Atopic dermatitis is a common chronic inflammatory skin disease often preceding the development of asthma and allergic disorders, such as food allergy or allergic rhinoconjunctivitis. The incidence of atopic dermatitis is increasing, and this poses a major burden on health care costs. The pathophysiology of atopic dermatitis has long remained enigmatic, but much scientific effort has been invested in elucidating the genetic background and the immunological mechanisms underlying atopic dermatitis. Pathophysiology involves a complex series of interactions between resident and infiltrating cells orchestrated by proinflammatory cytokines and chemokines. A deficiency of antimicrobial peptides might contribute to the propensity for colonization or infection by microbial organisms seen in atopic dermatitis. New management approaches have evolved form advances in our understanding of the pathophysiology of this common skin disorder.
Asthma ; Chemokines ; Colon ; Cytokines ; Dendritic Cells ; Dermatitis, Atopic* ; Food Hypersensitivity ; Health Care Costs ; Incidence ; Peptides ; Skin ; Skin Diseases ; Superantigens

No abstract available.
Bronchiolitis* ; Respiratory Syncytial Viruses*

Eosinophilia is common feature in many diseases, including allergic diseases. There are many factors involved in the survival and the death of eosinophil. Apoptosis is the most common form of physiological cell death and a necessary process to maintain cell numbers in multicellular organisms. It has been directly demonstrated that eosinophil apoptosis is delayed in allergic inflammatory sites, and that this mechanism contributes to the expansion of eosinophils in tissue. Overexpression of interleukin-5 appears to be crucial for delaying eosinophil apoptosis. Besides survival cytokines, eosinophil apoptosis is also regulated by death factor. Recent observations suggest a role for mitochondria in conducting eosinophil apoptosis, although the mechanisms that trigger mitochondria to release proapoptotic factors remain less clear. Acceleration of eosinophil apoptosis can be achieved by decreased expression of eosinophil survival factors, and promotion of death signals. However, many previous studies on the regulation of apoptosis have utilized cell lines which may not directly represent cells within the in vivo environment. Therefore, the control of eosinophil apoptosis can be another therapeutic strategy in allergic diseases.
Acceleration ; Apoptosis ; Cell Count ; Cell Death ; Cell Line ; Cytokines ; Eosinophilia ; Eosinophils ; Interleukin-5 ; Mitochondria

Asthma is a complex genetic disorder that is characterized by airway inflammation and reversible airflow obstruction. Asthma is increasing in prevalence worldwide as a result of factors associated with a western lifestyle. The heterogeneous nature of the clinical manifestation and therapeutic responses of asthma in both adult and pediatric patients indicate that it may be more of a syndrome rather than a specific disease entity. Numerous triggering factors including viral infections, allergen and irritant exposure, and exercise, among others, complicate both the acute and chronic treatment of asthma. Therapeutic intervention has focused on the appreciation that airway obstruction in asthma is composed of both bronchial smooth muscle spasm and variable degrees of airway inflammation characterized by edema, mucus secretion, and the influx of a variety of inflammatory cells. The presence of only partial reversibility of airflow obstruction in some patients indicates that structural remodeling of the airway may also occur over time. Choosing appropriate medications depends on the disease severity (mild intermittent, mild persistent, moderate persistent, severe persistent), extent of reversibility, both acutely and chronically, patterns of disease activity (exacerbations related to viruses, allergens, exercise, etc.), and age of onset (infancy, childhood, adulthood). Early recognition and early intervention for childhood asthma is an issue of great interest, and new information is forthcoming at a rapid pace. Current asthma guidelines identify inhaled corticosteroids as the preferred initial long-term control therapy even in young children.
Adrenal Cortex Hormones ; Adult ; Age of Onset ; Airway Obstruction ; Allergens ; Asthma* ; Child ; Early Intervention (Education) ; Edema ; Humans ; Inflammation ; Life Style ; Mucus ; Muscle, Smooth ; Prevalence ; Spasm

PURPOSE: Early sensitization to outdoor aeroallergens such as tree, grass and weed pollen in the early period of infancy is very important in the development of seasonal bronchial asthma or allergic rhinitis. There is a suggestion that pollen contact during the first 6 months of life increases the risk of pollen allergy for 20 years or later. The aim of our investigation was to identify the relationship between sensitization to outdoor aeroallergens and the month and season of birth in childhood respiratory allergic disorders. METHODS: One hundred three seasonal allergic rhinitis and bronchial asthmatic children were enrolled for this study, and skin prick tests done for each patient to detect the sensitized allergens. Ragweed, mugwort, alder, hazelnut, elm, willow, birch, beech, oak, plane tree, orchard and timothy grass were used for outdoor aeroallergens. The relative risk (RR) for development of hypersensitivity to outdoor aeroallergen in children born in certain months was calculated. RESULTS: We found that relative risk of immediate hypersensitivity to each outdoor aeroallergen was dependent on the season and month of birth. Tree pollen was the most common sensitizing allergen in children who were born in spring (RR=2.12, P< 0.001) and May (RR=1.83, P=0.042), grass pollen was most common in summer (RR=2.06, P=0.046) and June-born children (RR=3.69, P< 0.001) ; weed pollen was the in fall (ragweed RR=2.89; mugwort RR=2.23, P< 0.001) and September-born children. (ragweed RR=2.10, P=0.029; mugwort RR=1.98, P=0.026) CONCLUSION: Exposure in early infancy to outdoor aeroallergens is an important risk factor in the subsequent development of bronchial asthma and allergic rhinitis.
Allergens ; Alnus ; Ambrosia ; Artemisia ; Asthma ; Betula ; Child ; Corylus ; Fagus ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Parturition* ; Phleum ; Poaceae ; Pollen ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Risk Factors ; Salix ; Seasons ; Skin ; Skin Tests

PURPOSE: Recent studies have shown that the cysteinyl leukotriene (cysLT) of exhaled breath condensate (EBC) could be predictive of inflammatory status and effectiveness of treatment in allergic disease. The aim of this study was to evaluate the inflammation and therapeutic effectiveness of cysLT in EBC in pediatric patients with allergic rhinitis (AR). METHODS: We enrolled 34 healthy children (median age, 4 years 10 months) and 67 AR children (median age, 5 years 1 month). All of the AR patients received intranasal steroid (fluticasone furoate) once daily for 2 weeks. After 2 week of fluticasone furoate treatment, they were classified into 2 groups: the fluticasone furoate (F) and montelukast (M) groups. We treated each group for another 8 weeks. To evaluate the therapeutic effectiveness, we used symptom score (SS) and EBC leukotriene E4 (LTE4). EBC samples were collected with RTube. Each parameter was checked at 0, 2, and 10 weeks of therapy. RESULTS: Most of the AR patients showed clinical improvement with 2- and 10-week fluticasone therapy (F group: 0-week SS, 5.6; 2-week SS, 3.6; 10-week SS, 2.1; P<0.01; M group: 0-week SS, 4.8; 2-week SS, 3.2; 10-week SS, 1.9: P<0.01). LTE4 levels were higher in AR patients than in control subjects (0 week: 87 pg/mL vs. 18 pg/mL) and were reduced after 2 weeks of fluticasone treatment (F group: 90→51.6 pg/mL, P<0.01; M group: 84→46.1 pg/mL, P<0.01). After 10 weeks of treatment, there was no significant difference in the LTE4 level between the F and M groups. CONCLUSION: LTE4 in EBC may be useful for evaluating inflammation and therapeutic effectiveness in patients with allergic rhinitis.
Child* ; Fluticasone ; Humans ; Inflammation* ; Leukotriene E4* ; Rhinitis, Allergic*

Atopic dermatitis (AD) is one of the most common chronic childhood skin diseases affecting up to 30% of children in the Korea. The point prevalence of AD has increased based on validated questionnaires in the most recent update of the International Study of Asthma and Allergies in Childhood. The evaluation of risk factors of AD is very important to develop the therapeutic strategies of AD. Many risk factors were studied to evaluate the relationship with the prevalence of AD. However, the results were quite different depending on methods of study, study population, and country. The further objective and well designed prospective epidemiologic studies are required to confirm these outcomes because the environmental and risk factors may be different among the countries according to their living cultures.
Asthma ; Child ; Dermatitis, Atopic ; Epidemiologic Studies ; Humans ; Hypersensitivity ; Korea ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Skin Diseases

PURPOSE: Nasal stuffness is one of most common symptom in children who suffer from rhinitis although there is still debates at to the best measurable device. The aim of the study was to evaluate the sniff nasal inspiratory pressure (SNIP) with respiratory pressure meter and compare this with the clinical status of patients. METHODS: We enrolled 57 rhinitis patients who visited our hospital during June 2005 to July 2006. They were treated with intranasal steroid spray (mometasone furoate) for first 2 weeks. To evaluate the outcome of treatment, we used symptom score (SS) and measured the SNIP with respiratory pressure meter (Micro RPM, Micro Medical, Rochester, UK) and also measured peak nasal inspiratory flow (PNIF) with peak nasal inspiratory flow meter (Youlten peak flow meter, Clement Clarke Int., London, UK) before and after the therapy. Skin prick test was performed to all patient to classify the atopic (AR) and non-atopic rhinitis (NAR). RESULTS: Among 57 identified patients (median age, 7 years 9 months), 40 AR and 17 NAR were studied. Most patient showed clinically improvement with 2 weeks intranasal steroid therapy (0 wk SS=4.9, 2 wk SS=1.7 in AR; 0 wk SS=4.5, 2 wk SS=1.5 in NAR, P< 0.01). The SNIP of AR group was increased after intranasal therapy (0 wk SNIP=58.5 cm H2O, 2 wk SNIP=76.2 cmH2O; P<0.01). There was also significant improvement in terms of SNIP in NAR group (0 wk SNIP=51.7 cmH2O, 2 wk SNIP=62.9 cmH2O, P<0.01). However, we could not find any correlation between SS and SNIP. Although there was the improvement of symptoms scores, there was no significant difference of peak flow between before and after treatment (71.9-->77.6 L/min, P>0.05). And there was no correlation between SNIP and PNIF measurement. CONCLUSION: The respiratory pressure meter is a useful device to evaluate the therapeutic effectiveness and clinical improvement in pediatric rhinitis patients.
Child ; Humans ; Nasal Obstruction ; Rhinitis* ; Skin

Measurement of lung function is an integral component of respiratory physiology and of clinical assessment of lung diseases in school age children and adults. Pulmonary function test of infants and children under the age of 2 years have now been standardised and are being used both in research and as an adjunct to clinical management. By contrast, until recegntly, children of preschool age, i.e. between 2-6 years represented a major challenge for pulmonary function test assessment, this particular period commonly being referred to as the 'dark ages' of Pediatric Pulmonology. Measurement of lung function in preschool-aged children is now feasible. However, much work remains to be done in standardizing how these tests are performed, and in understanding the most appropriate role for the various tests in the study of growth and development of the respiratory system and in the clinical management of children in this age group. As the field develops and the knowledge of respiratory physiology in this age group expands, investigation of different and more appropriate algorithm use in preschool children, together with development of more appropriate reference data, may result in improved disease discrimination.
Adult ; Child ; Child, Preschool* ; Discrimination (Psychology) ; Growth and Development ; Humans ; Infant ; Lung Diseases ; Lung* ; Pulmonary Medicine ; Respiratory Function Tests* ; Respiratory Physiological Phenomena ; Respiratory System

Kawaski disease is the leading cause of acquired heart disease in children in many parts of the world. Atypical Kawasaki disease does not meet the diagnostic criteria of Kawasaki disease. Incomplete presentations make early diagnosis and timely treatment difficult. Delays in diagnosis and treatment are associated with an increased risk of coronary artery aneurysm. Thus, echocardiography should be considered in febrile infants of uncertain etiology. Clinical practitioners should have a high index of suspicion to diagnose and initiate prompt treatment to reduce the comorbidity of coronary arterial disease in patients with atypical Kawasaki disease. A 9-month-old girl had daily high spiking fever for 9 days and showed erythematous change on BCG vaccination site only. Echocardiography was performed and disclosed saccular aneurysm of left coronary artery and diffuse right coronary artery dilatation. She was treated with intravenous immunoglobulin and aspirin. After 6 months, a follow-up echocardiogram revealed decreased size of coronary arteries. In such cases, careful evaluation of clinical findings with erythematous change on BCG vaccination site are needed.
Aneurysm ; Aspirin ; BCG Vaccine ; Child ; Comorbidity ; Coronary Vessels ; Diagnosis ; Dilatation ; Early Diagnosis ; Echocardiography ; Female ; Fever ; Follow-Up Studies ; Heart Diseases ; Humans ; Immunoglobulins ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Mycobacterium bovis ; Vaccination