Idiopathic anaphylaxis is a life-threatening systemic reaction of unknown cause. The pathophysiology has not been established, although it has been postulated that the clinical manifestations of idiopathic anaphylaxis may result from the chemical mediators released by mast cells or basophils. The diagnosis of idiopathic anaphylaxis is made after an appropriate allergic evaluation and exclusion of provocative triggers. We report an unusual case of idiopathic anaphylaxis manifesting with periodically repeated urticaria, angioedema, dyspnea, and hypotension. His symptoms were not related to known causes of anaphylaxis such as foods, drugs, insect stings, or exercise. Other diseases simulating anaphylaxis were excluded by careful history, physical examination, and relevant diagnostic tests. High dose prednisolone, hydroxyzine, salbutamol, ketotifen, and methotrexate were prescribed to prevent recurrent episodes, but the symptoms relapsed 5 months after cessation of the treatment.
Albuterol ; Anaphylaxis* ; Angioedema ; Basophils ; Diagnosis ; Diagnostic Tests, Routine ; Dyspnea ; Hydroxyzine ; Hypotension ; Insect Bites and Stings ; Ketotifen ; Mast Cells ; Methotrexate ; Physical Examination ; Prednisolone ; Urticaria

Hypersensitivity myocarditis is an inflammatory disease of the myocardium usually related to drug allergy. The clinical manifestation may be nonspecific, and the diagnosis is seldom suspected or established during the life. So in most of the reported patients, the diagnosis was made at autopsy. Although, retrospectively, more than 90% of the patients described have had clinically recognizable cardiac involvement before death, tole clinical suspicion of hypersensitivity myocarditis is rare. The presence of nonspecific cardiac finding in a patient receiving any drug associated with hypersensitivity should alert the clinician to the possibility of drug related myocarditis. We experienced a case of hypersensitivity myocarditis accompanying allergic skin lesion in a 58 years old man with a history of taking cefadroxil. Fortunately, the outcome was favorable, therefore we do not have histologic confirmation of the diagnosis.
Autopsy ; Cefadroxil ; Diagnosis ; Drug Hypersensitivity ; Humans ; Hypersensitivity* ; Middle Aged ; Myocarditis ; Myocardium ; Retrospective Studies ; Skin

We studied sputum eosinophil count of patients with chronic cough. Differential count of sputum cells(simple direct smear with Wright stain) were successfully examined in 44(73%) among 60 patients with chronic cough. The patients were divided according to PC2O value; 20(45%) patients had increased airway hyper responsiveness(AHR) (PC2O < 24mg/ml), remained 24 Patients did not have any evidence of airway AHR. Age, sex, duration and severity of symptoms, serum total IgE and positive skin test reaction were not different between two groups. In patients with increased AHR, increased sputum eosinophil ratio(10%) was found in 11 patients (55%) and increased peripheral blood eosinophil ratio(>5%) was found in 66% of patients with increased AHR. In patients without increased AHR, increased sputum eosinophil ratio was found in three patients(12%) and increased peripheral blood eosinophil ratio was found in 24%. This discrepancy between two groups was statisticalla significant(p<0.01). In regarding to sputum eosinophilia, increased sputum eosinophil ratio was in 14(32%) of 44 patients with chronic cough. Eleven patients(78%) of them had increased AHR. Only nine(30%) among 30 patients without sputum eosinophilia had increased AHR. These discrepancies between two groups were statistically significant(p<0.01). To predict AHR, sputum eosinophilia has 55% of sensitivity and 88% of specificity. Significant positive correlation between peripheral blood eosinophil ratio and sputum eosinophil ratio was found in patients with cough-variant asthma (r=0.76, p<0.01), We suggest that simple direct smear for sputum eosinophil count could be an useful test to diagnose the patients with chronic cough.
Asthma ; Cough* ; Eosinophilia ; Eosinophils* ; Humans ; Immunoglobulin E ; Sensitivity and Specificity ; Skin Tests ; Sputum*

Aspirin(ASA) and NSAIDs can induce bronchoconstriction in 10~20% of adult asthmatics patients. Inhalation of lysine-ASA(L-ASA) has been described as an alternative method for diagnosis of ASA-sensitive asthma. To further understand the characterlstics of ASA-sensitive asthmas. we studied 38 asthmatic patients with ASA -sensitivity (36 intrinsic and 2 extrinsic asthma) proven by L-ASA bronchoprovocation test (BPT). Most were female (male to female ratio was 27:73). Twenty (53%) of them had no previous history of adverse reactions when exposed to ASA. Twenty nine (79%) had rhino-sinusitis symptoms. Early asthmatic response was observed in 16 (42%) patients, late only response in 16(42%), and dual response in 6(16%) patients. The threshold of L-ASA to provoke a positive response ranged from 11.2 to 180 mg/ml and most (68.3%) had a positive response after the inhalation of 180 mg/ml. Concurrent sensitivity to sulfite was noted in 14 (36%) patients, followed by sensitivity to tartrazine in one (3%) patient. None showed a positive response to sodium benzoate. After the avoidance from ASA/ NSAIDs with administration of anti-asthmatic medications, symptom and medication scores reduced in 26(87%) patients among 30 followed patients. They were classified into the improved group: four (13%) patients belonged to the not-improved group. There were no significant differences in clinical characteristics between the improved and not- improved group (p>0.05). In conclusion, L-ASA BPT could be considered as a useful method to diagnose ASA -sensitive asthma and be used to screen the causative agent for asthmatic patients with intrinsic type, especially in female patients with rhino-sinusitis and/or nasal polyp, even though they do not have arty history of adverse reactions. Cessation of exposure and proper treatment may allow to reduce symptom and medication scores.
Adult ; Anti-Inflammatory Agents, Non-Steroidal ; Asthma* ; Bronchoconstriction ; Diagnosis ; Female ; Humans ; Inhalation ; Nasal Polyps ; Sodium Benzoate ; Tartrazine

Although basic mechanisms of atopic dermatitis remain largely speculative, many studies on pathogenesis suggest the importance of food and inhalent allergens. To evaluate the frequency of food and house dust mite hypersensitivity and differences in this frequency according to ages, we measured the levels of specific IgE antibodies to egg white, egg yolk, milk, soy, and house dust mites in 119 children with atopic dermatitis. The results showed that 53% of patients had positive RAST to any one kind of allergens. The frequency of food and house dust mite hypersensitivity were 34.5%, 30.3 %, respectively. Among allergens, house dust mites and egg white are the most prevalent allergens in all atopic dermatitis patients. The Prevalence of egg white is most common under the age of 2 years, but those of house dust mites are the dust mites are the highest in the ages of 5-12 years. In conclusion, we recommend an egg restriction diet in atopic dermatitis patients who are less than 2 years old when their symptoms do not improve with general skin care.
Allergens ; Antibodies ; Antigens, Dermatophagoides ; Child* ; Child, Preschool ; Dermatitis, Atopic* ; Diet ; Dust* ; Egg White ; Egg Yolk ; Humans ; Hypersensitivity ; Immunoglobulin E ; Mites ; Ovum ; Prevalence ; Pyroglyphidae* ; Skin Care ; Soy Milk

As molecular size of the most major allergens of house dust mite(HDM) are known to be less than 30 kD, allergic immune reactions may be different according to the molecular fractions of HDM allergens. In this study, we fractionated D. pteronyssinus (D. pt) antigen according to its molecular weights, fraction I(FI), II(FII, more than 30 kD), III( FIII, less than 30 kD), and evaluated the differences of allergic immune responses in 40 atopic patients. FIII(A/H ratio-2.44+/-0.61) elicited stronger response on intradermal skin test than FI (0.76 +/-0.10, p<0.001) and FII(0.88+/-0.12, p<0.001). The immunoblot analysis revealed that the nine out of 10 atopics had IgE binding bands with 15 kD protein of FIII which were not found in FI and FII. The geometric mean of absorben value of specific IgE to FIII was 0.067, which was higher than that of FII(0.013, p<0.001), with no difference from that of FI(0.042). The skin reactivity to whole D. pt antigen correlated with FIII- specific IgE(r=0.3862, p<0.01), not with FI-(r=0.2605, p=0.07) and FII-specific IgE(r=0. 1103, p=0.45). FI-specific IgG levels in atopic sera(n=40) were significantly higher than that of FII and FIII in all IgG subclasses (p<0.001). Both atopic(n=4) and nonatopic (n=4) groups showed multiple IgG, IgG1, and IgG2 binding bands at high molecular proteins in immunoblot analysis. The prevalence and density of the IgG and IgG1 binding bands to 15 kD were higher and more intense in atopics than those of nonatopics. In conclusion, we suggest that fractionated antigens of D. pteronyssinus had different antigenicities and that the allergic immune responses to HDMs in atopics and nonatopic are different according to molecular fractions of HDM.
Allergens ; Dermatophagoides pteronyssinus* ; Dust ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Molecular Weight ; Prevalence ; Pyroglyphidae* ; Skin ; Skin Tests

In asthma, eosinophil roles as main end inflammatory effector cell, but neither the activation process nor the stimuli of that is known clearly, yet. Even though allergic asthma is IgE-mediated type I hypersensitivity disease, it is not clear whether there is FcepsilonRI on the surface of eosinophil like mast cell or basophil which is activated through the FcepsilonRl bridging with sensitized allergens. In this study, we speculate if there's FcepsilonRI on the eosinophil, sensitized allergen activates it like mast cell in allergic asthmatics, and with this result we can find out one of the stimuli of eosinophil in asthma and can suggest the possibility of the existence of FcepsilonRI on the eosinophil. We did direct stimulation of the house dust mite -sensitized astknatics'purified peripheral blood normodense eoisnophils with Dermatophagoides pteronyssiuns. Then we measured the LTC4 and ECP from the supernatant by RIA kit and observed the morphological changes with electron microscopy. There was neither increase in LTC4 and ECP level nor the morphological changes in asthmatics. And there were no significant differences in both LTC4, and ECP level, and morphologic changes between asthmatics and controls. We would summerize that house dust mite dose not dirctly activate eosinophil from house dust mite-sensitized asthmatics and couldn't find out the possibility that there's FcepsilonRI on the surface of eoslnophils. But no exitstence of FcepsilonRI on the eosinophil is the indirect evidence, so from now on we try to find more direct evidence of that by blotting.
Allergens ; Asthma ; Basophils ; Dust* ; Eosinophils* ; Humans* ; Hypersensitivity, Immediate ; Leukotriene C4 ; Mast Cells ; Microscopy, Electron ; Pyroglyphidae*

PAF itself induces the non-specific bronchial hyperreactivity(NSBH) in asthma. NSBH induced by PAF is nearly as same as that by the sensitized allergen inhalation even though PAF never provokes the late asthmatic response. Usually the amount of allergen for BPT inversely correlated with the severity of asthma, but in PAF, nothing was clarified about that, yet. usually eosinophil is the main effector cell in PAF-induced NSBH. So we want to declare whether PAF inhalation affects the NSBH differently according to the severity of asthma or not in this study and eosinophil is the main effector cell in asthmatics. Single dose PAF(400microgram/microliter) inhalation challenge was done by the Cockcroft' s method but that of methacholine by Chai's method before and after PAF until NSBH returned the basal value. From that, we calculated PC20. Also we checked the eosinophil and platelet count in peripheral blood before and after PAF until those returned the baseline. All these were done in two groups, mild asthmatics and moderate asthmatics classified by the PFT and their PC20. The Bronchoconstriction started at the 3 minutes after PAF inhalation and then relieved completely 30 minutes after inhalation but in mild asthmatics bronchi constricted much more than moderate asthmatics. The fall of NSBH also persisted much longer in mild asthmatics. But the decrease in peripheral eoslnophil counts was nearly same in both groups. None of asthmatics showed the changes in platelet counts in peripheral blood. The degree of bronchoconstriction and decrease in eosinophil counts didn't have any correlation with the persistence of the NSBH. Taken together, PAF inhalation affected the NSBH inversely according to the severity of asthma in this study but eosinophil might not be the only effector cell in PAF-induced NSBH.
Asthma* ; Bronchi ; Bronchial Hyperreactivity* ; Bronchoconstriction ; Eosinophils ; Inhalation* ; Methacholine Chloride ; Platelet Count

Lipocortin represents a family of similar Ca++ depentent phospholipid-binding proteins capable of blocking the activity of phospholipase A2 (PLA2) in vitro. Generally, these proteins are believed to inhibit the release of arachidonic acid from photopholipids and the formation of lipid mediators such as prostaglandin, leukotriene, and platelet activating factor. Lipocortin 1, initially identified as a glucocorticoid- responsive protein in macrophages and neutrophils has been implicated in transmembrane signal transduction during growth factor-mediated cell proliferation and transformation. To define the synthesis and its regulation, we investigated the expression of lipocortin 1 in both the mRNA and protein level in U937 cell line in the presence of several differentiation factors. The results were as follows. 1. The expression of lipocortin 1 and its mRNA was increased during TPA-induced differentiation of U937 cells to maximum of 2-fold and 5-fold respectively. Both the protein and mRNA levels decreased after 48 hours. 2. With the treatment with IFN-gamma, the expression of CD16 was increased. However, the protein and mRNA levels of lipocortin 1 were, not changed significantly. 3. Neither the dexamethasone or hydrocortisone have any effects on the expression of lipocortin 1 in both TPA-differentiated and undifferentiated U937 cells. The results from this study would give a light on defining the functional role of lipocortin 1 in macro-moncycle cell lineage and possibly some informative clues for the pathogenic mechanisms of the inflammatory diseases.
Annexin A1* ; Annexins* ; Arachidonic Acid ; Cell Lineage ; Cell Proliferation ; Dexamethasone ; Humans ; Hydrocortisone ; Macrophages ; Neutrophils ; Phospholipases A2 ; Platelet Activating Factor ; RNA, Messenger ; Signal Transduction ; U937 Cells*

32 year-old male patient has experienced the repeated swelling of the skin on the eyelid, both hand, foot, lower and upper extrimities and testicle spontaneously without any trauma since 17 years old. This happening has subsided with or without treatment after 2-3 days. His great grandfather had suffered from the same events but grandfather or father or even his two brothers and one sister didn't have any swellings like him. Two days after this attack, he visited emergency room, his serum complement level was decreased such as C1q 9.7mg/dl (10-20mg/dl), C3 52mg/dl (55-120mg/dl), C4 4mg/dl (20-50mg/dl) measured by single radial immunodiffusion (SRID), but two weeks after full recovery, C1q 11.2mg/dl, C3 79mg/dl, C4 5mg/dl. The level of C1 esterase inhibitor was decreased upto 8.1 mg/dl (> 11 mg/dl) measured by nephlemeter(Mitshibishi Co., Japan). Now he is just under the close observation without androgen treatment because the attack of HAE(hereditary angioedema) happens much less and less severe after adolescence.
Adolescent ; Adult ; Angioedemas, Hereditary* ; Complement C1 Inhibitor Protein ; Complement System Proteins ; Emergency Service, Hospital ; Eyelids ; Fathers ; Foot ; Hand ; Humans ; Immunodiffusion ; Male ; Siblings ; Skin ; Testis