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A case of intravenous immunoglobulin therapy in severe aspirin - sensitive asthma patient combined with IgG1 and IgG3 subclass deficiency.

Hae Sim PARK ; Hee Yeon KIM ; Dong Ho NAHM ; Sang Yong YOO ; Sung Gyun AHN ; Dong Suk HAN

Journal of Asthma, Allergy and Clinical Immunology.1999;19(4):610-614.

Common complications in a patient with IgG subclass deficiency include recurrent respiratory infections and concomitant inflammatory lung disease. The most effective therapy in these patients is the administration of intravenous immunoglobulin. The authors report a case of severe aspirin-sensitive asthma and recurrent pneumonia with combined IgG1, and IgG3 subclass deficiency in a 19-year-old man. The patient was treated with 0.4g/kg at monthly intervals for 6 months, and is still receiving 0.2g/kg every 2 weeks at our clinic. After the replacement of intravenous immunoglobulin, the patient has clinically improved.
Aspirin* ; Asthma* ; Humans ; Immunization, Passive* ; Immunoglobulin G* ; Immunoglobulins* ; Lung Diseases ; Pneumonia ; Respiratory Tract Infections ; Young Adult

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Angioedema-like facial swelling as a first manifestation of systemic lupus erythematosus.

O Yeong KWON ; Chang Hee SEO ; Sung Taek JUNG ; Dong Ho NAHM ; Hae Sim PARK

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):90-95.

Angioedma is a group of disorders with multifactorial etiology but a similar clinical expression, is characterized by swelling of subcutaneous or submucosal tissue. Systemic lupus erythematosus(SLE) is a chronic multi-systemtic disease characterized by inflammation and tissue damage resulting from deposition of auto-antibodies and immune complex. We experienced a case of angioedema which was the first manifestation of SLE in 24-year-old female patient. She had suffered from severe facial edema and multiple lymphadenopathy for six months and she also had pleural effusion, positive anti-nuclear and anti-DNA antibody test. Marked decrease of C3 and C4 levels was noted with normal antigenic level, and activity of Cl esterase inhibitor. The angioedema was not improved with anti-hitamine agents and instead disappeared with use of corticosteroid and non-steroidal anti-inflammatory drugs. Complement levels normalized after corticosteroid treament. We report a case of SLE which initial manifestation was angioedema.
Angioedema ; Antigen-Antibody Complex ; Complement System Proteins ; Edema ; Female ; Humans ; Inflammation ; Lupus Erythematosus, Systemic* ; Lymphatic Diseases ; Pleural Effusion ; Young Adult

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Hypersensitivity pneumonitis induced by oyster mushroom spores.

Moon Woo LEE

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):84-89.

Hypersensitivity pneumonitis due to the inhalation of oyster mushroom(pleurotos ostreatus) was demonstrated in a 44-year-old man who had cultiviated for 4 years. He had suffered from dyspnea, cough, myalgia and fever in the evening after working at first. After them he has experienced dyspnea aggravated. He showed not only positive reaction to the intradermal test but also to the bronchial challenge test such as 6 hr after inhalation falling down of FVC, FEV p, and DLCO in pulmonary function test and leukocytosis with fever upto 38.2C with antigenic extract of oyster mushroom spore. The size of spore was approximately 3.5 when measured by transmission electron microscopy.
Adult ; Alveolitis, Extrinsic Allergic* ; Bronchial Provocation Tests ; Cough ; Dyspnea ; Fever ; Humans ; Hypersensitivity* ; Inhalation ; Intradermal Tests ; Leukocytosis ; Microscopy, Electron, Transmission ; Myalgia ; Ostreidae* ; Pleurotus* ; Respiratory Function Tests ; Spores*

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Metered dose inhaler(MDI)-induced bronchocostriction in asthmatic patients: the effects of the incert ingredients and propellants.

Jun Woo BAHN ; Ho Joo YOON ; Jee Woong SON ; Sang Heon CHO ; Dong Chull CHOI ; Kyung Up MIN ; Yon Young KIM

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):78-83.

BACKGROUND: Bronchoconstriction associated with aerosolized agents delivered by a metered dose inhaler (MDI) is relatively uncommon, but has been of particular interest. MATERIAL AND METHOD: In this study, we investigated to what extent the inert ingredients and propellants (freons) influence pulmonary function in 25 asthmatic patients. Forced expiratory volume in one second(FEV,) was measured by spirometry, Autospira HI 498(Chest, Japan) before and 1, 3, 5 and 10 minutes after the inhalation of saline control and MDI-placebo containing freons and inert ingredients. RESULT: Twenty four % (6/25) of asthmatics experienced a decrease in FEV20 by 10% or greater when compared to saline control. Number of positive cases in steroid dependent asthmatics is significantly higher compared to non-steroid dependent asthmatics. (p<0.05) Bronchoconstriction associated with the use of MDI-placebo appeared within 3 to 5 minutes and resolved spontaneouly at 10 minutes after the inhalation. CONCLUSION: The bronchoconstrictive response induced by MDI might be caused by the pro-pellants and/or the other inert ingredients contained in MDIs.
Bronchoconstriction ; Chlorofluorocarbons ; Forced Expiratory Volume ; Humans ; Inhalation ; Metered Dose Inhalers ; Spirometry

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Familial aggregation of bronchial asthma, and genetic role of atopy and bronchial responsiveness in the development of asthma.

Yoon Keun KIM ; Sang Rok LEE ; Jee Woong SON ; Sang Heon CHO ; Myung Hyun LEE ; Young Yoll KOH ; Kyung Up MIN ; You Young KIM

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):69-77.

BACKGROUND: Familial aggregation of the phenotypes can be caused by common environmental and genetic factors, but there has been no family study on familial aggregation of the bronchial asthma, and genetic role of atopy and bronchial responsiveness in the development of asthma in Korean families. OBJECTIVE: We did family study to evaluate the familial aggregation of bronchial asthma, and the genetic role of atopy and bronchial responsiveness in the development of asthma. MATERIALS AND METHODS: Questionnaire, serum total IgE level, skin prick test with 10 common aeroallergens, and bronchial responsiveness to methacholine were performed in 154 parents of atopic asthmatics, 72 parents of atopic control, and 65 parents of non-atopic control. RESULTS: Bronchial asthma was more prevalent in parents of atopic asthmatics(7.1% ) than in parents of non-atopic control(0% ). Geometric mean of serum total IgE level was not different among parents of atopic asthmatics, atopic control, and non-atopic control(2.03+0.06, 2.10 +0.07, and 1.89 +0.09 IU/ml). Positive rates of skin prick test to 10 common aeroallergens were more prevalent in parents of atopic asthmatics(43.0% ) and atopic control(43.0% ) than in parents of non-atopic control(27.8%). Prevalence of bronchial hyperresponsiveness to methacholine was more prevalent in parents of atopic asthmatics(17.0% ) than in parents of atopic control(7.2%) and non-atopic control(1.5%), and slope of dose-response curve was more increased in parents of atopic asthmatics(11.0+ 1.5) than in parents of atopic control and non-atopic control(4.8+ 0.7 and 3.0+ 0.5). CONCLUSION: Bronchial asthma runs in Korean families, and genetic role of atopy and bronchial responsiveness may be important in the development of asthma.
Asthma* ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Parents ; Phenotype ; Prevalence ; Skin ; Surveys and Questionnaires

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Antagonism of licorice on selectin-mediated eodinophil and neutrophil adhesion.

Mi Kyeong KIM

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):61-68.

BACKGROUND AND OBJECTIVE: Early in inflammation, adhesion occurs between leukocytes and endothelium where selectins bind to sialyl Lewis x(Sle,) and related oligosaccharides. We tested glycerrhetinic acid(GA), msjor anti-inflammmatory component of licorice, for its ability to inhibit selectin-mediated adhesion of human eosinophils and neutrophils in vitro. MATERIAL AND METHOD: Neutrophils and eosinophils were isolated by density grsdient centrifugation and eosinophils were further purified by immunomagnetic negative selection. Adhesion to unstimulated or IL-1 p-stimulated(5ug/ml, 4-6hr, 37C) umbilical vein endothelial monolayers was tested under static or rotating conditions, where adhesion is E- or L-selectin dependent, respectively. P-selectin-dependent adhesion was tested on immobilized platelets treated with or without TPA(10-7M, 10mins, RT). Stimulus-induced adhesion was always at least four-fold higher than without stimulus, and selectin dependence was confirmed with specific blocking monoclonsl antibody RESULT: All three kinds of selectin-mediated eosinophil and neutrophil adhesion were inhibited by GA and they were reversible without affecting viability. CONCLUSION: The ability of GA to interfere with the selectin mediated adhesion may contribute the one of the mechanism of the anti-inflammatory effects by licorice.
Centrifugation ; Endothelium ; Eosinophils ; Glycyrrhiza* ; Humans ; Inflammation ; Interleukin-1 ; L-Selectin ; Leukocytes ; Neutrophils* ; Oligosaccharides ; Selectins ; Umbilical Veins

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Revival of Hop Japanese pollinosis in asthmatic subjects in Kyungki area.

Hae Sim PARK ; So Yeon COI ; Dong Ho NAHM ; Hee Yeon KIM

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):52-60.

BACKGROUND: Hop Japanese (Hop J) pollens are abundant in the air of Korea during the autumn season. Their significances as a source of allergenic sensitization have been underestimated in this country. MATERIAL AND METHOD: In other to observe clinical features of Hop J-sensitive asthmatic patients in this country, skin prick test with Hop J pollen was performed. The serum specific IgE antibodies to Hop J pollen antigen were detected by enzyme linked immunosorbent assay (ELISA) in positive responders (>2+ of A/H ratio) on skin prick test. To confirm the respiratory sensitization, bronchoprovocation test was performed in 17 asthmatic patients sensitive to this pollen. RESULT: Ten asthmatic subjects showed a significant bronchoconstriction following the inhalation of Hop J pollen extract (6 early and 4 dual astmatic responses) and all of them had high serum specific IgE bindings, with minimal bindings in negative responders. They have suffered from seasonal aggravation of asthmatic symptoms with or without rhinitis, and/or conjunctivitis symptoms. The skin reactivity to Hop J had more than 5+ of A/H ratio on skin prick test in nine positive responders, whlie negative responders showed from 1+ to 3+ response. Moreover, four (40%) asthmatic subjects showed a positive response to only the Hop J pollen on skin prick test and an isolated positive asthmatic response to the Hop J bronchoprovocation test. CONCLUSION: We believe that the Hop J pollen should be considered as an allergen during the Autumn season, and thus included in skin test batteries in this area. Some labelled having intrinsic asthma or rhinitis might be sensitized to this pollen or other unknown allergens.
Allergens ; Antibodies ; Asian Continental Ancestry Group* ; Asthma ; Bronchoconstriction ; Conjunctivitis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Humulus* ; Immunoglobulin E ; Inhalation ; Korea ; Pollen ; Rhinitis ; Rhinitis, Allergic, Seasonal* ; Seasons ; Skin ; Skin Tests

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Urinary N-methylhistamine and sulfidopeptide leukotriene in exercise-induced asthma.

Jae Kyung PARK ; Jun Woo BAHN ; Byung Jae LEE ; Jee Woong SON ; Sang Rok LEE ; Yoon Keun KIM ; Sang Heon CHO ; Kyung Up MIN ; You Young KIM

Journal of Asthma, Allergy and Clinical Immunology.1998;18(1):40-51.

BACKGROUND: Exercise can aggravate asthmatic symptoms in many patients with bronchial asthma. It is caused by that inhaled air bypasses nasal cavity and goes directly to the lower airways through open mouth dring exercise. Although the pathogenetic mechanisms of exercise-induced asthma(EIA) have not been clarified yet, there is evidence that chemical mediators, released from the inflammatory cells triggered by airway cooling or drying, might be responsible for induction of bronchoconstriction. However, it has been controversial which chemical mediators or cells are involved in such process. Objectiye . The aim of this study was to evaluate the role of activated mast cells in the pathogenesis of EIA and find out whether or not sulfidopeptide leukotrienes (LTC4/d4/E4) are involved in the exercise-induced bronchoconstriction. MATERIAL AND METHOD: Eleven asthmatics with documented exercise-induced bronchoconstriction and 10 control subjects were studied. Before and 6 hours after free running for 6 minutes, forced expiratory volume in 1 second (FEV,) and the concentrations of N- methylhistamine, LTE4, and creatinine in unine collected for 6 hours after exercise were determined. RESULT: Urinary concentrations of N-methylhistamine(mean+SE, ng/mg creatinine) of EIA patients before and after exercise were 159+40 and 450+75, respectively. Those of control subjects were 208+ 54 and 275+ 62, respectively. Uninary N-methylhistamine levels of EIA group increased significantly after exercise, while those of control group did not change. Urinary concentrations of LTE,(mean+SE, pg/mg creatinine) of EIA patients before and after exercise were 15.6 k2.6 and 22.2+5.8, respectively. Those of control subjects were 10.4+ 4.0, 18.2 +7.0, respectively. The concentrations of LTE4 in the urine samples collected before exerise revealed no difference between EIA and control subjects (p=0.07). There was no change after exercise in both groups. Percent fall of FEV, was 29.1+8.0% (mean+SD) in EIA group and 3.4 + 4.0% in control group, respectively. There was no correlation between reduction of FEV, and change in urinary concentrations of N-methyl-histmine after exercise. CONCLUSTION: Chemical mediators of activated mast cells may be involved in exercise-induced bronchoconstriction, but there is little evidence for enhanced sulfidopeptide leukotriene generation as assessed by urinary LTE4.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Creatinine ; Forced Expiratory Volume ; Humans ; Leukotriene E4 ; Leukotrienes ; Mast Cells ; Mouth ; Nasal Cavity ; Running

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A case of acetaminophen anaphylaxis without aspirin sensitivity.

Yeong Yeon YUN ; Jung Won PARK ; Chein Soo HONG

Journal of Asthma, Allergy and Clinical Immunology.1999;19(1):110-115.

Heterogeneity in clinical features and pathogenesis of non-steroidal anti-inflammatory agent (NSAIDs) hypersensitivity have been reported. NSAIDs can cause bronchial constriction in asthmatics or hives and angioedema in patients with chronic urticaria, in which case causative drugs show cross-reactivity with other NSAIDs. Normal subjects without allergic diseases may develop urticaria angioedema or anaphylaxis after ingestion of a specific NSAID. In this type of reaction, cross-reactivity between causative drugs and other NSAIDs does not occur. We experienced a case of acetaminophen anaphylaxis without aspirin sensitivity in a 38-year-old male, which was confirmed by oral provocation test. An oral challenge with 150mg of acetaminophen induced urticaria in lower legs, and erythema, with febrile sensation in ears. With a dose of 600mg acetaminophen, urticaria developed in trunk and extremities with facial angioedema. An oral provocation test with 650mg of aspirin was well tolerated without any adverse reactions. We report acase of acetaminophen anaphylaxis, which occurred in a normal individual at a small dose(150mg) without cross-reactivity with aspirin. This type of reaction supports heterogenei~ty of NSAIDs hypersensitivity and it may be caused by an other mechanism, not by cyclooxygenase inhibition.
Acetaminophen* ; Adult ; Anaphylaxis* ; Angioedema ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin* ; Bronchoconstriction ; Ear ; Eating ; Erythema ; Extremities ; Humans ; Hypersensitivity ; Leg ; Male ; Population Characteristics ; Prostaglandin-Endoperoxide Synthases ; Sensation ; Urticaria

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Two cases of upper airway obstruction masquerading as asthma: One tracheal adenoid cystic carcinoma, the other foreign body aspiration.

Hak Geun KIM ; Han Kyun LEE ; Bum Chan KWEON ; Choong Ki LEE ; Gun Woo KIM ; Sang Hoon HYUN ; Jong Myung LEE ; Nung Soo KIM

Journal of Asthma, Allergy and Clinical Immunology.1999;19(1):103-109.

Reversible airway obstruction and wheezing are typical features of bronchial asthma, but these features may also be observed in other conditions. However, the inclusion of these conditions in the differential diagnosis of asthma-like symptoms in adults is often neglected, resulting in a correct diagnosis being made after months of unsuccessful treatment for asthma. We report two cases of an upper airway obstruction masquerading as asthma. In case one, adenoid cystic carcinoma was identified in the trachea of a patient showing asthma-like symptoms, positive response to allergic skin test and methacholine inhalation challenge. In the other case, aspirated foreign body was misdiagnosed and treated as asthma for more than one year. A high degree of suspicion and a thorough medical evaluation censisting of history, physical examination and pulmonary function test including shapes of spirogram are essential to the differential diagnosis of asthma-like symptoms
Adenoids* ; Adult ; Airway Obstruction* ; Asthma* ; Carcinoma, Adenoid Cystic* ; Diagnosis ; Diagnosis, Differential ; Foreign Bodies* ; Humans ; Inhalation ; Methacholine Chloride ; Physical Examination ; Respiratory Function Tests ; Respiratory Sounds ; Skin Tests ; Trachea

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