PURPOSE: Allergen immunotherapy (AIT) has been used as a curative and specific treatment of allergic diseases. However, no data on the prescription patterns of AIT in Korea is available. Therefore, we surveyed the prescription patterns of AIT by allergy specialists in Korea. METHODS: We emailed a questionnaire on AIT prescription patterns to the 690 members of the Korean Academy of Asthma, Allergy and Clinical Immunology with clinical practice experience. All returned answers were evaluated. RESULTS: The response rate was 21.0%. Only 69.0% of the respondents performed AIT in practice. Hindrance factors for performing AIT in the practice included a lack of facilities (21%), lack of practical experience during their subspecialty or postgraduate educational training programs (15.8%), no need for AIT because of sufficient pharmacotherapy (14.5%), insufficient economic profits (14.5%), and risks for adverse reactions (13.2%). Ninety-two allergy specialists (82%) performed AIT subcutaneously subcutaneous immunotherapy (SCIT) and 20 allergy specialists (18%) performed it sublingually sublingual immunotherapy (SLIT). Only 8 specialists performed both SCIT and SLIT. The allergens used for SCIT were house dust mites (98.9%), pollens (72.8%), and animal dander (23.9%). SLIT was prescribed only for house dust mites. Twenty-eight physicians (30.4%) observed anaphylactic reactions during SCIT. Eight physicians (40.0%) who prescribed SLIT observed adverse reactions, including local reactions, but none of them observed anaphylactic reactions. CONCLUSIONS: In this survey, 69.0% of the respondents performed AIT in clinical practice. SCIT prescription is more popular than SLIT. The Lack of facilities and clinical education is a critical barrier to performing AIT. Therefore, proper clinical education of AIT is necessary for Korean allergists.
Allergens ; Anaphylaxis ; Animals ; Asthma ; Surveys and Questionnaires ; Desensitization, Immunologic ; Electronic Mail ; Hypersensitivity ; Immunotherapy ; Korea ; Pollen ; Prescriptions ; Pyroglyphidae ; Rhinitis, Allergic, Perennial ; Specialization ; Surveys and Questionnaires

Although aspirin-exacerbated respiratory disease (AERD) has attracted a great deal of attention because of its association with severe asthma, it remains widely under-diagnosed in the asthmatic population. Oral aspirin challenge is the best method of diagnosing AERD, but this is a time-consuming procedure with serious complications in some cases. Thus, development of non-invasive methods for easy diagnosis is necessary to prevent unexpected complications of aspirin use in susceptible patients. For the past decade, many studies have attempted to elucidate the genetic variants responsible for risk of AERD. Several approaches have been applied in these genetic studies. To date, a limited number of biologically plausible candidate genes in the arachidonate and immune and inflammatory pathways have been studied. Recently, a genome-wide association study was performed. In this review, the results of these studies are summarized, and their limitations discussed. In addition to the genetic variants, changes in methylation patterns on CpG sites have recently been identified in a target tissue of aspirin hypersensitivity. Finally, perspectives on application of new genomic technologies are introduced; these will aid our understanding of the genetic pathogenesis of aspirin hypersensitivity in asthma.
Aspirin ; Asthma ; Genome-Wide Association Study ; Humans ; Hypersensitivity ; Methylation ; Polymorphism, Single Nucleotide

Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.
Asia ; Asian Continental Ancestry Group ; Asthma ; Environmental Pollution ; Humans ; Hypersensitivity ; Prevalence ; Social Change ; Urbanization

No abstract available.
Desensitization, Immunologic

Kartagener syndrome is characterized by the triad of situs inversus, bronchiectasis, and chronic paranasal sinusitis. Recurrent sinopulmonary infection, the major determinant for diagnosing immunodeficiency, is the most common clinical manifestation of the disease. A 17-year-old female patient presented with dyspnea, cough, sputum, nasal congestion, and rhinorrhea for more than 5 years. Nasal symptoms and dyspnea had not been controlled by intermittent treatment with mucolytics and antibiotics from primary clinics since 3 months before visiting our clinic. Chest X-ray and computed tomography showed situs inversus, dextrocardia and bronchiectasis. Paranasal sinus series revealed mucosal thickening and haziness on both maxillary sinus. Serum immunoglobulin (Ig) G4 was decreased, but total IgG was within normal range. Under the diagnosis of Kartagener syndrome with IgG4 deficiency, monthly intravenous IgG (IVIG) treatment was performed for 6 months. Her symptoms were well controlled and the frequency of antibiotics use was markedly decreased. We report a patient having the Kartagener syndrome with IgG4 deficiency that was successfully controlled with a 6-month-treatment of IVIG.
Adolescent ; Anti-Bacterial Agents ; Bronchiectasis ; Cough ; Dextrocardia ; Dyspnea ; Estrogens, Conjugated (USP) ; Expectorants ; Female ; Humans ; Immunoglobulin G ; Immunoglobulins ; Immunoglobulins, Intravenous ; Kartagener Syndrome ; Maxillary Sinus ; Reference Values ; Sinusitis ; Situs Inversus ; Sputum ; Thorax

This case report describes a life-threatening anaphylaxis to fentanyl during radiofrequency ablation (RFA). A 50-year-old woman with hepatocellular carcinoma was admitted for RFA. She denied any history of adverse drug reactions or past adverse anesthetic reaction. Physical examination, vital signs, any laboratory findings were all within normal limits. Ten minutes after intravenous administration of 50 mcg of fentanyl before starting RFA, she developed generalized erythema and sudden onset of bronchospasm followed by respiratory arrest. Cardiopulmonary resuscitation (CPR) commenced with 100% oxygen and intravenous administration of epinephrine 1 mg. After 5 minutes of CPR, she had the return of spontaneous circulation. Chest X-ray revealed pulmonary edema which resolved over two days. She recovered completely and was discharged home. After six weeks, intradermal tests performed with fentanyl, remifentanyl, midazolam, and profopol. Among those, only fentanyl induced positive skin response. Fentanyl induced anaphylaxis was diagnosed for this case, and fentanyl was avoided in the subsequent general anesthesia for liver transplantation. This case suggested that fentanyl could induce anaphylaxis combined with uncommon comorbidities like pulmonary edema.
Administration, Intravenous ; Anaphylaxis ; Anesthesia, General ; Bronchial Spasm ; Carcinoma, Hepatocellular ; Cardiopulmonary Resuscitation ; Comorbidity ; Drug Toxicity ; Epinephrine ; Erythema ; Female ; Fentanyl ; Humans ; Intradermal Tests ; Liver Transplantation ; Midazolam ; Middle Aged ; Oxygen ; Physical Examination ; Pulmonary Edema ; Skin ; Skin Tests ; Thorax ; Vital Signs

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is diagnosed by three criteria including cutaneous drug eruption, hematologic abnormalities, and systemic involvements. The hematologic abnormalities include presence of atypical lymphocytes or eosinophilia. The systemic involvements include lymphadenopathy, hepatitis, interstitial nephritis, interstitial pneumonia, or carditis. We experienced a 41-year-old female patient who presented DRESS syndrome at initial visit, but finally manifested with T-cell lymphoma. The patient complained of erythematous pruritic plaques with itching on her abdomen and thigh. There was no initiating factor and she was diagnosed with urticarial dermatitis. After treatment with antihistamine and systemic steroid, she recovered from skin lesion. However, 1 month later, she came to emergency department with aggravated skin lesion after taking nonsteroidal anti-inflammatory drug for 3 days. On admission, she showed a fever, skin rash, atypical lymphocytes in peripheral blood smear, and hepatitis. She was treated with systemic steroid under the impression of DRESS syndrome. Her symptoms began to improve, however, laboratory parameters were aggravated again. We performed bone-marrow biopsy because of her unusual progress. Finally she diagnosed with peripheral T-cell lymphoma and treated with allo-peripheral blood stem cell transplantation. In conclusion, we report a case of T-cell lymphoma which presented as DRESS syndrome. If patients with DRESS syndrome present lymphadenopathy and atypical lymphocytes, and do not respond to anti-inflammatory treatment, we should consider underlying lymphoproliferative disease.
Abdomen ; Adult ; Biopsy ; Dermatitis ; Drug Eruptions ; Emergencies ; Eosinophilia ; Exanthema ; Female ; Fever ; Hepatitis ; Humans ; Lung Diseases, Interstitial ; Lymphatic Diseases ; Lymphocytes ; Lymphoma ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Myocarditis ; Nephritis, Interstitial ; Porphyrins ; Pruritus ; Skin ; Stem Cell Transplantation ; T-Lymphocytes ; Thigh

OBJECTIVE: Neurological soft signs are very common in children with the attention deficit hyperactivity disorder (ADHD), and the first line medication of this disorder is methylphenidate. The aim of the study was to assess the effect of methylphenidate on the neurological soft signs in children and adolescents suffering from ADHD depending on the dose of methylphenidate. METHODS: Thirty five patients with ADHD were investigated by the ADHD RS-IV parent version questionnaire and the Revised Neurological Examination for Subtle Signs before treatment adjustment and after four weeks of methylphenidate medication. The changes in hyperactivity symptomatology, neurological soft signs during therapy and the influence of the methylphenidate dose were statistically analyzed. RESULTS: A significant decrease in hyperactivity symptomatology was found after one month of methylphenidate medication (p=0.0001) and significant decrease in neurological soft signs was demonstrated in 21 from a total of 26 items (p<0.05). Correlation analysis showed no relationship between the dose of methylphenidate and the improvement of neurological soft signs. Similarly, the improvement of ADHD symptomatology had not correlation with the improvement of neurological soft signs. CONCLUSION: The study demonstrated the positive effect of methylphenidate on neurological soft signs in which improvement occurred independently of the dose, indicating that their progress may be due to methylphenidate treatment of any dose. The unrelated effect of methylphenidate on the attention deficit hyperactivity disorder and neurological soft signs suggest that methylphenidate might be useful in the therapy of clumsy child syndrome and in ADHD treatment of non-responders.
Adolescent ; Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Methylphenidate* ; Neurologic Examination ; Parents

OBJECTIVE: Changes in serum neurosteroid levels have been reported in stress-related disorders such as anxiety and depression, but not in patients with obsessive-compulsive disorder (OCD). We thus investigated such changes in patients with OCD. METHODS: We compared the serum levels of progesterone, pregnanolone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEA-S), cortisol and testosterone in 30 patients with OCD and 30 healthy controls. RESULTS: When male and female patients were evaluated together, DHEA and cortisol levels were significantly higher in patients with OCD than the control group. When the genders were evaluated separately, DHEA and cortisol levels were higher in female patients than the female controls. The increase in DHEA levels in female patients is likely an effect of the hypothalamic-pituitary-adrenal (HPA) axis. In contrast, cortisol levels in male patients were higher than the control group, while testosterone levels were lower. The increased cortisol and decreased testosterone levels in male patients likely involves the hypothalamic-pituitary-gonadal (HPG) axis. CONCLUSION: These findings suggest that neurosteroid levels in patients with OCD should be investigated together with the HPA and HPG axes in future studies.
Anxiety ; Axis, Cervical Vertebra ; Dehydroepiandrosterone ; Depression ; Female ; Humans ; Hydrocortisone ; Male ; Obsessive-Compulsive Disorder* ; Pregnanolone ; Progesterone ; Testosterone

OBJECTIVE: Electroconvulsive therapy (ECT) is a reasonable option for intractable depression or schizophrenia, but a mechanism of action has not been established. One credible hypothesis is related to neural plasticity. Three genes (Oct4, Sox2, c-Myc) involved in the induction of induced pluripotent stem (iPS) cells are Wnt-target genes, which constitute a key gene group involved in neural plasticity through the TCF family. Klf4 is the other gene among Yamanaka's four transcription factors, and increases in its expression are induced by stimulation of the canonical Wnt pathway. METHODS: We compared the peripheral blood gene expression of the four iPS genes (Oct4, Sox2, c-Myc, and Klf4) before and after modified ECT (specifically ECT with general anesthesia) of patients with intractable depression (n=6) or schizophrenia (n=6). Using Thymatron ten times the total bilateral electrical stimulation was evoked. RESULTS: Both assessments of the symptoms demonstrated significant improvement after mECT stimulation. Expression of all four genes was confirmed to increase after initial stimulation. The gene expression levels after treatment were significantly different from the initial gene expression in all twelve cases at the following treatment stages: at the 3rd mECT for Oct4; at the 6th and 10th mECT for Sox2; and at the 3rd, 6th and 10th mECT for c-Myc. CONCLUSION: These significant differences were not present after correction for multiple testing; however, our data have the potential to explain the molecular mechanisms of mECT from a unique perspective. Further studie should be conducted to clarify the pathophysiological involvement of iPS-inducing genes in ECT.
Depression ; Electric Stimulation ; Electroconvulsive Therapy* ; Gene Expression* ; Humans ; Induced Pluripotent Stem Cells ; Plastics ; Schizophrenia ; Transcription Factors* ; Wnt Signaling Pathway