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A case of allergic bronchopulmonary aspergillosis (ABPA) occurring in a bullae of the lung.

June Hyuk LEE ; Ki Young HONG ; Sang Hoon HAN ; Gun Young CHA ; Young Mok LEE ; Su Taek UH ; Young Hoon KIM ; Choon Sik PARK ; Dong Won KIM

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):561-565.

Allergic bronchopulmonary aspergillosis(ABPA) is a syndrome seen in patients with asthma and cystic fibrosis. It is characterized by chronic cololinization of the airways with a ubiquitous fungus, Aspergillus fumigatus. Clinically, it is a syndrome characterized by recurrent episodes of wheezing, mucus production, pulmonary infiltrates, and elevated levels of serum IgE. ABPA patients are also accompanied with bronchiectasis in 89% and observed in 10% of cystic fibrosis that show the features of end-stage lung pattern. There are few reports of ABPA associated with bullae. We will report here a case of ABPA developing in an old cicartrical and bullous lesion of a lung.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Asthma ; Blister ; Bronchiectasis ; Cystic Fibrosis ; Fungi ; Humans ; Immunoglobulin E ; Lung* ; Mucus ; Respiratory Sounds

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The early changes of humoral immune response after rush immunotherapy with Dermatophagoides farinae (D.f) and Dermatophagoides pteronyssinus (D.p) in house dust mite sensitive asthmatic children.

Bong Seong KIM ; Soo Keol LEE ; Hae Sim PARK ; Soo Jong HONG

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):543-551.

PURPOSE: Rush immunotherapy (RIT) with house dust mite may be effective to treat house dust mite allergic disease, but the mechanisms are not clear. Considerable attention has been devoted to the IgG subclass in relation to clinical outcome. Usually, conventional immunotherapy with D.f and D.p is followed early on by a rise in allergen-specific IgG1 with a gradual decline over time and slow rise in allergen-specific IgG4. Some investigators have implicated that IgG4 is a more important blocking antibody than IgG1 in RIT. But there is no consistent data on the early changes of allergen-specific IgG1 or IgG4. To inves- tigate the alteration of humoral immunity in the mechanism of early phase of RIT, the D.f -specific IgE, IgG1, and IgG4 levels of the RIT group were compared with that of the con- trol group with asthma. METHOD: The RIT group included 17 D.f and D.p-sensitized asthmatic children, who had received RIT with D.f and D.p, and the control group included 15 D.f and D.p-sensitized asthmatic children who had not received RIT. They received RIT to mite for just over 8 weeks until maintenance was achieved. The symptom scores of asthma, skin reactivity to D.f (allergen/histamine ratio), RIT changes of D.f-specific IgE, IgG1, and IgG4 levels were compared before and 8 weeks after for the two groups. D.f-specific IgE, IgG1, and IgG4 levels were measured by ELISA. RESULTS: The symptom scores and the skin reactivity to D.f decreased significantly 8 weeks after RIT. D.f-specific IgG1 levels increased significantly 8 weeks after RIT in the RIT group but not in the control group. But D.f-specific IgE and D.f- specific IgG4 levels did not change 8 weeks after RIT in either of the two groups. CONCLUSION: D.f-specific IgG1 production was increased in the early phase of RIT. These findings suggest that the early clinical changes after RIT may be linked to the early increase of IgG1 blocking antibody.
Asthma ; Child* ; Dermatophagoides farinae* ; Dermatophagoides pteronyssinus* ; Dust* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunity, Humoral* ; Immunoglobulin E ; Immunoglobulin G ; Immunotherapy* ; Mites ; Pyroglyphidae* ; Research Personnel ; Skin

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Nitric oxide metabolites, eosinophils, eosinophil cationic protein, EG2+ eosinophils in sputum according to asthma severity.

An Soo JANG ; In Seon CHOI

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):535-542.

BACKGROUND: Eosinophils play an important role in asthmatic airway inflammation collaborateing with other inflammatory cells. Nitric oxide (NO) may amplify and perpetuate allergic inflammation. OBJECTIVE: The present study was aimed to determine whether NO metabolites and eosinophil activation markers in sputum reflect the severity of asthma. METHODS: Sputum was obtained in 27 asthmatic patients. We processed freshly expectorated sputum separated from saliva and by a treatment with equal volume of dithiothreitol 0.1%, cytospins for cell count and special stain, we collected the supernatant for biochemical assay. We used immunocytochemical staining to detect EG2+ eosinophils, and fluoroimmunoassay to detect eosinophil cationic protein (ECP). NO metabolites were assayed by using modified Griess reaction. RESULTS: Moderate and severe asthmatic patients had a significantly higher proportion of eosinophils (37.9+/-7.8% vs 58.4+/-7.9% vs 8.9+/-2.0%, p<0.01) and lower proportion of macrophages (46.5+/-5.5% vs 18.1+/-4.6% vs 75.6+/-4.0%, p<0.01) compared to mild asthmatics. The proportion of EG2+ eosinophils, and ECP levels in the sputum were significantly higher in moderate and severe asthmatic patients than in mild asthmatic patients (p<0.01, respectively). The level of NO metabolites in the sputum was significantly increased in severe asthmatic patients compared to that in mild asthmatic patients (1372.0+/-168.5micromole/L vs 658.3+/-186.4micromole/L, p<0.05). The proportion of eosinophils in sputum was inversely correlated with FEV1 and FEV1/FVC. EG2+ eosinophils and ECP also had an inverse relationship with FEV1 and FEV1/FVC. CONCLUSION: These findings demonstrate that the proportion of eosinophils, ECP, EG2+ eosinophils, and NO metabolites in the sputum of patients with asthma may be correlated with asthma severity.
Asthma* ; Cell Count ; Dithiothreitol ; Eosinophil Cationic Protein* ; Eosinophils* ; Fluoroimmunoassay ; Humans ; Inflammation ; Macrophages ; Nitric Oxide* ; Saliva ; Sputum*

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Panonychus citri induced allergy among Yuzu farm workers in Koheung area.

Jae Hyun LEE ; Jung Won PARK ; Cheol Woo KIM ; Yun Su PARK ; Si Hwan KO ; Chein Soo HONG

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):525-534.

BACKGROUND: Citrus red mite (CRM; Panonychus citri), which damages the peels and leaves of Citrus, has been reported as an important occupational allergen in Citrus farm workers. Yuzu belongs to the Citrus genus and its peels are the favorite material for tea in Korea. AIMS: We evaluated the prevalence of the sensitization to CRM in Yuzu farm workers in Koheung area (Southern provinces of Korean peninsula) and analyzed the allergenicity of CRM and the cross-reactivity between CRM and Dermatophagoides pteronyssinus (DP) with the sera of the workers and urbanites. METHODS: One hundred and eleven Yuzu farm workers and 36 respiratory allergic urban patients were enrolled in this study. Skin prick test (SPT) to CRM and DP was performed. CRM specific IgE was detected by ELISA and immunoblotting method. Cross-reactivity was investigated through inhibition ELISA and inhibition immunoblotting. RESULTS: About 39% of the workers showed positive response to CRM in SPT. Prevalence of allergic disease was 66%. Symptoms were associated with their work in 53% of patients. CRM-specific IgE from workers was not inhibited by DP crude antigen but CRM-specific IgE from urban patients was inhibited by DP crude antigen by an average of 70%. With immuno- blotting, we could identify 14.5, 15, 17, 18, 21, 22, 32, 33, 49.5 kDa CRM allergens with the sera of the worker. CONCLUSIONS: These results suggest that CRM is one of the unique occupational allergens to the Yuzu farm workers. Cross-reactivity between CRM and DP was found in urban patients.
Allergens ; Citrus ; Dermatophagoides pteronyssinus ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity* ; Immunoblotting ; Immunoglobulin E ; Korea ; Mites ; Prevalence ; Skin ; Tea

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Relationship of airway remodeling with clinical characteristics in bronchial asthma.

Sook Young LEE ; Jae Soon JANG ; Soon Seog KWON ; Young Kyoon KIM ; Kwan Hyoung KIM ; Hwa Sik MOON ; Jeong Sup SONG ; Sung Hak PARK

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):517-524.

BACKGROUND: We observed airway remodeling, which is the thickness of the susepithelial layer, in asthmatic patients and inhealthy subjects in order to determine its relationship with severity of disease, such as symptom, bronchial hyperresponsiveness, and degree of acute exacerbation. Moreover, for evaluation of factors contributing to airway remodeling, we analyzed the age, sex, presence of atopy, length of asthmatic history and degree of airway inflammation. METHODS: Thirty-six patients with asthma and ten healthy controls were recruited for the study. The degree of asthma symptom severity was assessed using NIH criteria. Bronchial responsiveness to methacholine was expressed as provocative concentration of methacholine causing a 20% fall in FEV1. The degree of acute exacerbation was assessed by PaCO2 during acute exacerbation. Bronchoscopy, bronchoalveolar lavage(BAL), and bronchial biopsy were performed for all subjects; the total cell counts, differential cell counts and levels of ECP were measured in BAL fluid, and the basement membrane thickness and degree of epithelial shedding were measured in biopsy samples under light microscopy. RESULTS: The mean values of basement membrane thickness were 7.8+/-0.6 micrometer in asthmatics, and 4.1+/-0.5 micrometer in healthy subjects (p<0.05). Basement membrane thickness in patients with severe persistent asthma differed significantly from that of patients with mild intermittent asthma (11.8+/-1.0 micrometer vs 6.5+/-0.7 micrometer p<0.05). A lower level of PC20 for methacholine was observed in asthma with thick basement membrane(> or =7.5 micrometer) compared to those with base- ment membrane less than 7.5micrometer (0.26+/-0.13 mg/ml vs. 0.74+/-0.16 mg/ml, p<0.05). No difference was found between the degree of thickening in patients with different degree of acute exacerbation with age, sex, atopy and lengths of asthmatic history. The degree of thickening was positively correlated to degree of epithelial shedding (r=0.393, p<0.05), but not to the degree of total cell counts, differential cell percentage nor ECP in BAL fluid. CONCLUSION: We confirmed that thickening of the basement membrane is a characteristic finding of asthma. We also demonstrated that it affects symptom severity and bronchial hyperresponsiveness, and is related to degree of epithelial damage rather than duration of asthma history.
Airway Remodeling* ; Asthma* ; Basement Membrane ; Biopsy ; Bronchoscopy ; Cell Count ; Humans ; Inflammation ; Membranes ; Methacholine Chloride ; Microscopy

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The effect of deep inspiration on methacholine induced bronchoconstriction.

An Soo JANG

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):508-516.

BACKGROUND: Deep inspiration not only has a bronchodilatory effect but also a bronchopro- tective effect. We compared the 2-min tidal breathing method and the five-breath dosimeter method to evaluate effect of deep inspiration on airway narrowing during methacholine provocation tests (MPT) in normal subjects. METHODS: Eleven normal volunteers (seven males and four females) inhaled five doses of methacholine (25mg/ml) at 5-min intervals during the 2-min tidal breathing method and the five-breath dosimeter method. MPT was cross-overly performed by the two methods. On first visit, a questionnaire for symptoms, allergy skin test, spirometry, and MPT (2-min tidal breathing and five-breath dosimeter method) were performed. On second visit, pulmonary function tests and methacholine challenge using the 25mg/mL dose were performed on two separate days at the same time each day. The perception of dyspnea during methacholine challenge was scored using modified Borg scale. The recovery time from maximal decrease in FEV1 to baseline FEV1 was checked without using bronchodilator after MPT. RESULTS: The maximal decreases in FEV1 and FVC during the 2-min tidal breathing method were 38.8+/-5.3% and 27.8+/-5.1%, respectively. The maximal decreases in FEV1 and FVC during the five-breath dosimeter method were 16.5+/-6.1% and 14.2+/-4.9%, respectively. Score on Borg scale during the 2-min tidal breathing method at methacholine dose 1 was from 0.5 to 7. The FEV1 and FVC at methacholine dose 1, 2, 3, 4, 5 showed significantly greater decreases during the 2-min tidal breathing method compared to those during the five-breath dosimeter method. There was significant correlation between maximal decrease in FEV1 during the five-breath dosimeter method and recovery time from decrease in FEV1 to baseline FEV1 (r=0.82; p<0.01). A significant correlation (r=0.79; p<0.05) was found between decrease in FEV1 at methacholine dose 1 during the 2-min tidal breathing method and perception score. CONCLUSION: These observations indicate that the continuous generation method produces more bronchoconstriction than the dosimeter method for delivering methacholine aerosol during MPT, suggesting inhibition of deep inspiration enhances methacholine induced airway narro- wing in normal subjects.
Bronchoconstriction* ; Dyspnea ; Healthy Volunteers ; Humans ; Hypersensitivity ; Male ; Methacholine Chloride* ; Respiration ; Respiratory Function Tests ; Skin Tests ; Spirometry ; Surveys and Questionnaires

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Localization of transforming growth factor beta1 in airway mucosa of toluene diisocyanate-induced asthma.

Soo Keol LEE ; Sun Min LEE ; Ki Baik HAHM ; Hyun Ee YIM ; Choon Sik PARK ; Sun Sin KIM ; Dong Ho NAHM ; Hae Sim PARK

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):500-507.

BACKGROUND AND OBJECTIVE: There have been some reports on the expression of TGF beta-an anti-inflammatory and fibrosing cytokine in airway mucosa of asthmatics. However, the ex- pression of TGF beta1 in bronchial mucosa of TDI-induced asthma is not known. The aim of this study was to observe immunolocalization of TGF beta1 in airway mucosa of TDI-induced asthma. METHODS: TGF beta1 expressions were compared using immunohistochemistry in bronchial muco- sa from 22 subjects with TDI-induced asthma (group I: 10 newly diagnosed, group II: 12 subjects with persistent asthma symptoms for more than 4 years after diagnosis), and 8 non- asthmatics undergoing pneumonectomy from lung tumor. The distribution and intensity of expression were analyzed by two observers in four areas of bronchial tissue-epithelium(EP), vascular endothelium(VE), smooth muscle(SM), and mucous glands(MG). RESULTS: Positive rates of TGF beta1 expression for groups I and II in the four areas were as follows; EP (50% vs 100%, p<0.05), VE(40% vs 100%, p<0.05), SM(33.3% vs 100%, p<0.05), and MG(66.7% vs 80%, p>0.05). Grades of TGF beta1 expression of EP, VE, and SM were significantly higher in group II than in group I(p<0.05, respectively). There was no significant difference in distribution and intensity of TGF beta1 expression between TDI-induced asthma and controls(p>0.05, respectively). CONCLUSION: TGF beta1 expressions of EP, VE, SM and MG were noted in airway mucosa of TDI-induced asthma and expressions of EP, VE, and SM were more intense and frequent in patients with persistent asthma symptoms.
Asthma* ; Humans ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Pneumonectomy ; Toluene* ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

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Usefulness of impulse oscillometry in patients with asymptomatic bronchial asthma.

Jeong Youp PARK ; Cheol Woo KIM ; Jae Hoon LEE ; Yoon Soo PARK ; Byung Gyu PARK ; Jung Won PARK ; Chein Soo HONG

Journal of Asthma, Allergy and Clinical Immunology.2001;21(3):491-499.

BACKGROUND: Impulse oscillometry (IOS) is a valuable method for evaluating respiratory func- tion in a patient with bronchial asthma. There have been no reports on compliance assessment of the remodeled airway by estimation of the relationship between resistance and breathing volume in asymptomatic asthma using IOS. OBJECTIVE: This study was performed to evaluate whether IOS could distinguish asymptomatic asthma from healthy control and detect altered physiology of the airway due to airway remodeling in asymptomatic asthmatic patients with normal pulmonary function. METHOD: 16 healthy and 16 asymptomatic patients with bronchial asthma were asked to breathe with the usual tidal volume (Vt) and with twice the amount of Vt. Using IOS, impedance, resistance for frequency at 5Hz and 20 Hz, reactance, and resonant frequency were measured. RESULTS: Resonant frequency was significantly higher in asymptomatic asthma than in healthy control for breathing with both usual Vt and twice the amount of Vt (mean+/-S.E.M. 16.35+/-1.44 Hz vs 13.34+/-0.66 Hz, 16.27+/-0.72 Hz vs 13.68+/-0.66 Hz, p<0.05 respectively), but the discriminant power of resonant frequency for distinguishing asymptomatic asthma from healthy control was low. There were no significant differences of other IOS parameters between asthma and control groups. Compared with control group, asymptomatic asthma group showed no significant change of IOS parameters according to breathing volume change. CONCLUSION: In this study, we could not find any IOS parameters sensitive enough to detect altered physiology of the remodeled airway in patients with asymptomatic bronchial asthma. Further studies are recommended to improve sensitivity of IOS method for investigating airway physiology in bronchial asthma.
Airway Remodeling ; Asthma* ; Compliance ; Electric Impedance ; Humans ; Oscillometry* ; Physiology ; Respiration ; Tidal Volume

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A case of anaphylactoid reaction to nonionic radiocontrast media iopromide (Ultravist).

Inseon S CHOI ; Seog Chae PARK ; Chang Min PARK ; Sang Hee CHO ; Bo Heyun MYEOUNG

Journal of Asthma, Allergy and Clinical Immunology.2001;21(4):668-672.

Because the risk of adverse reactions is lower with nonionic radiocontrast media than with conventional ionic agent, it is recommended that high-risk patients receive lower osmolality, a nonionic radiocontrast for their examination. However, the occurrence of a severe, life-threatening anaphylactoid reaction to even a small dose of nonionic radiocontrast has been reported. We report the first case in Korea of near-fatal anaphylactoid reaction to a nonionic contrast media. A 21-year-old lady with an abdominal mass due to benign mucinous cystadenoma received an injection of iopromide (Ultravist ) for abdominal computerized tomogram. Two minutes after the injection, perioral swelling and erythema, vomiting, seizure, and cardiopulmonary arrests developed. Immediate cardiopulmonary resuscitation and administrations of antihistamine, steroid, and sympathomimetics were performed with successful recovery. She had a history of allergic rhinitis and showed mild airway hyperresponsiveness on histamine bronchoprovocation test. Since a pretreatment with corticosteroid & antihistamine regimen in addition to use of nonionic agent helped to reduce the further occurrence of anaphylactoid reactions in previous contrast reactors, this near-fatal anaphylactoid reaction in an atopic individual suggests that a use of pretreatment plus nonionic agent is desirable in all patients with atopy or asthma.
Asthma ; Cardiopulmonary Resuscitation ; Contrast Media* ; Cystadenoma, Mucinous ; Erythema ; Heart Arrest ; Histamine ; Humans ; Korea ; Osmolar Concentration ; Rhinitis ; Seizures ; Sympathomimetics ; Vomiting ; Young Adult

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A case of hypereosinophilic syndrome with eosinophilic pneumonia, and bronchitis.

Hyun Suk JEE ; Chang Hyuk AN ; Byung Hoon LEE ; Ji Hoon YU ; Jae Sun CHOI ; Jong Wook SHIN ; Sung Ryong LIM ; Jae Yol KIM ; Mi Kyoung KIM ; In Won PARK ; Byoung Whui CHOI

Journal of Asthma, Allergy and Clinical Immunology.2001;21(4):662-667.

Idiopathic hypereosinophilic syndrome is characterized by multiorgan involvement without any cause, and peripheral eosinophilia(1,500/microliter) for more than 6 months. Clinically, many organs can be involved, but the heart is the most commonly involved organ. Although lung involvement is usual(20-30%)1) in hypereosinophilic syndrome, there are few reports of eosinophilic pneumonia proven by biopsy confirmation in Korea. We experienced a case of hypereosinophilic syndrome with eosinophilic pneumonia and bronchitis confirmed by biopsy, and we report it here with a review of the literature.
Biopsy ; Bronchitis* ; Eosinophils* ; Heart ; Hypereosinophilic Syndrome* ; Korea ; Lung ; Pulmonary Eosinophilia*

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