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A Case of Idiopathic Anaphylaxis Followed by Acute Liver Injury.

Sujeong KIM ; Sun Young YOON ; So Young PARK ; Hyouk Soo KWON ; You Sook CHO ; Hee Bom MOON ; Tae Bum KIM

Allergy, Asthma & Immunology Research.2013;5(4):245-247. doi:10.4168/aair.2013.5.4.245

Idiopathic anaphylaxis is characterized by recurrent anaphylaxis without a known trigger. The coexistence of acute liver injury with idiopathic anaphylaxis is rare, even in cases of severe anaphylaxis such as shock. An unusual case involving repeated episodes of anaphylactic shock accompanied by acute liver injury is described here. A 36-year-old woman who experienced anaphylaxis due to an unknown cause was referred to our hospital because of marked elevations in her liver enzyme levels. After a thorough evaluation to determine the cause of the acute liver injury, viral infection, drug use, and autoimmune hepatitis were excluded. The episodes were accompanied by elevated liver enzymes, which suggested that this was a case of anaphylaxis followed by acute liver injury. The patient will have to use self-injectable epinephrine to prevent future hepatic failure.
Anaphylaxis ; Epinephrine ; Female ; Hepatitis, Autoimmune ; Humans ; Liver ; Liver Failure ; Shock

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Acute Eosinophilic Pneumonia Leading to Acute Respiratory Failure in a Current Systemic Corticosteroid User.

Hwa Yong SHIN ; Ju Won CHOE ; Minsuk KWON ; Ju Young JANG ; Jae Woo JUNG ; Jae Chol CHOI ; Jong Wook SHIN ; In Won PARK ; Byoung Whui CHOI ; Jae Yeol KIM

Allergy, Asthma & Immunology Research.2013;5(4):242-244. doi:10.4168/aair.2013.5.4.242

A 69-year-old female patient visited the emergency room with fever (38.3degrees C) and dyspnea. She had been taking prednisolone (5 mg once per day) and methotrexate (2.5 mg once per week) for rheumatoid arthritis for 2 years. Chest computed tomography (CT) showed bilateral, multifocal ground glass opacity with interlobular septal thickening. Peripheral blood leukocyte count was 6,520/mm3 (neutrophils, 77.4%; eosinophils, 12.1%). During the night, mechanical ventilation was initiated due to the development of severe hypoxemia. Bronchoalveolar lavage fluid showed a high proportion of eosinophils (49%). Her symptoms improved dramatically after commencement of intravenous methylprednisolone therapy. This is the first report of idiopathic acute eosinophilic pneumonia developing in a current user of systemic corticosteroids.
Adrenal Cortex Hormones ; Anoxia ; Arthritis, Rheumatoid ; Bronchoalveolar Lavage Fluid ; Dyspnea ; Emergencies ; Eosinophils ; Female ; Fever ; Glass ; Humans ; Leukocyte Count ; Methotrexate ; Methylprednisolone ; Prednisolone ; Pulmonary Eosinophilia ; Respiration, Artificial ; Respiratory Insufficiency ; Thorax

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Breastfeeding Might Have Protective Effects on Atopy in Children With the CD14C-159T CT/CC Genotype.

So Yeon LEE ; Mi Jin KANG ; Ji Won KWON ; Kang Seo PARK ; Soo Jong HONG

Allergy, Asthma & Immunology Research.2013;5(4):239-241. doi:10.4168/aair.2013.5.4.239

Breastfeeding is widely recommended to reduce risk of sensitization, eczema and asthma. However, the role of breastfeeding in prevention of allergic diseases is uncertain. We aimed to investigate whether the relationship between breastfeeding and sensitization to aeroallergens is modified by cluster of differentiation 14 (CD14) genotype. This study included 1,828 school children aged 9-12. We administered a detailed questionnaire and genotyped the CD14C-159T polymorphism. Skin prick tests for 12 aeroallergens were performed. School children who had been breastfed were less likely sensitized to aeroallergens (adjusted odds ratio [aOR] 0.712, 95% confidence interval [CI]: 0.555-0.914). There was no significant association between CD14C-159T genotype and atopy. Breastfeeding was associated with a decreased risk of atopic sensitization in children with CT/CC genotype (aOR 0.667, 95% CI: 0.463-0.960). Our data might identify the gene-environment interaction between the CD14C-159T polymorphism and breastfeeding in relation to aeroallergen sensitization.
Aged ; Asthma ; Breast Feeding ; Child ; Eczema ; Gene-Environment Interaction ; Genotype ; Humans ; Odds Ratio ; Skin ; Surveys and Questionnaires

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Rhinitis Patients With Sputum Eosinophilia Show Decreased Lung Function in the Absence of Airway Hyperresponsiveness.

Min Suk YANG ; Hyun Seung LEE ; Min Hye KIM ; Woo Jung SONG ; Tae Wan KIM ; Jae Woo KWON ; Sae Hoon KIM ; Heung Woo PARK ; Yoon Seok CHANG ; Sang Heon CHO ; Kyung Up MIN

Allergy, Asthma & Immunology Research.2013;5(4):232-238. doi:10.4168/aair.2013.5.4.232

PURPOSE: Sputum eosinophilia is observed frequently in patients with rhinitis. Sputum eosinophilia in patients with non-asthmatic allergic rhinitis has been suggested to be related to nonspecific airway hyperresponsiveness (AHR). However, the clinical significance of sputum eosinophilia in patients with non-asthmatic rhinitis without AHR has not been determined. We conducted a retrospective study examining the influence of sputum eosinophilia in patients with non-asthmatic rhinitis without AHR on pulmonary function and expression of fibrosis-related mediators. METHODS: Eighty-nine patients with moderate-to-severe perennial rhinitis without AHR were included. All underwent lung function tests (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), skin tests to inhalant allergens, methacholine bronchial challenge tests, and hypertonic saline-induced sputum to determine eosinophil counts. Sputum mRNA levels for transforming growth factor-beta (TGF-beta), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were also examined. Patients were divided into two groups according to the presence of sputum eosinophilia (> or =3%, eosinophilia-positive [EP] and <3%, eosinophilia-negative [EN] groups). RESULTS: FEV1 was significantly lower (P=0.04) and FEV1/FVC tended to be lower (P=0.1) in the EP group than in the EN group. In sputum analyses, the MMP-9 mRNA level (P=0.005) and the ratio of MMP-9 to TIMP-1 expression (P=0.01) were significantly higher in the EP group than in the EN group. There was no significant difference in TGF-beta mRNA expression between the two groups. CONCLUSIONS: Sputum eosinophilia in patients with moderate-to-severe perennial rhinitis without AHR influenced FEV1 and the expression pattern of fibrosis-related mediators.
Allergens ; Bronchial Provocation Tests ; Eosinophilia ; Eosinophils ; Forced Expiratory Volume ; Humans ; Lung ; Matrix Metalloproteinase 9 ; Methacholine Chloride ; Respiratory Function Tests ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; RNA, Messenger ; Skin Tests ; Sputum ; Tissue Inhibitor of Metalloproteinase-1 ; Transforming Growth Factor beta ; Vital Capacity

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Effect of Prostaglandin E2 on Vascular Endothelial Growth Factor Production in Nasal Polyp Fibroblasts.

Dong Yeol HAN ; Jung Sun CHO ; You Mi MOON ; Hye Rim LEE ; Heung Man LEE ; Byung Don LEE ; Byoung Joon BAEK

Allergy, Asthma & Immunology Research.2013;5(4):224-231. doi:10.4168/aair.2013.5.4.224

PURPOSE: Angiogenesis is involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. We aimed to investigate the effects of prostaglandin E2 (PGE2) on vascular endothelial growth factor (VEGF) production, the role of E-prostanoid (EP) 4 receptors, and the signal transduction pathway mediating VEGF production in nasal polyp-derived fibroblasts (NPDFs). METHODS: Eight primary NPDF cultures were established from nasal polyps, which were incubated with or without PGE2. Reverse transcription-polymerase chain reaction amplification of EP receptors (EP1, EP2, EP3, and EP4) and immunofluorescence staining for VEGF production were performed. VEGF production via the cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) and phosphatidylinositol 3-kinase (PI3K) pathways was evaluated by enzyme-linked immunosorbent assay. RESULTS: All EP receptors were expressed in NPDFs. PGE2 significantly increased VEGF production concentration- and time dependently, and VEGF production was regulated by an EP4 receptor. Activation of intracellular cAMP regulated VEGF production. VEGF production was decreased by PKA and PI3K inhibitors via intracellular cAMP. CONCLUSIONS: PGE2 stimulates VEGF production via the EP4 receptor in NPDFs. These results indicate that PGE2-induced VEGF production is mediated, at least partially, through cAMP-dependent signaling pathways. Therapies targeting the EP4 receptor may be effective in inhibiting the development of nasal polyps.
Adenosine Monophosphate ; Cyclic AMP-Dependent Protein Kinases ; Dinoprostone ; Fibroblasts ; Fluorescent Antibody Technique ; Nasal Polyps ; Negotiating ; Phosphatidylinositol 3-Kinase ; Signal Transduction ; Vascular Endothelial Growth Factor A

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Rhinovirus-Infected Epithelial Cells Produce More IL-8 and RANTES Compared With Other Respiratory Viruses.

Yoon Hong CHUN ; Ju Young PARK ; Huisu LEE ; Hyun Sook KIM ; Sulmui WON ; Hyun Jung JOE ; Woo Jin CHUNG ; Jong Seo YOON ; Hyun Hee KIM ; Jin Tack KIM ; Joon Sung LEE

Allergy, Asthma & Immunology Research.2013;5(4):216-223. doi:10.4168/aair.2013.5.4.216

PURPOSE: The environmental factors human rhinoviruses (HRVs) and house dust mites (HDMs) are the most common causes of acute exacerbations of asthma. The aim of this study was to compare the chemokine production induced by HRVs in airway epithelial cells with that induced by other respiratory viruses, and to investigate synergistic interactions between HRVs and HDMs on the induction of inflammatory chemokines in vitro. METHODS: A549 human airway epithelial cells were infected with either rhinovirus serotype 7, respiratory syncytial virus (RSV)-A2 strain, or adenovirus serotype 3 and analyzed for interleukin (IL)-8 and regulated on activation, normal T-cell expressed and secreted (RANTES) release and mRNA expression. Additionally, activation of nuclear factor (NF)-kappaB and activator protein (AP)-1 were evaluated. The release of IL-8 and RANTES was also measured in cells stimulated simultaneously with a virus and the HDM allergen, Der f1. RESULTS: HRV caused greater IL-8 and RANTES release and mRNA expression compared with either RSV or adenovirus. NF-kappaB and AP-1 were activated in these processes. Cells incubated with a virus and Der f1 showed an increased IL-8 release. However, compared with cells incubated with virus alone as the stimulator, only HRV with Der f1 showed a statistically significant increase. CONCLUSIONS: IL-8 and RANTES were induced to a greater extent by HRV compared with other viruses, and only HRV with Der f1 acted synergistically to induce bronchial epithelial IL-8 release. These findings may correspond with the fact that rhinoviruses are identified more frequently than other viruses in cases of acute exacerbation of asthma.
Adenoviridae ; Antigens, Dermatophagoides ; Arthropod Proteins ; Asthma ; Chemokine CCL5 ; Chemokines ; Cysteine Endopeptidases ; Epithelial Cells ; Humans ; Interleukin-8 ; Interleukins ; NF-kappa B ; Pyroglyphidae ; Respiratory Syncytial Viruses ; Rhinovirus ; RNA, Messenger ; Sprains and Strains ; T-Lymphocytes ; Transcription Factor AP-1 ; Viruses

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Mutations in the Filaggrin are Predisposing Factor in Korean Children With Atopic Dermatitis.

Ho Sung YU ; Mi Jin KANG ; Young Ho JUNG ; Hyung Young KIM ; Ju Hee SEO ; Young Joon KIM ; Seung Hwa LEE ; Ha Jung KIM ; Ji Won KWON ; Byoung Ju KIM ; Jinho YU ; Soo Jong HONG

Allergy, Asthma & Immunology Research.2013;5(4):211-215. doi:10.4168/aair.2013.5.4.211

PURPOSE: Filaggrin (FLG) is a key protein that facilitates the terminal differentiation of the epidermis and the formation of the skin barrier. Recent studies showed that atopic dermatitis (AD) associates closely with loss-of-function mutations in the FLG gene. Asian and European populations differ in the frequencies of FLG mutations. Several FLG mutations, including 3321delA, E2422X, K4671X, S2554X, and R501X, occur frequently in Chinese and Japanese populations. The association between three FLG null mutations and AD in Korean children was investigated. METHODS: The FLG mutations in 1,430 children (aged 0-18 years) with AD and 862 control subjects were genotyped by using the TaqMan assay. RESULTS: The FLG null mutation E2422X was not detected in any patients with AD or control subjects. The R501X null mutation was detected in only one child with AD (0.1%). Children with AD had the 3321delA deletion significantly more frequently (2.4%) than the control subjects (0.0%, P<0.001). Children with AD also had a significantly higher combined allele frequency of the three FLG null mutations (2.6%) than the controls (0.0%, P<0.001). The 3321delA null mutation did not associate significantly with AD severity (P=0.842). When the patients with AD were divided into allergic AD and non-allergic AD patient groups, these two groups did not differ in terms of the frequency of 3321delA. CONCLUSIONS: The Korean children had a lower frequency of FLG mutations than European populations. FLG null mutations may be associated with the development of AD in Korean children.
Asian Continental Ancestry Group ; Child ; Dermatitis, Atopic ; Epidermis ; Gene Frequency ; Humans ; Intermediate Filament Proteins ; Skin

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Correlation Between Serum Vitamin D Level and the Severity of Atopic Dermatitis Associated With Food Sensitization.

Seon Ah LEE ; Soyoung HONG ; Hyun Jung KIM ; Soo Hyung LEE ; Hye Yung YUM

Allergy, Asthma & Immunology Research.2013;5(4):207-210. doi:10.4168/aair.2013.5.4.207

PURPOSE: A growing body of literature has linked vitamin D deficiency with allergic diseases, particularly atopic dermatitis (AD). In this study, we investigated the association between serum vitamin D status and the clinical manifestation of AD. We also developed an analytical method for the simultaneous determination of 25-hydroxy vitamin D3 (25(OH)D3), using liquid chromatography (LC) coupled with tandem mass spectrometry (MS/MS). METHODS: This study included 157 patients (79 males and 78 females) with AD, aged 4 months to 56 years. We evaluated disease severity using the SCORing Atopic Dermatitis (SCORAD) index. Serum levels of 25(OH)D3 were determined by LC coupled with MS/MS. Total IgE and specific IgE levels were assayed using the immunoCAP system. ANOVA was used for statistical evaluation. RESULTS: We found mild, moderate, and severe AD in 30 (11.1%), 87 (55.4%), and 40 (25.5%) patients, respectively. There was no significant correlation between serum levels of 25(OH)D3 and AD severity. However, among the 36 patients with food sensitization, the mean+/-SD serum levels of 25(OH)D3 were significantly higher (P<0.05) in patients with mild disease (21.2+/-5.18 ng/mL) compared with the levels in patients with moderate (17.9+/-4.02 ng/mL) or severe AD (13.3+/-5.11 ng/mL) disease. CONCLUSIONS: These results suggest that vitamin D deficiency is related to the severity of AD associated with food sensitization. Thus, these data suggest a role for vitamin D in a select group of AD patients.
Aged ; Cholecalciferol ; Chromatography, Liquid ; Dermatitis, Atopic ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Male ; Tandem Mass Spectrometry ; Vitamin D ; Vitamin D Deficiency ; Vitamins

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A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test.

Jakyoung KIM ; Shinyoung PARK ; Chul Min JUNG ; Chee Won OH ; Jae Woo KWON

Allergy, Asthma & Immunology Research.2017;9(3):281-284. doi:10.4168/aair.2017.9.3.281

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.
Cycloserine ; Diagnosis ; Drug Eruptions* ; Drug Hypersensitivity ; Humans ; Lichenoid Eruptions ; Lymphocyte Activation* ; Lymphocytes* ; Patch Tests

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Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review.

Jae Won SONG ; Young Sook JANG ; Moon Chan JUNG ; Joo Hee KIM ; Jeong Hee CHOI ; Sunghoon PARK ; Yong Il HWANG ; Seung Hun JANG ; Ki Suck JUNG

Allergy, Asthma & Immunology Research.2017;9(3):278-280. doi:10.4168/aair.2017.9.3.278

Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication.
Anaphylaxis* ; Angioedema ; Antitussive Agents ; Basophils ; Chiroptera ; Common Cold ; Cough ; Drug-Related Side Effects and Adverse Reactions ; Dyspnea ; Exanthema ; Humans ; Hypersensitivity ; Neuropeptides ; Pharmacovigilance ; Skin ; Skin Tests ; Urticaria

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