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Intradermal Tests for Diagnosis of Drug Allergy are not Affected by a Topical Anesthetic Patch.

Mariana COUTO ; Diana SILVA ; Ana FERREIRA ; Josefina R CERNADAS

Allergy, Asthma & Immunology Research.2014;6(5):458-462. doi:10.4168/aair.2014.6.5.458

The use of topical anesthesia to perform intradermal tests (IDTs) for drug allergy diagnosis was never investigated. We aimed to determine the effects of a topical anesthetic patch containing prilocaine-lidocaine on wheal size of IDT with drugs. Patients who had positive IDT as part of their investigation process of suspected drug hypersensitivity were selected. IDT were performed according to guidelines. Anesthetic patch (AP) was placed and the same prior positive IDT, as well as positive histamine skin prick test (SPT) and negative (saline IDT) controls, were performed in the anesthetized area. Patients with negative IDT were also included to check for false positives with AP. Increase in wheals after 20 minutes both with and without AP was recorded and compared. 45 IDT were performed (36 patients), of which 37 have been previously positive (14 antibiotics, 10 general anesthetics, 6 non-steroidal anti-inflammatory drugs, 3 iodinated contrasts, 3 anti-Hi-histamines and 1 ranitidine). Mean histamine SPT size without the AP was 4.7 mm [95%CI (4.4-5.1]), and 4.6 mm [95%CI(4.2-5.0)] with anesthesia. Mean wheal increase in IDT for drugs without the anesthesia was 4.5 mm [95%CI(3.3-5.7)] and with anesthesia was 4.3 mm [95%CI(2.8-5.8)]. No statistical significant differences were observed between skin tests with or without AP for histamine SPT (P=0.089), IDT with saline (P=0.750), and IDT with drugs (P=0.995). None of the patients with negative IDT showed positivity with the AP, or vice-versa. The use of an AP containing prilocaine-lidocaine does not interfere with IDT to diagnose drug allergy, and no false positive tests were found.
Anesthesia ; Anesthetics, General ; Anti-Bacterial Agents ; Diagnosis* ; Drug Hypersensitivity* ; Histamine ; Humans ; Intradermal Tests* ; Skin ; Skin Tests

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Prostaglandin E2 Induces IL-6 and IL-8 Production by the EP Receptors/Akt/NF-kappaB Pathways in Nasal Polyp-Derived Fibroblasts.

Jung Sun CHO ; In Hye HAN ; Hye Rim LEE ; Heung Man LEE

Allergy, Asthma & Immunology Research.2014;6(5):449-457. doi:10.4168/aair.2014.6.5.449

PURPOSE: Interleukin 6 (IL-6) and IL-8 participate in the pathogenesis of chronic rhinosinusitis with nasal polyps, and their levels are increased by prostaglandin E2 (PGE2) in different cell types. The purposes of this study were to determine whether PGE2 has any effect on the increase in the levels of IL-6 and IL-8 in nasal polyp-derived fibroblasts (NPDFs) and subsequently investigate the possible mechanism of this effect. METHODS: Different concentrations of PGE2 were used to stimulate NPDFs at different time intervals. NPDFs were treated with agonists and antagonists of E prostanoid (EP) receptors. To determine the signaling pathway for the expression of PGE2-induced IL-6 and IL-8, PGE2 was treated with Akt and NF-kappaB inhibitors in NPDFs. Reverse transcription-polymerase chain reaction for IL-6 and IL-8 mRNAs was performed. IL-6 and IL-8 levels were measured byenzyme-linked immunosorbent assay (ELISA). The activation of Akt and NF-kappaB was evaluated by western blot analysis. RESULTS: PGE2 significantly increased the mRNA and protein expression levels of IL-6 and IL-8 in NPDFs. The EP2 and EP4 agonists and antagonists induced and inhibited IL-6 expression. However, the EP4 agonist and antagonist were only observed to induce and inhibit IL-8 expression level. The Akt and NF-kappaB inhibitors significantly blocked PGE2-induced expression of IL-6 and IL-8. CONCLUSIONS: PGE2 increases IL-6 expression via EP2 and EP4 receptors, and IL-8 expression via the EP4 receptor in NPDFs. It also activates the Akt and NF-kappaB signal pathways for the production of IL-6 and IL-8 in NPDFs. These results suggest that signaling pathway for IL-6 and IL-8 expression induced by PGE2 might be a useful therapeutic target for the treatment of nasal polyposis.
Blotting, Western ; Dinoprostone* ; Fibroblasts* ; Interleukin-6* ; Interleukin-8* ; Nasal Polyps ; NF-kappa B ; Prostaglandins E ; RNA, Messenger ; Signal Transduction

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Increased Th2-like Invariant Natural Killer T cells in Peripheral Blood From Patients With Asthma.

Jae Uoong SHIM ; Young Il KOH

Allergy, Asthma & Immunology Research.2014;6(5):444-448. doi:10.4168/aair.2014.6.5.444

PURPOSE: Invariant natural killer T (iNKT) cells might play an important role in asthma pathogenesis in humans. Our previous study found no difference in the number of blood iNKT cells between asthma patients and controls. However, few studies have examined the function of blood iNKT cells in human asthma. METHODS: Twenty asthma patients and eight controls were included in this study. Blood iNKT cells were identified using double staining with anti-Valpha24 and anti-Vbeta11 monoclonal antibodies (mAbs) or with 6B11 and anti-Vbeta11 mAbs. Intracellular IL-4, IL-10, and IFN-gamma cytokines were stained in blood iNKT cells using their respective mAbs and isotypes. In addition, their relationships with clinical parameters were analyzed. RESULTS: The number of Valpha24+Vbeta11+ iNKT cells or 6B11+Vbeta11+ iNKT cells did not differ between asthma patients and controls. However, among Valpha24+Vbeta11+iNKT cells, the proportion of IL-4+iNKT cells was increased in asthma patients compared to controls (7.0+/-3.0% vs 0.5+/-0.4%, P<0.05). There were no differences in the proportions of IL-10+or IFN-gamma+iNKT cells between the groups. The proportion of IL-4+ cells among 6B11+Vbeta11+iNKT cells inversely correlated with FEV1, expressed as a percentage predicted value in asthma patients (Rs=-0.64, P<0.05, n=19). CONCLUSIONS: Blood iNKT cells are thought to be Th2-like, and IL-4-producing iNKT cells may be associated with lung function in human asthma.
Antibodies, Monoclonal ; Asthma* ; Cytokines ; Humans ; Interleukin-10 ; Interleukin-4 ; Lung ; Natural Killer T-Cells*

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Changes in Allergen Sensitization Over The Last 30 Years in Korea Respiratory Allergic Patients: A Single-Center.

Hye Jung PARK ; Hyun Sun LIM ; Kyung Hee PARK ; Jae Hyun LEE ; Jung Won PARK ; Chein Soo HONG

Allergy, Asthma & Immunology Research.2014;6(5):434-443. doi:10.4168/aair.2014.6.5.434

PURPOSE: Determining the culprit allergen is important for the diagnosis and management of allergic diseases. The skin prick test (SPT) has been widely used to identify culprit allergens. Skin reactivity to allergens has changed due to changes in lifestyle and outdoor environments. Therefore, the aim of the present paper was to examine changes in allergen sensitization in Korea. METHODS: We enrolled 1,135 patients with respiratory allergic diseases who were diagnosed at Severance Hospital from January 2010 to December 2011. SPTs were performed with inhalant allergens, and were compared to our previous studies of the SPTs in the 1980s and the 1990s. RESULTS: In the 2010s, the SPT positive rate of allergic rhinitis or allergic conjunctivitis was higher than asthma without allergic rhinitis or allergic conjunctivitis. The SPT positive rate was decreased by increments of age (P value <0.01). Skin reactivity to tree pollens was significantly increased to 36.4% in the 2010s from 19.0% in the 1990s and 8.8% in the 1980s. Among tree pollens, skin reactivity to oak (4.7%->14.4%), birch (7.1%->13.6%), alder (6.3%->13.4%) and pine (2.9%->14.3%) was significantly increased in the 2010s compared with the 1990s, respectively. Current skin reactivity to grass pollens (13.9%) and weed pollens (27.0%) has significantly decreased since the 1990s (20.3%, 40.9%, respectively). Skin reactivity to house dust mites showed no difference between the 1990s (55.2%) and the 2010s (55.6%). Skin reactivity to dog (27.3%->20.7%) and cockroach (25.3%->12.3%) have significantly decreased in the 2010s in comparison with the 1990s. CONCLUSIONS: In light of the above results, we revealed the changes in skin reactivity to inhalant allergens that have occurred in Korean allergic patients over the past three decades. Since outdoor environmental factors such as the amount of pollen, global warming and plant distribution causes the changes in skin reactivity, further study and continuous close observation will be needed.
Allergens ; Alnus ; Animals ; Asthma ; Betula ; Cockroaches ; Conjunctivitis, Allergic ; Diagnosis ; Dogs ; Global Warming ; Humans ; Korea ; Life Style ; Plant Dispersal ; Poaceae ; Pollen ; Pyroglyphidae ; Rhinitis ; Skin ; Skin Tests

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Serial Changes in Serum Eosinophil-associated Mediators between Atopic and Non-atopic Children after Mycoplasma pneumoniae pneumonia.

Joo Hwa KIM ; Tae Shik CHO ; Jin Hwa MOON ; Chang Ryul KIM ; Jae Won OH

Allergy, Asthma & Immunology Research.2014;6(5):428-433. doi:10.4168/aair.2014.6.5.428

PURPOSE: Mycoplasma pneumoniae pneumonia (MP) is associated with the exacerbation, timing, and onset of asthma. The goal of this study was to elucidate the impact of MP on eosinophil-related hyper-reactive amplification in atopic children. METHODS: We studied 48 patients with MP (26 atopic, 22 non-atopic), between 3 and 12 years of age. Serial changes in blood eosinophil counts, serum interleukin-5 (IL-5), and serum eosinophil cationic protein (ECP) levels were measured in atopic and non-atopic children with MP upon admission, recovery, and at 2 months post-recovery. Serum IL-5 and ECP levels were measured by enzyme-linked immunosorbent assays; eosinophil counts were measured using an autoanalyzer. RESULTS: Serial changes in serum IL-5, ECP, and total eosinophil counts were significantly higher in atopic patients, relative to non-atopic controls (P< or =0.001). Serum IL-5 and ECP levels were significantly higher in atopic patients at all three time points tested, while eosinophil counts were higher in the clinical recovery and follow-up phases, but not in the acute phase. Furthermore, among atopic patients, serum ECP levels were significantly higher in the recovery and follow-up phases than in the acute phase. CONCLUSIONS: The present study demonstrated significant differences in eosinophil counts, serum IL-5, and serum ECP levels between atopic and non-atopic children with MP at admission, recovery, and 2 months after clinical recovery. These outcomes are suggestive of eosinophil-related hyperreactivity in atopic children, with this status maintained for at least 2 months after MP.
Asthma ; Child* ; Enzyme-Linked Immunosorbent Assay ; Eosinophil Cationic Protein ; Eosinophils ; Follow-Up Studies ; Humans ; Interleukin-5 ; Mycoplasma pneumoniae* ; Pneumonia* ; Pneumonia, Mycoplasma*

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Exploring Household-level Risk Factors for Self-reported Prevalence of Allergic Diseases Among Low-income Households in Seoul, Korea.

Sungchul SEO ; Dohyeong KIM ; Christopher PAUL ; Young YOO ; Ji Tae CHOUNG

Allergy, Asthma & Immunology Research.2014;6(5):421-427. doi:10.4168/aair.2014.6.5.421

PURPOSE: Indoor risk factors for allergic diseases in low-income households in Korea have been characterized only partially. We evaluated the prevalences of atopic dermatitis, asthma, and allergic rhinitis in Seoul, Korea, to identify key housing and behavioral risk factors of low-income households. METHODS: Statistical analysis of the prevalence of these diseases and various risk factors was conducted using data from a 2010 Ministry of Environment household survey. Logistic regression models were generated using data from 511 low-income household apartments in districts of Seoul. RESULTS: In general, housing factors such as renovation history (P<0.1) and crowding status (P<0.01) were associated with allergic rhinitis, whereas behavioral factors such as frequency of indoor ventilation (P<0.05) and cleaning (P<0.1) were inversely correlated with atopic dermatitis. Indoor smoking was a major trigger of asthma and atopic dermatitis in low-income households (P<0.05). The presence of mold and water leakage in houses were the most important risk factors for all three diseases (P<0.05). CONCLUSIONS: Various risk factors play a role in triggering allergic diseases among low-income households in Seoul, and health or environmental programs mitigating allergic diseases should be tailored to address appropriate housing or behavioral factors in target populations.
Asthma ; Crowding ; Dermatitis, Atopic ; Family Characteristics* ; Fungi ; Health Services Needs and Demand ; Housing ; Korea ; Logistic Models ; Poverty ; Prevalence* ; Rhinitis ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Ventilation ; Water

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Clinical Features of Fixed Drug Eruption at a Tertiary Hospital in Korea.

Jae Woo JUNG ; Sang Heon CHO ; Kyu Han KIM ; Kyung Up MIN ; Hye Ryun KANG

Allergy, Asthma & Immunology Research.2014;6(5):415-420. doi:10.4168/aair.2014.6.5.415

PURPOSE: Fixed drug eruption (FDE) is characterized by a well-defined erythematous patch, plaque, or bullous eruption that recurs at the same site as the result of systemic exposure to a causative drug, and resolves with or without hyperpigmentation. This study was carried out to identify the common causative drugs and clinical features of FDE in Korea. METHODS: We reviewed electronic medical records of all patients diagnosed with FDE from January 2000 to December 2010 at a tertiary hospital in Korea. RESULTS: A total of 134 cases were diagnosed as FDE. The mean age was 35.9 years (range, 0-82 years) and 69 (51.5%) of the patients were male. The mean duration from the first event to attending hospital was 1.9 years (range, 1-20 years). The mean number of recurrences was 2.6 (1-10), and 72.6% of patients sought medical care after experiencing symptoms twice or more. Four patients (3.1%) needed hospitalization. The most common sites were the upper extremities (47.7%), followed by the lower extremities, face, abdomen, chest, buttocks and perineum. Clear documentation on the causative drugs was available for 38 patients (28.4%), and among these, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for 71.1% of cases, and antibiotics accounted for 15.8%. Eighty patients (59.7%) underwent active treatment for FDE, and topical steroids were most frequently prescribed (43.3%), with systemic steroids used in 11.2% of patients. CONCLUSIONS: NSAIDs and acetaminophen were the main causative agents of FDE, however, the causative agents were not assessed in 25% of patients.
Abdomen ; Acetaminophen ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Buttocks ; Drug Eruptions* ; Electronic Health Records ; Hospitalization ; Humans ; Hyperpigmentation ; Korea ; Lower Extremity ; Male ; Perineum ; Recurrence ; Steroids ; Tertiary Care Centers* ; Thorax ; Upper Extremity

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Allergic Diseases and Multiple Chemical Sensitivity in Korean Adults.

Inchul JEONG ; Inah KIM ; Hye Jung PARK ; Jaehoon ROH ; Jung Won PARK ; Jae Hyun LEE

Allergy, Asthma & Immunology Research.2014;6(5):409-414. doi:10.4168/aair.2014.6.5.409

PURPOSE: Multiple chemical sensitivity (MCS) is a clinical syndrome representing multi-organ and psychological symptoms caused by chronic exposure to various chemicals in low concentrations. We evaluated the prevalence and related factors of MCS targeting Korean adults using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(c)). METHODS: A total of 446 participants were recruited from Severance Hospital. Participants underwent a questionnaire interview including questions on sociodemographic factors, occupational and environmental factors, allergic diseases, and the QEESI(c). Among them, 379 participants completed the questionnaire and the QEESI(c). According to the QEESI(c) interpretation results, participants were divided into very suggestive (VS) group and less suggestive (LS) group. RESULTS: The estimated prevalence of MCS was higher in allergic patients than non-allergic participants (19.7% and 11.3%, respectively, P=0.04). In the multivariate logistic regression analysis, ages of 30-39 (OR, 2.94; 95% CI, 1.25-6.95) and those of 40-49 (OR, 2.51; 95% CI, 1.02-6.21) were significantly related to MCS compared to those aged less than 30 years. Female sex (OR, 2.16; 95% CI, 1.11-4.18), experience of dwelling in a new house (OR, 2.05; 95% CI, 1.04-4.03), and atopic dermatitis (OR, 1.95; 95% CI, 1.04-3.69) were also significantly related to MCS. However, only age of 30-39 in the allergic group was significant in the stratified analysis. CONCLUSIONS: The estimated prevalence of MCS was higher among allergic patients than non-allergic participants. People with experience of dwelling in a new house and atopic dermatitis were more at risk of being intolerant to chemicals. Further studies to provide the nationally representative prevalence data and clarify risk factors and mechanisms of MCS are required.
Adult* ; Dermatitis, Atopic ; Environmental Exposure ; Female ; Humans ; Logistic Models ; Multiple Chemical Sensitivity* ; Prevalence ; Risk Factors

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Capsaicin cough sensitivity is related to the older female predominant feature in chronic cough patients.

Woo Jung SONG ; Ju Young KIM ; Eun Jung JO ; Seung Eun LEE ; Min Hye KIM ; Min Suk YANG ; Hye Ryun KANG ; Heung Woo PARK ; Yoon Seok CHANG ; Kyung Up MIN ; Sang Heon CHO

Allergy, Asthma & Immunology Research.2014;6(5):401-408. doi:10.4168/aair.2014.6.5.401

PURPOSE: The present study aimed to examine the age and gender distributions among chronic cough patients referred to a tertiary cough clinic in Korea, and to investigate clinical factors related to the demographic findings. METHODS: Study participants were unselectively recruited from adult chronic cough patients who attended the cough clinic for the first time during one year. To validate their representativeness, their age and gender distributions were compared to the entire chronic cough population, or with those presenting with other chronic disease. Data from the baseline investigations were analyzed to identify clinical factors related to the demographic findings. RESULTS: A total of 272 chronic cough patients were included. They had a middle-aged female predominant feature (mean age: 52.8+/-15.7 years and female 69.1%). Their age and gender distributions were almost identical to the entire chronic cough population, but were distinct from patients with hypertension. Among clinical factors, the older female predominance was associated with enhanced capsaicin cough sensitivity, and also with the presence of 'cough by cold air' symptom. Allotussia and laryngeal paresthesia were highly common in chronic cough patients, affecting 94.8% and 86.8% of them, respectively. CONCLUSIONS: The present study demonstrated older female predominance among adult chronic cough patients attending a referral cough clinic in Korea. The demographic features were significantly associated with the capsaicin cough responses and also potentially with allotussia (particularly cold air as the trigger). These findings suggest a role of cough reflex sensitization in the pathophysiology of chronic cough in adults.
Adult ; Capsaicin* ; Chronic Disease ; Cough* ; Female ; Humans ; Hypertension ; Korea ; Paresthesia ; Referral and Consultation ; Reflex ; Respiratory Hypersensitivity

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Environmental Changes, Microbiota, and Allergic Diseases.

Byoung Ju KIM ; So Yeon LEE ; Hyo Bin KIM ; Eun LEE ; Soo Jong HONG

Allergy, Asthma & Immunology Research.2014;6(5):389-400. doi:10.4168/aair.2014.6.5.389

During the last few decades, the prevalence of allergic disease has increased dramatically. The development of allergic diseases has been attributed to complex interactions between environmental factors and genetic factors. Of the many possible environmental factors, most research has focused on the most commonly encountered environmental factors, such as air pollution and environmental microbiota in combination with climate change. There is increasing evidence that such environmental factors play a critical role in the regulation of the immune response that is associated with allergic diseases, especially in genetically susceptible individuals. This review deals with not only these environmental factors and genetic factors but also their interactions in the development of allergic diseases. It will also emphasize the need for early interventions that can prevent the development of allergic diseases in susceptible populations and how these interventions can be identified.
Air Pollution ; Climate Change ; Early Intervention (Education) ; Epigenomics ; Microbiota* ; Prevalence

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