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Kimura Disease Associated with Allergy and Remote Parasite Infection.

Eun Sil PARK ; Hyun Jung KIM ; Jung Hee LEE ; Gyung Hyuck KO ; Ji Hyoun SEO ; Jae Young LIM ; Chan Hoo PARK ; Hyang Ok WOO ; Hee Shang YOUN

Pediatric Allergy and Respiratory Disease.2006;16(4):349-354.

Kimura disease is rare chronic inflammatory disorder of an unknown etiology and it has a predilection for males of Asian descent. It typically presents with non-tender subcutaneous swellings in the head and neck region, peripheral eosinophilia and an elevated immunoglobulin E level. We present here the case of 8-year-old boy with a past history of food allergy, and he developed swelling of the left neck and incidental eosinophilia. Kimura disease was diagnosed on the basis of the clinical and histological findings. The serum IgG titer of cysticercosis was twice the normal level. After surgical excision of the subcutaneous lesion, the patients eosinophilia was dramatically decreased. We suggest that allergy and remote parasite infection may be the causality or a triggering factor for Kimura disease.
Angiolymphoid Hyperplasia with Eosinophilia* ; Asian Continental Ancestry Group ; Child ; Cysticercosis ; Eosinophilia ; Food Hypersensitivity ; Head ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Male ; Neck ; Parasites*

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A Case of Huge Mediastinal Lipoma Incidentally Found in a 13-Year-Old Boy.

Su Myung LEE ; Jong Min KIM ; Kyung Won KIM ; Eun Soo KIM ; Dae Joon KIM ; Myung Hyun SOHN ; Myung Joon KIM ; Kyu Earn KIM

Pediatric Allergy and Respiratory Disease.2006;16(4):345-348.

Lipomas are the most common benign neoplasm and usually arise in the subcutaneous tissue. The trunk and proximal limbs are the most frequent sites. Mediastinal lipoma is an uncommon benign neoplasm of mediastinum(1-5% of all lipomas). They are most often located in the anterior mediastinum. They can occur singly or multiply in the mediastinum and can stimulate cardiomegaly or pleural effusion on chest X-ray. They are usually well circumscribed and encapsulated but can grow to be quite large:greater than 20 cm and 4 kg in size. A 13-year-old boy was asymptomatic and coincidentally found to have a large soft tissue density in chest X-ray. Computer tomography showed an anterior mediastinal mass consistent of a fat density and vascular structure. Thymus, in the right upper lobe showed mass effect. The mass was surgically excised and pathologically confirmed lipoma. We hereby present the case with review of literature.
Adolescent* ; Cardiomegaly ; Child ; Extremities ; Humans ; Lipoma* ; Male* ; Mediastinal Neoplasms ; Mediastinum ; Pleural Effusion ; Subcutaneous Tissue ; Thorax ; Thymus Gland

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Clinical course of Chronic Intractable Sinusitis in Children.

Soo Jin LEE ; Young Min AHN ; Jung A HUR

Pediatric Allergy and Respiratory Disease.2006;16(4):335-344.

PURPOSE:Chronic intractable sinusitis is a sinus infection persisting for more than 3 months and characterized by refractoriness to conventional treatment. Despite much research on pathogenesis and treatment, its prevalence is reported to be on the increase and the management of chronic sinusitis has also become increasingly problematic for pediatricians. So we evaluated the effectiveness of treatments targetted the causes and followed the course of childhood chronic sinusitis persisting for more than 3 months despite maximal medical therapy. METHODS:We followed up 41 patients diagnosed as chronic intractable sinusitis between January 1998 and December 2002 at the Department of Pediatrics, Kangnam General Hospital (Seoul Medical Center). The mean age was 4 years and the female to male ratio was 1.2:1. The duration of follow-up was 4.2 years. From medical records and questionnaires, a composite symptom score and medication use outcome (good/bad result) was created by assigning points to each category of symptom score and use of medication. Nasal endoscopy, allergy skin prick test, and serum immunoglobulin level checks were performed in all patients. CT scans were done in 3 patients and saccharin tests for diagnosis of ciliary dysfunction in 6 patients. A 24 hour pH mornitoring, esophagography, and upper GI endoscopy were done in 1 patient, respectively. RESULTS:Adenoidectomy was done in 17 patients. Fifteen patients with adenoidectomies were assessed to have good results. Among them, 4 patients had concommitant alleric rhinitis treatments, 1 patient a GERD treatment. Two patients with adenoidectomies were assessed to have bad results. Twenty-four patients without adenoidectomies were assessed to have good results. Among the 7 patients with underlying allergic rhinitis, 4 patients improved after immunotherapy. Two patients had polypectomies and 15 patients improved with medical management of sinusitis. One patients had functional endoscopic sinus surgery. CONCLUSION:If medical treatments with management of underlying diseases including immunotherapy, GERD management, and adenoidectomy are done, functional endoscopic sinus surgery is rarely necessary for treatment of chronic sinusitis in children.
Adenoidectomy ; Child* ; Diagnosis ; Endoscopy ; Female ; Follow-Up Studies ; Gastroesophageal Reflux ; Hospitals, General ; Humans ; Hydrogen-Ion Concentration ; Hypersensitivity ; Immunoglobulins ; Immunotherapy ; Male ; Medical Records ; Pediatrics ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Saccharin ; Sinusitis* ; Skin ; Tomography, X-Ray Computed

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Comparison of Clinical Characteristics of Mycoplasma pneumoniae Pneumonia According to the Pleural Effusion.

Shin Yun BYUN ; Yun Jin BAE ; Jae Ho YOO ; Jin A JUNG

Pediatric Allergy and Respiratory Disease.2006;16(4):327-334.

PURPOSE:Mycoplasma pneumoniae (M. pneumoniae) is a major cause of respiratory infections in school-aged children. Complications of M. pneumoniae pneumonia include atelectasis, pleural effusion, empyema, pneumothorax and bronchiectasis. We evaluated the clinical characteristics of M. pneumoniae pneumonia with pleural effusion. METHODS:A total of 210 medical records of children who were admitted to the Dong-A University hospital due to M. pneumoniae pneumonia from 2000 to 2004 were retrospectively analyzed. Diagnosis of M. pneumoniae pneumonia was based on the single titer of antimycoplasmal antibody higher than 1:320. Enrolled children were divided into Group A (with pleural effusion) and Group B (without effusion). We analysed the differences between the two groups according to sex, age, onset, symptoms, clinical manifestations, laboratory findings and chest x-rays. RESULTS:There were no significant differences in age, sex and clinical manifestations between the two groups. Group A had longer fever durations (9.3+/-7.8 days vs 5.0+/-3.7 days), and a longer duration of hospitalization (10.4+/-6.3 days vs 6.9+/-6.3 days) compare to Group B. Also, compared to the Group B, Group A had higher ESR (49.6+/-32.9 mm/hr vs 28.7+/-20.4 mm/hr), CRP (23.0+/-60.4 mg/dL vs 8.7+/-30.9 mg/dL), SGOT (67+/-74.2 IU/L vs 53.6+/-60.0 IU/L), SGPT (37.4+/-18.6 IU/L vs 26.2+/-16.9 IU/L). There was no significance between antimycoplasmal antibody titer and pleural effusion. CONCLUSION:This study shows that M. pneumoniae pneumonia with pleural effusion has a longer duration of fever and hospitalization, higher ESR, CRP, SGOT, SGPT compare to the M. pneumoniae pneumonia without pleural effusion. We conclude that these findings could be used as the prognostic factors in M. pneumoniae pneumonia with pleural effusion.
Alanine Transaminase ; Aspartate Aminotransferases ; Bronchiectasis ; Child ; Diagnosis ; Empyema ; Fever ; Hospitalization ; Humans ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pleural Effusion* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Pneumothorax ; Pulmonary Atelectasis ; Respiratory Tract Infections ; Retrospective Studies ; Thorax

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Correlation between Methacholine Bronchial Hyperresponsiveness and Peak Expiratory Flow Variability in Children with Asthma.

Sun Hee LEE ; Do Kyun KIM ; Sun Hee CHOI ; Young Yull KOH

Pediatric Allergy and Respiratory Disease.2006;16(4):317-326.

PURPOSE:Bronchial hyperresponsiveness (BHR) to methacholine and exaggerated peak expiratory flow (PEF) variability are hallmarks of asthma. The aims of our study were to evaluate the relationship between PEF variability and BHR to methacholine and which PEF index correlates best with BHR to methacholine. METHODS:Methacholine challenge test was performed in 73 children having mild to moderate asthma. Those subjects recorded PEF morning and evening before and after bronchodilator for 2 weeks. The response to methacholine challenge was measured by PC20 (provocative concentration causing a 20% fall in FEV1), and seven different PEF variability indices(including prebrochodilator amplitude%mean, postbronchodilator amplitude%mean, standard deviation%mean) were calculated. RESULTS:Geometric mean of methacholine PC20 was 1.7 mg/mL. All PEF variability indices were associated with BHR to methacholine. Among PEF variability indices, two indices showed the best correlation with BHR to methacholine: standard deviation%mean (r=-0.45, P<0.001) and postbronchodilator amplitude%mean (r=-0.42, P<0.001). CONCLUSION:Standard deviation%mean provided the strongest correlation with BHR to methacholine. Meanwhile, postbronchodilator amplitude%mean which is counted easily and is more intuitively visualized manifested similar correlation as standard deviation%mean. Methacholine challenge test and PEF variability were correlated significantly but weakly; therefore we supposed that they do not reflect the same pathophysiological process in the airways.
Asthma* ; Child* ; Humans ; Methacholine Chloride*

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Comparison of Cytokine and Chemokine Production and Activation of NF-kappaB in RSV- and Adenovirus-infected Bronchial Epithelial Cells.

Kyoung Soon CHO ; Ju Young LEE ; Jong Seo YOON ; Yoon LEE ; Hyun Hee KIM ; Joon Sung LEE

Pediatric Allergy and Respiratory Disease.2006;16(4):306-316.

PURPOSE:Our study was designed to evaluate the effects of respiratory syncytial virus (RSV) and adenovirus (Ad) on the production of interleukin (IL)-6, IL-8 and RANTES by BEAS-2B cells. The role of NF-kappaB in the production of those was also studied. METHODS:We studied the concentration of IL-6, IL-8, RANTES in the culture supernatant of BEAS-2B cell infected by RSV, adenovirus type 3 (Ad3), Ad7. The activation of NF-kappaB was also investigated and the role in the production of IL-6, IL-8, RANTES compared among RSV-, Ad3-, and Ad7- infected cells by electromobility shift assay (EMSA). RESULTS:The protein production of RANTES, IL-6, and IL-8 in RSV infection was more than Ad infection. The NF-kappaB binding activities in the promotor genes of RANTES, IL-6, IL-8 appeared in RSV, Ad3, and Ad7. These activities of NF-kappaB were inhibited by each gene specific probe. CONSULSION:We suggest that such differences in the immune responses between RSV and Ad may affect the clinical patterns and prognosis after RSV and Ad infection.
Adenoviridae ; Chemokine CCL5 ; Epithelial Cells* ; Interleukin-6 ; Interleukin-8 ; Interleukins ; NF-kappa B* ; Prognosis ; Respiratory Syncytial Viruses

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The Association between Recent Dietary Pattern as a Risk Factor of 12-month Asthma Symptom Prevalence in Korean Elementary School Children.

Soo Young LEE ; Soo Jong HONG ; Bong Seung KIM ; Chang Keun KIM ; Dong Jean LEE ; Dong Keun LEE ; Young Yul KOH ; Joon Sung LEE

Pediatric Allergy and Respiratory Disease.2006;16(4):296-305.

PURPOSE:To investigate the impact of dietary pattern on the risk of asthma development, we undertook a nation-wide study with ISSAC written questionnaire. METHODS:We analyzed the relations between the previous 12-month dietary patterns (16 food groups) and asthma symptom prevalence, using the ISSAC written questionnaire and a domestically developed dietary questionnaire in 24,260 elementary school children. RESULTS:Odds ratios (OR) were significantly decreased by increased food intake of natural seafood (OR:0.88, P=0.0126, 95% CI:0.795-0.973), fruit (OR:0.785, P<0.0001, 95% CI:0.715-0.861), vegetables (OR:0.825, P<0.0001, 95% CI:0.764-0.891), and cow's milk (OR:0.9, P=0.0451, 95% CI:0.811-0.998). Compared to children that seldom consumed natural seafood, ORs of symptom development were lower in children that ate natural seafood 1-2 times per week (OR:0.863, P=0.028, 95% CI:0.761-0.978) and almost everyday (OR:0.802, P=0.0755, 95% CI:0.630-1.023), respectively. For green vegetables, ORs were significantly lower than in children who also ate gree vegetables 1-2 times per week (OR:0.753, P=0.0416, 95% CI:0.595-0.950) and almost everyday (OR:0.674, P=0.0179, 95% CI:0.408-0.752), respectively. Fruits showed the same pattern as green vegetables. CONCLUSION:Taken together, our study shows that the increased intake of natural seafood, fruit, and vegetables is significantly related to reduced asthma symptom prevalence in Korean children.
Asthma* ; Child* ; Eating ; Fruit ; Humans ; Milk ; Prevalence* ; Surveys and Questionnaires ; Risk Factors* ; Seafood ; Vegetables

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Association between Leptin and Asthma in Children.

Kyung Won KIM ; Kyung Eun LEE ; Eun Soo KIM ; Tae Won SONG ; Jun Young PARK ; Myung Hyun SOHN ; Kyu Earn KIM

Pediatric Allergy and Respiratory Disease.2006;16(4):287-295.

PURPOSE: The prevalences of asthma and obesity have increased substantially during the last several decades in many countries, leading to speculation that obese persons might be at increased risk of asthma development. As a part of the investigation of asthma pathogenesis associated with obesity, we evaluated the role of leptin in childhood asthma and its effect on the levels of atopy markers, pulmonary function and bronchial hyperresponsiveness. METHODS: We studied 126 asthmatic children and 38 healthy children. Body mass index was calculated using height and weight, which were measured on the same day that pulmonary function tests and methacholine challenge tests were performed. Total eosinophil count, total serum IgE, serum eosinophil cationic protein and leptin were measured in all subjects. RESULTS: BMI percentile did not differ between the asthma group and controls. Leptin did not show any difference between asthmatic patients and control subjects in all, male and female participants. Leptin was found to be associated with FEV1 (P<0.01), but not with FVC, FEF25-75% and PC20 in all subjects. Also, there were no correlations between leptin and markers of atopy, which are total eosinophil count, total serum IgE, serum eosinophil cationic protein. CONCLUSION:Our findings suggest that leptin showed close associations with pulmonary function and may have disease-modifying effects in children with asthma.
Asthma* ; Body Mass Index ; Child* ; Eosinophil Cationic Protein ; Eosinophils ; Female ; Humans ; Immunoglobulin E ; Leptin* ; Male ; Methacholine Chloride ; Obesity ; Prevalence ; Respiratory Function Tests

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Association between Asthma and Serum Leptin Level in Obese Children.

Jae Won OH

Pediatric Allergy and Respiratory Disease.2006;16(4):284-286.

No Abstract available.
Asthma* ; Child* ; Humans ; Leptin*

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Diagnosis and Treatment of Food Allergy in Children.

Woo Kyung KIM

Pediatric Allergy and Respiratory Disease.2006;16(4):274-283.

Food allergy is a common allergic manifestation in early childhood. However, some medical practitioners remain sceptical about the role of food allergies in a number of clinical syndromes, such as atopic dermatitis, colic and gastrooesophageal reflux in infancy, despite increasing evidences that food allergy can contribute to these conditions. Symptoms usually begin in the first 2 years of life, often after the first exposure to the known food. Diagnosis is made using medical history and can usually be detected by skin prick testing (SPT) or measuring food-specific serum IgE antibody levels. But to obtain final confirmation a double blind controlled food challenge (DBPCFC) must be performed. Delayed-onset reactions (occurring within several hours to days after ingestion) are often difficult to diagnose. The patients usually show negative SPT, so elimination or challenge protocols are required to make a definitive diagnosis. These forms of food allergy are not usually associated with anaphylaxis. Prevention and treatment are based on the avoidance of the culprit food. Children often develop tolerance to cows milk, egg, soy and wheat by school age, whereas allergies to nuts and shellfish are more likely to be lifelong. This article will help general practitioners and other clinicians understand the principles of diagnosis and management of food allergy in childhood, and suggests when to refer patients to specialist.
Anaphylaxis ; Child* ; Colic ; Dermatitis, Atopic ; Diagnosis* ; Food Hypersensitivity* ; General Practitioners ; Humans ; Hypersensitivity ; Immunoglobulin E ; Milk ; Nuts ; Ovum ; Shellfish ; Skin ; Specialization ; Triticum

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