Staphylococcus aureus is the most common bacterium present in upper respiratory tract, and the toxins it produced are involved in allergic inflammation pathogenesis. In this study, we investigated the clinical significance of IgE in association with staphylococcal superantigens in allergic asthma with rhinitis (BAwAR) and allergic rhinitis alone (AR). We recruited 100 patients with BAwAR (group I), 100 patients with AR (group II), and 88 healthy controls (group III). Patients were clinically diagnosed by physicians, and were sensitized to house dust mites. Specific IgE antibodies to staphylococcal superantigen A (SEA), B (SEB), and toxic shock syndrome toxin-1 (TSST-1) were measured using the ImmunoCAP system. Other clinical parameters were retrospectively analyzed. All specific IgE antibodies to SEA, SEB, and TSST-1 were detected most frequently in group I (22%, 21%, and 27%), followed by group II (11%, 14%, and 21%) and group III (4.5%, 3.4%, and 2.3%). Absolute values of serum specific IgE to SEA, SEB, and TSST-1 were also significantly higher in group I (0.300+/-1.533 kU/L, 0.663+/-2.933 kU/L, and 0.581+/-1.931 kU/L) and group II (0.502+/-2.011 kU/L, 0.695+/-3.337 kU/L, and 1.067+/-4.688 kU/L) compared to those in group III (0.03+/-0.133 kU/L, 0.03+/-0.14 kU/L, and 0.028+/-0.112 kU/L). The prevalence of serum specific IgE to SEA was significantly higher in group I compared to group II (P=0.025). Blood eosinophil counts were significantly higher in patients with specific IgE to SEA or SEB, and higher serum levels of specific IgE to house dust mites were noted in patients with specific IgE to TSST-1. In conclusion, the present study suggested that IgE responses to staphylococcal superantigens are prevalent in the sera of both BAwAR and AR patients. This may contribute to an augmented IgE response to indoor allergens and eosinophilic inflammation.
Allergens ; Antibodies ; Asthma* ; Eosinophils ; Humans ; Immunoglobulin E* ; Inflammation ; Prevalence* ; Pyroglyphidae ; Respiratory System ; Retrospective Studies ; Rhinitis* ; Shock, Septic ; Staphylococcus aureus ; Superantigens*

Pituitary tumor can be accompanied with various pituitary hormone abnormalities. Pituitary tumors can be divided into functioning or nonfunctioning tumors. A functioning pituitary tumor, via the oversecretion of pituitary hormones, causes diverse clinical features. A nonfunctioning pituitary tumor can be accompanied with pituitary dysfunction and this may be due to compression or destruction of normal pituitary tissue, suppression of the pituitary portal system or direct damage to the hypothalamus. Corticotropin-releasing hormone (CRH) deficiency, which is caused by defects in the synthesis or release of CRH, is a cause of secondary adrenocortical insufficiency. The clinical presentations are hypoglycemia, weight loss, anemia, weakness, nausea, vomiting and hyponatremia. Acquired CRH deficiency has also been suggested to occur based on a lack of adrenocorticotropic hormone (ACTH) response to insulin-induced hypoglycemia, but there is a normal ACTH response to exogenous CRH. We experienced a case of a woman with pituitary macroadenoma accompanied with CRH deficiency. We report here on this case with the review of the literature.
Adrenocorticotropic Hormone ; Anemia ; Corticotropin-Releasing Hormone ; Female ; Humans ; Hypoglycemia ; Hyponatremia ; Hypothalamus ; Nausea ; Pituitary Hormones ; Pituitary Neoplasms ; Portal System ; Vomiting ; Weight Loss

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.
Angioplasty, Balloon ; Arm ; Brachiocephalic Veins ; Catheterization* ; Catheters* ; Central Venous Catheters ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Incidence ; Jugular Veins* ; Phlebography ; Renal Dialysis* ; Stents ; Subclavian Vein ; Superior Vena Cava Syndrome* ; Veins ; Vena Cava, Superior*

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.
Angioplasty, Balloon ; Arm ; Brachiocephalic Veins ; Catheterization* ; Catheters* ; Central Venous Catheters ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Incidence ; Jugular Veins* ; Phlebography ; Renal Dialysis* ; Stents ; Subclavian Vein ; Superior Vena Cava Syndrome* ; Veins ; Vena Cava, Superior*

Allergen-specific immunotherapy is the only causal treatment for allergic diseases. However, the efficacy of immunotherapy may vary around the world due to differences in climate, the nature of aero-allergens and their distribution. The aim of this study was to describe the effects of subcutaneous immunotherapy (SCIT) in Korean adults with allergic asthma (AA). As a retrospective cohort study, we reviewed medical records for 627 patients with AA in Korea who were sensitized to house dust mite (HDM) and/or pollens and who underwent SCIT with aluminum hydroxide adsorbed allergen extract from 2000 to 2012. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Herein, 627 asthmatic patients achieved remission within a mean of 4.7 ± 0.2 years. The cumulative incidence rates of remission from AA were 86.9% upon treatment with SCIT. Baseline forced expiratory volume in the first second (FEV1) ≥ 80% (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.79–5.39; P < 0.001), and maintenance of immunotherapy for more than 3 years (HR, 1.82; 95% CI, 1.21–2.72; P = 0.004) were significant predictors of asthma remission during SCIT. In 284 patients on SCIT with HDM alone, initial specific immunoglobulin E (IgE) levels to Dermatophagoides pteronyssinus and Dermatophagoides farinae did not show significant difference between remission and non-remission group after adjusting demographic variables. In conclusion, SCIT was effective and safe treatment modality for patients with AA. Initial FEV1 ≥ 80% and immunotherapy more than 3 years were found to be associated with favorable clinical responses to SCIT.
Adult ; Aluminum Hydroxide ; Asthma* ; Climate ; Cohort Studies ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Immunoglobulins ; Immunotherapy* ; Incidence ; Korea* ; Life Tables ; Medical Records ; Pollen ; Pyroglyphidae ; Retrospective Studies

Anaphylaxis is the most common systemic allergic reaction caused by bee stings. Delayed-type allergic reactions, including serum sickness, occur much less frequently. We report a 27-year-old man who developed serum sickness reaction nine days after multiple bee-stings. He had complained of erythematous skin rash, fever, arthralgia, myalgia and proteinuria. High specific IgE to bee venoms (honeybee, yellow jacket, yellow hornet) were observed by CAP system and C3, C4 and circulating immune complex levels measured by C1q binding assay showed normal values. We report a case of serum sickness reaction caused by multiple bee stings.
Adult ; Anaphylaxis ; Antigen-Antibody Complex ; Arthralgia ; Bee Venoms ; Bees ; Bites and Stings ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Immunoglobulin E ; Insect Bites and Stings ; Myalgia ; Proteinuria ; Reference Values ; Serum Sickness* ; Wasps

PURPOSE: To evaluate asthma control in elderly individuals and identify the factors that predict poor control. METHODS: A retrospective, observational study evaluating 108 elderly individuals with asthma (59 females: > or =60 years, mean age: 70.5 years) was conducted at Ajou University Hospital from October 2010 to March 2011. Subjects were classified into two groups according to scores on the asthma control test (ACT). Group I consisted of 38 patients with ACT scores < or =19 (poor controllers) and group II included 70 patients with ACT scores >19 (controllers). Clinical data was analyzed. Spirometry was performed, and the ACT and asthma quality-of-life survey were completed. Medication possession ratios were calculated to evaluate compliance. RESULTS: Of the 108 enrolled subjects, 54.6% were female, 7.5% were obese, and 49.0% were atopic. The mean age of the patients was 70.5, and the average of time patients had suffered from asthma was 15.5 years. Comorbid conditions were found in more than 80% of the patients. Allergic rhinitis was most common comorbid condition; this was followed by cardiovascular disease and degenerative arthritis (76.9%, 65.7%, and 51.9%, respectively). Many patients (35.2%) were in poorly controlled states characterized by significantly lower asthma quality of life scores (P<0.001) and higher admission rates (P=0.034). Multivariate logistic regression analysis showed that a history of pulmonary tuberculosis was a predictor of poorly controlled asthma in elderly individuals even after adjusting for age, sex, smoking, lung function and other comorbidities (OR=4.70, CI=1.06-20.81, P=0.042). CONCLUSIONS: The asthma of more than one-third of elderly individuals with this condition was poorly controlled, and a history of pulmonary tuberculosis may have contributed to this outcome. Proper evaluation and management of comorbid conditions in elderly patients with asthma is essential for the achievement of better control of the disease and a higher quality of life for those who suffer from it.
Achievement ; Aged ; Asthma ; Cardiovascular Diseases ; Comorbidity ; Female ; Humans ; Logistic Models ; Lung ; Osteoarthritis ; Quality of Life ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Smoke ; Smoking ; Spirometry ; Tuberculosis, Pulmonary

Adult-onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by high spiking fever, evanescent salmon-colored rash, arthralgia or arthritis, leukocytosis and the involvement of various organs. However, leukopenia is rarely associated with AOSD. It may be due to hemophagocytic syndrome, which usually present with acute febrile illness, pancytopenia, hepatosplenomegaly, and hyperferritinemia. We report a case of 28-year-old man with AOSD and leukopenia. There is no evidence of other causes of cytopenia and hemophagocytosis in bone marrow examination. Leukopenia can be the initial presentation of AOSD.
Adult ; Arthralgia ; Arthritis ; Bone Marrow Examination ; Exanthema ; Fever ; Humans ; Leukocytosis ; Leukopenia* ; Lymphohistiocytosis, Hemophagocytic ; Pancytopenia ; Still's Disease, Adult-Onset*

PURPOSE: Omalizumab, an anti-immunoglobulin E (IgE) monoclonal antibody, has proved to be effective for the treatment of severe asthma. However, there is no direct evidence of effectiveness of omalizumab in Korean patients with severe asthma. We sought to evaluate the real-world effectiveness of omalizumab in Korean adult patients suffering from severe asthma and to identify predictors of favorable response. METHODS: A retrospective analysis of electrical medical records was performed on severe allergic asthmatic patients with omalizumab treatment group (OT group) for more than 6 months between March 2008 and February 2016. Propensity score matching was applied to define the standardized treatment control group (STC group) treated without omalizumab. Asthma-related outcomes were compared between the 2 groups, and analyzed before and after omalizumab use in the OT group. Responders to treatment were defined as patients showing >50% reduction in asthma exacerbations and/or systemic steroid requirement during the outcome period. RESULTS: One hundred twenty-four patients with severe asthma (62 in the OT group; 62 in the STC group) were enrolled in the study. Proportion of patients having the reduction of asthma exacerbation (53.2% vs 35.5%, P=0.015) and the rate of responders (67.7% vs 41.9%, P=0.007) were significantly higher in the OT group than in the STC group. Significant reductions were noted in asthma exacerbation (P=0.006), hospitalization (P=0.009), hospitalization days (P=0.006), systemic corticosteroid requirements (P=0.027), and sputum eosinophil count (P=0.031) in OT group compared with STC group. There were no significant differences in changes of forced expiratory volume in the 1 second (FEV1) levels between the 2 groups. No predictors of responders were found for omalizumab treatment. CONCLUSIONS: Omalizumab can reduce exacerbations/hospitalization/systemic steroid burst in Korean adult patients with severe asthma.
Adult ; Asthma* ; Eosinophils ; Forced Expiratory Volume ; Hospitalization ; Humans ; Korea* ; Medical Records ; Omalizumab* ; Propensity Score ; Retrospective Studies ; Sputum

PURPOSE: House dust mites (HDM) are major allergens that cause allergic rhinitis (AR). Allergen-specific subcutaneous immunotherapy (SCIT) has been shown to be clinically beneficial in many clinical trials. Such trials, however, are not reflective of all patient populations. The aim of this study was to describe the efficacy and safety of SCIT in routine clinical practice in Korean adults with AR sensitized to HDM. METHODS: We reviewed medical records of 304 patients with AR treated at an allergy clinic of a tertiary hospital using SCIT with aluminum hydroxide-adsorbed allergen extract targeting HDM alone or with pollens for at least 1 year from 2000 to 2012. Patients with asthma were excluded. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Specific immunoglobulin E (IgE) levels to HDM were categorized into 6 classes. RESULTS: The mean time until achieving remission was 4.9±0.1 years, and the cumulative incidence of remission from AR was 76.6%. Severe AR (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.69; P=0.001), specific IgE levels to HDM ≥17.5 kU/L (OR, 1.85; 95% CI, 1.01-3.37; P=0.045), and duration of immunotherapy ≥3 years (OR, 7.37; 95% CI, 3.50-15.51; P<0.001) were identified as significant predictors of clinical remission during SCIT for patients with AR sensitized to HDM. Overall, 73 patients (24.0%) experienced adverse reactions to SCIT, and only 1 case of anaphylaxis (0.3%) developed. CONCLUSIONS: SCIT with HDM was found to be effective and safe for patients with AR. Specific IgE levels to HDM and a duration of SCIT ≥3 years may be predictors of clinical responses to SCIT in AR patients.
Adult ; Allergens ; Aluminum ; Anaphylaxis ; Asthma ; Desensitization, Immunologic ; Dust ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Immunotherapy ; Incidence ; Life Tables ; Medical Records ; Pollen ; Pyroglyphidae ; Retrospective Studies ; Rhinitis, Allergic ; Tertiary Care Centers