Moyamoya disease is a cerebrovascular disorder of unknown cause, characterized by slowly progressive bilateral stenosis or occlusion of the internal carotid arteries and produces collateral vessels. Moyamoya syndrome has rarely been reported in association with Graves' disease, especially in children. Several reports suggest that a cerebral infarction might have occurred in patients with clinical and laboratory evidence of hyperthyroid function. We report a case of Moyamoya disease in a girl with Down syndrome and thyrotoxicosis, and we review the relevant literature. To our best knowledge, this is the first report of Moyamoya disease associated with thyrotoxicosis in a young person in Korea.
Down Syndrome/complications ; Female ; Humans ; Korea ; Moyamoya Disease/*complications/*diagnosis ; Thyrotoxicosis/*complications ; Young Adult

PURPOSE: It is widely known that allergic diseases progress through an allergic march. However, there have not been any recent reports in Korea on how the diseases progress. METHODS: Parents who visited one of the Pediatric Allergy Clinics of four university hospitals in Seoul with a child under the age of 6 years during the period from May 1-30, 2006 were asked to complete a questionnaire. RESULTS: A total of 229 parents answered the questionnaire about their children, of which 122 were male and 107 were female. The most common allergic disease before 2 years of age was atopic dermatitis (79%). Meanwhile, in 2- to 4-year age group, allergic rhinitis (38%) and asthma (37%) were predominant. The most common allergic disease in the 4- to 6-year age group was asthma (72%), followed by allergic rhinitis (64%). Seventy-three percent of the children had a family history of allergic disease, most often in the fathers (39%). Among patients with allergic rhinitis, 50% had experienced asthma in their earlier days and 30% had experienced atopic dermatitis. In addition, 57% of the children with asthma had suffered from atopic dermatitis. Parents believed that asthma was the most serious allergic disease. CONCLUSION: In the present study, allergic disease showed a tendency to march from atopic dermatitis to asthma and then to allergic rhinitis. Early diagnosis and treatment of atopic dermatitis is, therefore, considered important for prevention of the allergic march.
Asthma ; Child ; Dermatitis, Atopic ; Early Diagnosis ; Fathers ; Female ; Hospitals, University ; Humans ; Hypersensitivity ; Korea ; Male ; Parents ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial

PURPOSE: There is currently no information regarding predisposing factors for chronic and recurrent rhinosinusitis (RS), although these are considered to be multifactorial in origin, and allergic diseases contribute to their pathogenesis. We evaluated the predisposing factors that may be associated with chronic and recurrent RS. METHODS: In this prospective study, we examined patients with RS younger than 13 years of age, diagnosed with RS at six tertiary referral hospitals in Korea between October and December, 2006. Demographic and clinical data related to RS were recorded and analyzed. RESULTS: In total, 296 patients were recruited. Acute RS was the most frequent type: 56.4% of the patients had acute RS. The prevalences of other types of RS, in descending order, were chronic RS (18.9%), subacute RS (13.2%), and recurrent RS (11.5%). Factors associated with recurrent RS were similar to those of chronic RS. Patients with chronic and recurrent RS were significantly older than those with acute and subacute RS. The prevalences of allergic rhinitis, atopy, and asthma were significantly higher in patients with chronic and recurrent RS than those with acute and subacute RS. CONCLUSIONS: An association between atopy and chronic/recurrent RS, compared to acute and subacute RS, suggests a possible causal link.
Aluminum Hydroxide ; Asthma ; Carbonates ; Child ; Humans ; Korea ; Prevalence ; Prospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Tertiary Care Centers

PURPOSE: A life threatening systemic anaphylaxis can be caused by a food allergy, and the complete avoidance of all foods containing problematic allergens is the only way to manage food allergies. To prevent unexpected exposure to causative foods, food labeling systems have developed and are used in Korea. This study was conducted to evaluate the consumer's use and satisfaction of food labels, and to make recommendations for improving food labels. METHODS: A total of 962 subjects from 7 university hospitals, 130 adults had adverse food reactions (adult-AFR), 177 parents of children/adolescents that had AFR (parent-AFR), and 655 adults did not have AFR or no family history of AFR (no-AFR), were enrolled. We evaluated the use and satisfaction of food labels using a questionnaire. RESULTS: Only 25.4% of adult-AFR and 49.7% of parent-AFR, read food labels. Over 73% of the subjects were not satisfied with current labeling system, and the information was thought to be difficult to find or read, incorrect or insufficient, and required more information. The major suspected causes of AFR in adults were peach, egg, milk, mackerel, peanut/tree nuts, crab, shrimp and milk, peach, shrimp, pork and peanut/tree nuts in children/adolescent. Among the 12 foods enrolled in Korean allergic food labeling system, from the consumer's aspects, the most important items were egg, milk, peanut, mackerel and pork. CONCLUSION: The consumer's use and satisfaction of allergic food labels was very low. Thus, we need to improve consumer's accessibility and develop an education and information system for food labels.
Adult ; Allergens ; Anaphylaxis ; Food Hypersensitivity ; Food Labeling ; Hospitals, University ; Humans ; Information Systems ; Korea ; Milk ; Nuts ; Ovum ; Parents ; Perciformes ; Prunus persica

BACKGROUND: Atopic dermatitis(AD) and urticaria(UR) are common allergic diseases associated with various food allergens. We evaluated possible differences of sensitization rates to egg, milk, and soy bean according to the age in children with AD and UR. MATERIALS AND METHOD: One hundred and thirty-six patients(n=100 in AD, n=36 in UR) who had visited Samsung Medical Center from January 1998 to February 2000 were enrolled and divided into 3 groups by age: gruop I, children under 1year of age (45 in AD, 17 in UR); group II, between 1 and 3 years of age (32 in AD, 12 in UR); and group III, children over 3 years of age (23 in AD, 7 in UR). Total and specific IgE to cow milk, a-lactalbumin(a-LA), beta-lactoglobulin(beta-LG), casein, soy, egg white(EW) and egg yolk(EY) were measured by RAST or CAP system. RESULTS: Total IgE was highest in group III of AD patients(p<0.05), while there were no significant differences among the three groups of UR patients(p>0.05). The most common allergen among AD patients was EW(54%) for all age groups (51.1% in group I, 56.3% in group II, 56.5% in group III), while among UR patients, beta-LG(22.2%) was the most common food allergen, especially beta-LG(35.3%) in Group I, CM/casein(27.3%) in Group II, and CM/alpha-LA/casein/EW(12.5%) in Group III. Sensitization rate to EW, EY and soy bean were higher in AD than in UR(p<0.05). CONCLUSION: Sensitization rate to egg was higher in patients with AD than in those with UR. Restriction of eggs maybe helpful in management of infants with a family history of AD.
Allergens ; Caseins ; Child* ; Dermatitis, Atopic* ; Eggs ; Humans ; Immunoglobulin E ; Infant ; Milk* ; Ovum* ; Soy Milk* ; Soybeans ; Urticaria*

PURPOSE: This study aimed to analyze the prevalence of allergic diseases in Korean schoolchildren according to their residential areas in 2010. METHODS: A nationwide, cross-sectional study was conducted in children aged 6-7 years (n=4,003) and adolescents aged 12-13 years (n=4,112) who were randomly selected. Demographic and disease-related information was obtained through a Korean version of ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire, and skin prick tests for 18 inhalant allergens were performed. RESULTS: There was statistically significant regional difference in the prevalence of allergic rhinitis (AR) (P<0.05). The regions with highest and lowest prevalence in 12- to 13-year-old children were as follows: Chungcheong and Honam in "Diagnosis of AR, ever" (33.7% vs. 24.5%), Jeju and Yeongnam in "Treatment of AR, last 12 months" (25.5% vs. 18.0%), Chungcheong and Yeongnam in "Rhinitis with sensitization" (31.6% vs. 23.6%). The regions with highest and lowest prevalence in 6-7 years old children were as follows: Yeongnam and Seoul in "Diagnosis of AR, ever" (42.1% vs. 31.0%), Yeongnam and Jeju in "Treatment of AR, last 12 months" (31.8% vs. 21.9%), Jeju and Seoul in "Rhinitis with sensitization" (26.0% vs. 18.4%). We also found a regional difference in inhalant allergens among the children with "rhinitis with sensitization" CONCLUSION: The prevalence of AR in children differs according to residential areas in a nationwide survey in 2010 while there is no significant regional difference in the prevalence of asthma and AD.
Adolescent ; Allergens ; Asthma ; Child* ; Cross-Sectional Studies ; Dermatitis, Atopic ; Humans ; Hypersensitivity ; Prevalence* ; Rhinitis ; Seoul ; Skin ; Surveys and Questionnaires

Diagnosis of asthma is often challenging in primary-care physicians due to lack of tools measuring airway obstruction and variability. Symptom-based diagnosis of asthma utilizing objective diagnostic parameters and appropriate software would be useful in clinical practice. A total of 302 adult patients with respiratory symptoms responded to a questionnaire regarding asthma symptoms and provoking factors. Questions were asked and recorded by physicians into a computer program. A definite diagnosis of asthma was made based on a positive response to methacholine bronchial provocation or bronchodilator response (BDR) testing. Multivariate logistic regression analysis was used to evaluate the significance of questionnaire responses in terms of discriminating asthmatics. Asthmatic patients showed higher total symptom scores than non-asthmatics (mean 5.93 vs. 4.93; p<0.01). Multivariate logistic regression analysis identified that response to questions concerning the following significantly discriminated asthmatics; wheezing with dyspnea, which is aggravated at night, and by exercise, cold air, and upper respiratory infection. Moreover, the presence of these symptoms was found to agree significantly with definite diagnosis of asthma (by kappa statistics). Receiver-operating characteristic curve analysis revealed that the diagnostic accuracy of symptom-based diagnosis was high with an area under the curve of 0.647+/-0.033. Using a computer-assisted symptom-based diagnosis program, it is possible to increase the accuracy of diagnosing asthma in general practice, when the facilities required to evaluate airway hyperresponsiveness or BDR are unavailable.
Adult ; Asthma/*diagnosis/*pathology ; *Bronchial Provocation Tests ; Bronchodilator Agents/pharmacology ; *Diagnosis, Computer-Assisted ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Questionnaires ; ROC Curve ; Regression Analysis ; Sensitivity and Specificity

Oral food challenge is a definitive diagnostic test for immediate and occasionally delayed adverse reaction to foods. The gold standard for diagnosing food allergy is still the double-blind, placebo-controlled food challenge, but it is time-consuming, expensive and troublesome for physician and patients. Open oral food challenge controlled by trained personnel is useful and sufficient methods when concern of bias is low. We aimed to provide a practical guideline for oral food challenge in children for the diagnosis of suspected food allergy or the evaluation of food tolerance. We considered reasons, types, indications, contraindications, risks, benefits, detailed methods, practical performance, interpretations of test results, and treatments for the adverse reactions of oral food challenge.
Bias (Epidemiology) ; Child ; Diagnostic Tests, Routine ; Food Hypersensitivity ; Humans

We performed this study to assess the prevalence of sensitization to aeroallergens and to analyze the difference between prevalence rates according to children's ages and residential areas. In this nationwide cross-sectional study, first grade students of 45 elementary schools and 40 middle schools were randomly selected, and skin prick tests were performed for 18 inhalant allergens between October and November 2010. Of 7,829 analyzed subjects, 3,753 (47.9%) were sensitized to at least one aeroallergen. Sensitization to Dermatophagoides farinae was found to be the most prevalent in elementary schoolchildren (32.4%), followed by Dermatophagoides pteronyssinus, Tyrophagus putrescentiae, Japanese hop, and oak. In middle schoolchildren, D. pteronyssinus yielded the highest prevalence (42.7%), followed by D. farinae, T. putrescentiae, Japanese hop, and cat. In middle schoolchildren, the sensitization rate to aeroallergens in metropolitan, urban, and rural areas was 57.2%, 54.3%, and 49.8%, respectively (P = 0.019). In this age group, the sensitization rate in low, middle, high, and very high income groups was 53.8%, 51.8%, 59.0%, and 59.6%, respectively (P = 0.002). In conclusion, the sensitization rate is 47.9% and house dust mite is the most prevalent allergen in the pediatric population in Korea. The rate is higher in metropolitan areas and the highest income group than in rural areas and low income groups.
Adolescent ; Age Factors ; Air Pollutants/*immunology ; Allergens/*immunology ; Animals ; Child ; Cross-Sectional Studies ; Demography ; Female ; Humans ; Hypersensitivity/*diagnosis/epidemiology/immunology ; Male ; Pyroglyphidae/immunology ; Republic of Korea ; Rural Population ; Sex Factors ; Skin Tests ; Socioeconomic Factors ; Urban Population

The present study aimed to investigate the distribution of total serum immunoglobulin E (IgE) levels in Korean schoolchildren and to evaluate its utility in the prediction of atopy and allergic diseases. A nationwide, cross-sectional survey was conducted in first grade students from randomly selected elementary and middle schools. Total IgE levels were measured by ImmunoCAP. Skin prick tests were performed for 18 common inhalant allergens to determine the presence of atopy. Children aged 12–13 years and parents of children aged 6–7 years were asked to complete questionnaire assessing allergic diseases. The cut-off levels of total IgE were determined by analyzing receiver operating characteristic curves. The median total IgE level was 86.7 kU/L (range: 1.5–4,523.1) in 3,753 children aged 6–7 years and 94.7 kU/L (range: 1.5–3,000.0) in 3,930 children aged 12–13 years. Total IgE concentrations were higher in children with atopy or allergic diseases than in those without (all P < 0.001). At the cut-off value of 127.7 kU/L, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 67.1%, 75.4%, 65.4%, and 76.7%, respectively, in elementary schoolchildren. At the cut-off value of 63.0 kU/L, sensitivity, specificity, PPV, and NPV were 81.9%, 66.6%, 75.0%, and 75.1%, respectively, in middle schoolchildren. PPV and NPV were ≥ 70% when cut-offs of 258.8 kU/L and 38.4 kU/L were used for the diagnosis of atopy in 6–7 year-olds and 12–13 year-olds, respectively. This nationwide population-based study provided the first normal reference ranges of total IgE in Korean schoolchildren.
Allergens ; Child ; Cross-Sectional Studies ; Diagnosis ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Immunoglobulins* ; Korea ; Parents ; Reference Values* ; ROC Curve ; Sensitivity and Specificity ; Skin