Purpose: Awareness of environmental control is considered a major influence on the performance of asthma self-management behaviors that are involved in maintaining effective control of asthma. The aim of this study was to investigate whether immersive virtual reality (VR) education is effective in environmental control education for asthmatic children. Methods: Thirty asthmatic children aged 9 to 13 years with aeroallergen sensitization were enrolled. Environmental control education for asthmatic subjects were performed using either immersive VR (VR group) or conventional leaflets provided by asthma specialists (control group). Five questionnaires, such as awareness of environmental control, memory, assessment of intent to act, satisfaction test, and asthma control test (ACT) questionnaires were used for estimating the effects of education. Results: Awareness of environmental control, memory, and intent to act scores were significantly increased after education in both groups and the scores were maintained high until 4 weeks after education. In both group, ACT scores were maintained high scores before and 4 weeks after education. Satisfaction scores were very high in the VR group. Conclusion The increased scores in awareness of environmental control and intent to act indicate that the environmental control education using VR is worthy of attention as an effective educational tool for asthma management. Application of further developed techniques, including active environmental intervention by participants in VR, could be applied to effective asthma management.

Purpose: Patients with atopic dermatitis (AD) experience a chronic relentless course which may affect emotional and behavioral problems. Moreover, AD could affect serious psychosocial problems due to its disfiguring skin conditions, particularly in adolescents who are under various stresses. The aim of this study was to investigate behavioral problems in children and adolescents with AD and to identify associated clinical factors. Methods: A total of 69 subjects with AD were enrolled in this study. The severity of AD was assessed using the SCORAD (Scoring of Atopic Dermatitis) index and divided into 2 groups: mild-to-moderate and severe groups. Behavioral problems were assessed by using the Korean Child Behavior Checklist (K-CBCL). Results: The severe AD group had higher total behavior problem scores and internalizing scores than the mild-to-moderate group. Social problem and attention problem scores were slightly higher in the severe AD group than in the mild-to-moderate AD group. The DSM (diagnostic and statistical manual of mental disorders)-anxiety, obsessive compulsive problems, and sluggish cognitive tempo problems were more frequently observed in the severe AD group. Longer disease duration was an independent risk factor of internalizing problems in subjects with AD. Conclusion This study showed that subjects with severe AD had higher total behavioral problem scores, particularly internalizing scales. Their behavioral problems may have poor compliance and consequently poor outcomes as well. Clinicians should be aware that children and adolescents with severe AD have more behavioral problems and that an interdisciplinary approach with medical and psychological supports is necessary for proper management.

Background: Recent studies have shown that oral administration of probiotics may improve the immune imbalance caused by dysbiosis of the gut microbiome in atopic dermatitis (AD). This study aimed to investigate the clinical and immunological effects of Lactobacillus pentosus in children with mild to moderate AD. Methods: Children aged 2–13 years with AD were randomized to receive either 1.0 × 1010 colony-forming units of L. pentosus or placebo, daily, for 12 weeks. The clinical severity of AD and transepidermal water loss were evaluated. Blood eosinophil counts, serum total immunoglobulin E (IgE), and cytokine levels were measured. The diversity and composition of the gut microbiota were also analyzed. Results: Eighty-two children were recruited, and 41 were assigned to the probiotics intervention group. The mean scoring of atopic dermatitis (SCORAD) indices at baseline were 30.4 and 34.3 for the probiotics and placebo groups, respectively. At week 12, the mean indices were 23.6 and 23.1 for the probiotics and placebo groups, respectively. Clinical severity decreased significantly over time in both groups, with no significant difference between the two groups. In both groups, there were no significant differences in cytokine levels, microbial diversity, or the relative abundance of the gut microbiota at week 12 compared with the corresponding baseline values. The mean subjective scores of SCORAD indices after intervention for the probiotics group were significantly lower than those for the placebo group in IgE sensitized AD (P = 0.019). Conclusion Our results show improved symptoms in the probiotics and placebo groups, and we could not find additional effects of L. pentosus in AD. However, the mean subjective scores of SCORAD indices for the probiotics group are significantly improved compared with those for the placebo group in allergen-sensitized AD.

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrixassisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.
Abscess* ; Adolescent* ; Anti-Bacterial Agents ; Breast* ; Child ; Colon ; Dermatitis, Atopic* ; Drainage ; Dysbiosis ; Female* ; Firmicutes ; Humans ; Inflammation ; Mastitis ; Microbiota ; Skin ; Skin Diseases ; Staphylococcus aureus* ; Staphylococcus*

PURPOSE: Recent data indicate that sensitization to mold contributes to the severity and persistence of asthma. In this study, we investigated the relationships between sensitization to mold and lung function parameters in children with asthma. METHODS: We retrospectively reviewed clinical data from 551 asthmatic subjects. We selected subjects who met clinical diagnostic criteria of asthma. Their spirometry, methacholine challenge tests, and measurements of blood eosinophils, serum IgE, eosinophil cationic protein (ECP) and fractional exhaled nitric oxide (FeNO) results were included. Skin prick testing (SPT) results with 13 common aeroallergens in Korea including house dust mites, animal dander, pollen, cockroach and mold were reviewed. Subjects were divided into 3 groups according to their SPT results. Subjects who showed no positive result to any aeroallergen were designated as group 1 (non-sensitized). Group 2 represented subjects who were sensitized to aeroallergens other than mold (other allergen-sensitized) and group 3 included subjects who were sensitized to mold allergens (mold-sensitized). RESULTS: Among the 551 asthmatic subjects, 67 (12.2%) were sensitized to mold and 366 (66.4%) were sensitized to other aeroallergens. The log mean IgE levels were higher in groups 2 (5.96±1.14 IU/mL) and 3 (5.81±0.97 IU/mL) compared to group 1 (3.88±1.68 IU/mL). Blood eosinophils, ECP and FeNO concentrations were significantly higher in groups 2 and 3, but no significant difference was found between the 2 groups. The mean FEV1 value was significantly lower in group 3 (86.9±12.1%pred) than in groups 2 (92.0±14.8%pred) and 1 (93.4±15.4%pred). The log mean methacholine PC20 was significantly lower in group 3 (0.08±1.91 mg/mL) than in groups 2 (1.31±1.69 mg/mL) and 1 (2.29±1.66 mg/mL). CONCLUSIONS: We observed a differential association between mold and other aeroallergen sensitization, and severity of asthma. Sensitization to mold is associated with lower lung function and increased airway hyper-responsiveness in children with asthma. Mold sensitization could be an important factor determining asthma severity particularly airflow limitation in children.
Allergens ; Animals ; Asthma* ; Child* ; Cockroaches ; Dander ; Eosinophil Cationic Protein ; Eosinophils ; Fungi* ; Humans ; Immunoglobulin E ; Korea ; Lung ; Methacholine Chloride ; Nitric Oxide ; Pollen ; Pyroglyphidae ; Respiratory Hypersensitivity ; Retrospective Studies ; Skin ; Spirometry