconjunctivitis symptoms and eczema was 13.0%, 13.6% and 9.9%, respectively. On skin prick test, the most common sensitizing allergen was citrus red mite (20.6%), followed by Dermatophagoides pteronyssinus (18.5%), Dermato-phagoides farinae (14.6%) and cockroach (9.8). The prevalence of eczema was higher in those with sensitization to CRM than in those without sensitization to any allergens(p< 0.05) but the prevalence of asthma was not different between adolescents with sensitization to CRM and those without sensitization to any allergens(p> 0.05). On the contrary, the sensitization to house dust mites were significantly associated with the prevalence of asthma and allergic rhinitis. CONCLUSION: Citrus red mite was the most common sensitizing allergen in 16-18 year-old adolescents living in rural areas with citrus farms and sensitization to CRM was significantly associated with the prevalence of atopic dermatitis.
Adolescent* ; Allergens ; Asthma ; Citrus* ; Cockroaches ; Dermatitis, Atopic ; Dermatophagoides pteronyssinus ; Dust* ; Eczema ; Humans ; Hypersensitivity ; Mites* ; Prevalence ; Pyroglyphidae* ; Respiratory Sounds ; Rhinitis ; Skin ; Surveys and Questionnaires

BACKGROUND: The prevalence of asthma has been increasing due to changes in lifestyles. OBJECTIVE: The aim of this study was to evaluate the prevalence of asthma and atopy for an interval of three years in children living in rural areas of Cheju island. METHODS: A total of 1,055 and 755 subjects aged 7-15 years in South Cheju County were enrolled for an interval of three years, respectively. They responded to the modified ISAAC questionnaire, and underwent allergy skin prick test with locally common aeroallergens and methacholine bronchial provocation test. Children who had asthma symptom as reported on the questionnaire and bronchial hyperresponsiveness to methacholine were diagnosed as current asthma. Atopy was defined as the positive skin responses to one or more aeroallergens. RESULTS: The prevalence of current asthma had increased from 4.4% to 7.0% during the three years, especially among children aged 13 to 15 years (3.9% vs. 7.6%), although the asthma prevalence was similar between the two intervals among children aged 7 to 12 years (5.2% vs. 6.8%). The atopy rate had significantly increased from 37.7% to 45.9% during the three years. As for common sensitizing aeroallergens, sensitization rate to citrus red mite had significantly increased among both the young and the old age groups. The sensitization rates to house dust mites, such as D. pteronyssinus and D. farinae, had increased among the old age groups, but not among the young age groups, although the sensitization rates to cockroach and Japanese cedar pollen were similar among both the young and old age groups at the two intervals. CONCLUSION: The prevalence of current asthma and atopy had increased among children living in rural areas of Cheju island during the three year interval. The sensitization to house dust mite and citrus red mite had increased during the three years, and may play an important role in the increased prevalence of current asthma.
Asthma* ; Bronchial Provocation Tests ; Child* ; Citrus ; Cockroaches ; Cryptomeria ; Epidemiology ; Humans ; Hypersensitivity ; Jeju-do* ; Life Style ; Methacholine Chloride ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Skin ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Tetranychus urticae(TU) is a widely distributed parasitic mite found on fruit trees and green house flowers. A recent investigation demonstrated that TU inhalation causes allergic asthma even in non-farmers. We tried to evaluate skin reactivity and specific IgE sensitization to TU, identify IgE binding components, and evaluate allergenic rela- tionship with house dust mite(HDM). MATERIALS AND METHODS: We carried out skin prick test with TU in 1806 respiratory allergy patients over 1 year living in urban and rural areas. ELISA was performed for detection of specific IgE antibody. To evaluate the cross allergenicity between TU and HDM, ELISA inhibition test was carried out with two kinds of pooled sera ; serum pool A included patients' sera sensitized to both TU and HDM, and serum pool B included sera sensitized only to TU. To identify IgE binding components, SDS-PAGE followed by IgE-immunoblot were applied. RESULTS: 358 patients(19.8%) showed positive response(A/H > or = 2+) on skin prick test. Twelve patients showed isolated positive response to TU. Specific IgE was detected in sixty patients(54.5%) out of 110 sensitized patients. ELISA inhibition test using two sera pools (A and B) showed significant inhibitions by TU with minimal inhibitions by HDM. SDS-PAGE and IgE-immunoblot with patients' individual sera sensitized to both TU and HDM showed 10 IgE binding components (67kD, 29kD, 27kD, 10kD, 14kD, 39kD, 46kD, 35kD, 72kD, 77kD) and two(67kD and 29kD) were bound to IgE in more than 50% of sera tested. In patients' sera sensitized only to TU, nine IgE binding components(67kD, 10kD, 14kD, 29kD, 39kD, 46kD, 72kD, 77kD, 9kD) were found and two(67kD and 10kD) were bound to IgE in more than 50%. CONCLUSION: Of allergy patients visiting the Allergy Clinic, 19.8% were sensitized to TU and specific IgE was detected in 54.5% of them. No cross allergenicity was noted between TU and HDM. Eleven IgE binding components and three (67kD, 10kD and 29kD) major allergens were identified.
Allergens ; Asthma ; Dust ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Flowers ; Fruit ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Inhalation ; Mites ; Pyroglyphidae ; Skin* ; Trees