diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.]]>
Angioedema ; Asthma ; Classification ; Diagnosis ; Drug Hypersensitivity ; Humans ; Hypersensitivity ; Phenotype ; Rhinitis ; Urticaria

OBJECTIVES: The aim of this study was to compare the prescription patterns according to characteristics of physicians using a survey distributed amongst physicians in Korea. METHODS: We surveyed the prescription patterns for allergic rhinitis (AR) of the members of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and the Korean Association of Otorhinolaryngologists (KAO). Questionnaire contained 4 categories with 28 queries. 448 physicians including 98 internal medicine (IM), 113 pediatrics (PED), and 237 otorhinolaryngology (ENT) were responded. RESULTS: Although the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines are most frequently used in all specialties, seasonal or perennial AR is the most frequent classification system. For the definitive diagnosis of AR, ENT physicians reported using multiple allergen simultaneous test (MAST)/radio allergy sorbent test (RAST) more than others (IM, 10.9%; PED, 20.6%; ENT, 44.2%; P < 0.001). In treatment, most physicians reported that antihistamine medication is the initial treatment for AR. PED physicians prescribed fewer intranasal steroid to combinations with an antihistamine than other specialists (IM, 65.3%; PED, 42.5%; ENT, 63.3%), but preferred leukotriene antagonists (IM, 4.1%; PED, 23.0%; ENT, 3.9%; P=0.041). Overall, 53% (235/448) of the physicians performed allergen immunotherapy (AIT), and IM administers the most AIT (IM, 71.6%; PED, 42.0%; ENT, 39.5%; P=0.019). Furthermore, university and general hospital physicians prescribed more AIT than doctors at other hospital types (university hospital, 76.4%; general hospital, 64.3%; local hospital, 21.4%; private clinic, 20.2%; P < 0.001). CONCLUSION: The prescription patterns for AR were different according to the physicians’ characteristics and general rate of prescribing AIT is just about 53% in Korea. Thus, the development of complementary Korean-specific guidelines is needed and proper clinical instruction of AIT would be necessary.
Allergy and Immunology ; Asthma ; Classification ; Desensitization, Immunologic ; Diagnosis ; Drug Prescriptions ; Hospitals, General ; Hypersensitivity ; Internal Medicine ; Korea ; Leukotriene Antagonists ; Otolaryngology ; Pediatrics ; Prescriptions* ; Rhinitis, Allergic* ; Seasons ; Specialization ; Surveys and Questionnaires

The concept of personalized medicine for disease diagnosis, treatment, and management, considering individual variability, including susceptibility, clinical manifestations, and drug responsiveness, is a global emerging trend in medicine, which is also inevitable. However, clinical applications of personalized medicine in the real-world practice have been limited to certain cancers so far. Furthermore, this new concept to the diagnosis and treatment of adult asthma has not been applied to clinical use. Asthma is a multifactorial and heterogeneous disease. It seems to encompass a broad spectrum of clinical manifestations with different underlying pathophysiological mechanisms. Thus, it is not easy to categorize by their clinical features alone. Endotypical categorization that considering specific pathophysiological mechanisms will be more helpful in applying the concept of personalized medicine. The success of personalized medicine depends on patient selection for precise prescription of asthma medications. In the recent years, many investigators and physicians have devoted a lot of effort to the discovery of reliable biomarkers in asthmatic patients, which will be able to actualize the personalized medicine in near future. Despite such great efforts toward investigation of good biomarkers, few things have turned out to be practical in the clinic. Easily interpretable biomarkers of asthma are necessary to assess early detection, determination of treatment, prognosis prediction, and monitoring of exacerbation. Herein, we review recent studies regarding disease classifications and biomarkers of asthma.
Adult* ; Asthma* ; Biomarkers* ; Classification ; Diagnosis ; Humans ; Precision Medicine* ; Patient Selection ; Phenotype ; Prescriptions ; Prognosis ; Research Personnel

BACKGROUNDThe current theory of dyspnea perception presumes a multidimensional conception of dyspnea. However, its validity in patients with cardiopulmonary dyspnea has not been investigated.

METHODSA respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort, affective aspects, and behavioral items was administered to 396 patients with asthma, chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease, pulmonary vascular disease, chronic heart failure, and medically unexplained dyspnea. Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis. The separation of patient groups was achieved by a variance analysis on symptom factors.

RESULTSSeven factors appeared to measure three dimensions of dyspnea: sensory (difficulty breathing and phase of respiration, depth and frequency of breathing, urge to breathe, wheeze), affective (chest tightness, anxiety), and behavioral (refraining from physical activity) dimensions. Difficulty breathing and phase of respiration occurred more often in COPD, followed by asthma (R(2) = 0.12). Urge to breathe was unique for patients with medically unexplained dyspnea (R(2) = 0.12). Wheeze occurred most frequently in asthma, followed by COPD and heart failure (R(2) = 0.17). Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R(2) = 0.04). Anxiety characterized medically unexplained dyspnea (R(2) = 0.08). Refraining from physical activity appeared more often in heart failure, pulmonary vascular disease, and COPD (R(2) = 0.15).

CONCLUSIONSThree dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups. These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma ; physiopathology ; Dyspnea ; classification ; diagnosis ; etiology ; Female ; Heart Failure ; physiopathology ; Humans ; Lung Diseases ; physiopathology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Young Adult

Allergic conjunctivitis (AC) represents a spectrum of disorders, comprising seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC) and giant papillary conjunctivitis. Of these ocular allergy types, SAC and PAC are the most common. The most striking difference within this group of ocular diseases is that SAC and PAC remain self-limited without ocular surface damage, while AKC and VKC can compromise the cornea, causing ulcers and scarring and can ultimately lead to vision loss. Data on AC in the Asia Pacific is scarce however some understanding of prevalence of the condition has been obtained from the International Study of Asthma and Allergies in Childhood (ISAAC) studies and more recently from the Allergies in Asia Pacific study as well as some information from individual country surveys. Unfortunately none of this data has been collected using validated survey instruments specifically designed for AC. Surveys such as ISAAC have been predominantly concerned with respiratory allergic symptoms with questions added that incorporate some ocular symptoms. These questionnaires do not detect individuals who may have AC in the absence of allergic rhinitis. Using hospital ophthalmology outpatient populations for prevalence studies of ocular allergy immediately introduces a bias towards the more severe, complex forms of the condition as patients with the milder forms of SAR and PAR will rarely present to a hospital outpatient clinic. There is a real need for the development of validated questionnaires specifically addressing ocular allergy. There are no widely accessible studies examining prevalence of the complex forms of ocular allergy (AKC, VKC) in Asia Pacific region. This review will provide an overview of ocular allergy, its classification, clinical presentation and differential diagnosis, and will also discuss what is known about the epidemiology of ocular allergy in the Asian Pacific region.
Asia ; Asian Continental Ancestry Group ; Asthma ; Bias (Epidemiology) ; Cicatrix ; Classification ; Conjunctivitis, Allergic ; Cornea ; Cross-Sectional Studies ; Diagnosis, Differential ; Epidemiology ; Humans ; Hypersensitivity ; Keratoconjunctivitis ; Ophthalmology ; Outpatient Clinics, Hospital ; Outpatients ; Prevalence ; Rhinitis, Allergic ; Seasons ; Strikes, Employee ; Ulcer

INTRODUCTIONAllergic rhinitis (AR) is a prevalent disease worldwide but is still underdiagnosed in many parts of Asia. We studied the clinical profiles of AR patients in our community based on the new ARIA classification and investigated the aetiological allergens using a skin prick test.

MATERIALS AND METHODSIn 2008, 142 newly diagnosed patients with AR were seen and underwent skin prick testing with 90 patients completing the study.

RESULTSIntermittent mild and moderate/severe AR were evident in 10% and 21.1% of the patients, while persistent mild and moderate/severe were seen in 20% and 48.9%, respectively. Rhinitis and asthma co-morbidity occurred in 28.8% with asthma incidence significantly higher in persistent AR (P = 0.002). There was no significant association between AR severity, city living and asthma co-morbidity. Nasal itchiness and sneezing were the main presenting complaints and were more common in intermittent AR (P <0.05). Sleep disturbance was associated with moderate-severe AR (P <0.05). Polypoidal mucosa was associated with asthma co-morbidity (P <0.05). Monosensitivity reaction occurred in 12.2% of patients and was associated with fungi sensitivity (P <0.05). Majority of patients were oligosensitive (52.8%) and polysensitive (34.4%) and were significantly associated with moderate-severe persistent AR (P <0.01). The highest positive skin prick reaction and the largest average wheal diameter were for the house dust mites and cat allergen (P <0.05).

CONCLUSIONOur results reflected the AR profiles in our country, which was comparable with typical profiles of the neighbouring country and other Mediterranean countries with a similar temperate climate.

Adolescent ; Adult ; Aged ; Allergens ; Animals ; Asthma ; Cats ; Female ; Fungi ; Health Status Indicators ; Humans ; Incidence ; Malaysia ; epidemiology ; Male ; Middle Aged ; Pilot Projects ; Pollen ; Prevalence ; Pyroglyphidae ; Rhinitis, Allergic, Perennial ; classification ; diagnosis ; epidemiology ; pathology ; Severity of Illness Index ; Skin Tests ; Sleep Wake Disorders ; Statistics as Topic ; Time Factors ; Young Adult

Allergic rhinitis is defined as an immunologic response moderated by IgE and is characterized by sneezing, rhinorrhea, nasal congestion, and nasal itching. Allergic rhinitis represents a global health problem. It is an extremely common disease worldwide affecting 10 to 25% of the population. Because of its increasing prevalence over the last decades, allergic rhinitis has been identified as one of the top ten reasons for visits to primary care clinics. Although allergic rhinitis is not a severe disease usually, it significantly affects the social life of patients and compromises school performance as well as work productivity. In addition, allergic rhinitis is associated with asthma, sinusitis, otitis media, nasal polyposis, lower respiratory tract infection and dental occlusion. Therefore, the cost incurred by rhinitis is substantial. Allergic rhinitis was previously classified into seasonal, perennial, and occupational. From a therapeutic point of view, however, it is often difficult to differentiate between seasonal and perennial symptoms. In 2001, therefore, a new classification has been proposed by the ARIA as 'ntermittent' or 'persistent' rhinitis. The severity of allergic rhinitis can be classified as 'mild' or 'moderate-severe' on the basis of symptoms as well as the quality of life of the patient. Treatment of allergic rhinitis involves allergen avoidance, pharmacotherapy, and in selected cases, immunotherapy. Surgical procedures can be performed in refractory cases. This article reviews the predisposing factors to allergic rhinitis, clinical presentation, diagnosis, and the recommended treatment options.
Asthma ; Causality ; Classification ; Dental Occlusion ; Diagnosis ; Drug Therapy ; Efficiency ; Estrogens, Conjugated (USP) ; Humans ; Immunoglobulin E ; Immunotherapy ; Otitis Media ; Prevalence ; Primary Health Care ; Pruritus ; Quality of Life ; Respiratory Tract Infections ; Rhinitis* ; Seasons ; Sinusitis ; Sneezing

Monosensitization differs both immunologically and clinically from polysensitization, and specific immunotherapy is more effective in patients sensitized only to a single pollen than in multiple-pollen sensitized patients. To further examine the differences between monosensitized and polysensitized allergies, allergic indices were examined in 68 monosensitized and 62 polysensitized patients with childhood asthma. Measurements included symptom scores, eosinophil counts, skin prick tests, serum total and specific IgE levels, and IL-10 levels, and were used to compare allergic indices between the two groups. Patients were followed for 18 months following immunotherapy to examine the effectiveness of the treatment. Symptom scores and total IgE levels were significantly higher in the polysensitized group than those in the monosensitized group (p<0.05). The levels of skin test response decreased significantly in both groups following immunotherapy. In the monosensitized group, symptom scores and specific IgE levels were significantly reduced after immunotherapy (p<0.05). In the polysensitized group, symptom scores were reduced after immunotherapy (p<0.05), but the degree of reduction was less than that of the monosensitized group (p<0.05). Moreover, in the polysensitized group, specific IgE levels after immunotherapy did not differ from that before immunotherapy. Serum IL-10 levels were not significantly increased after immunotherapy in either group. In conclusion, polysensitized patients tend to show higher allergic indices and immunotherapy might be less effective for these patients.
Skin Tests/*methods ; Sensitivity and Specificity ; Reproducibility of Results ; Male ; Hypersensitivity/*classification/*diagnosis ; Humans ; *Health Status Indicators ; Female ; Child ; Asthma/*classification/*diagnosis

Monosensitization differs both immunologically and clinically from polysensitization, and specific immunotherapy is more effective in patients sensitized only to a single pollen than in multiple-pollen sensitized patients. To further examine the differences between monosensitized and polysensitized allergies, allergic indices were examined in 68 monosensitized and 62 polysensitized patients with childhood asthma. Measurements included symptom scores, eosinophil counts, skin prick tests, serum total and specific IgE levels, and IL-10 levels, and were used to compare allergic indices between the two groups. Patients were followed for 18 months following immunotherapy to examine the effectiveness of the treatment. Symptom scores and total IgE levels were significantly higher in the polysensitized group than those in the monosensitized group (p<0.05). The levels of skin test response decreased significantly in both groups following immunotherapy. In the monosensitized group, symptom scores and specific IgE levels were significantly reduced after immunotherapy (p<0.05). In the polysensitized group, symptom scores were reduced after immunotherapy (p<0.05), but the degree of reduction was less than that of the monosensitized group (p<0.05). Moreover, in the polysensitized group, specific IgE levels after immunotherapy did not differ from that before immunotherapy. Serum IL-10 levels were not significantly increased after immunotherapy in either group. In conclusion, polysensitized patients tend to show higher allergic indices and immunotherapy might be less effective for these patients.
Skin Tests/*methods ; Sensitivity and Specificity ; Reproducibility of Results ; Male ; Hypersensitivity/*classification/*diagnosis ; Humans ; *Health Status Indicators ; Female ; Child ; Asthma/*classification/*diagnosis

PURPOSE: Atopic Dermatitis (AD) is a chronically relapsing inflammatory skin disease. Generally, aeroallergens and food allergens can exacerbate symptoms in AD. Currently they are divided into two groups: one is an IgE mediated form and the other is a non-IgE mediated form. This study focused upon clinical manifestations of two distinct forms of AD. METHODS: We evaluated 110 patients (male: 58, female: 52) with AD. All patients had visited Masan Samsung Hospital from June 2002 to February 2005. The patients were divided into 2 sub-groups according to their serum total IgE and specific IgE levels. The serum total IgE and specific IgE to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Egg white, Cow's milk and Soybean were measured by the Pharmacia CAP-FEIA system. Metacholine provocation tests were conducted to reveal bronchial hyper-responsiveness and ARIA guidelines for diagnosis of AR were applied. RESULTS: Our study showed more female predominance in non IgE-mediated atopic dermatitis patients and showed higher total eosinophil count in IgE-mediated atopic dermatitis. (P< 0.05) There was no difference in frequency of asthma between two groups (P> 0.05), but allergic rhinitis was significantly predominant in non IgE-mediated atopic dermatitis patients. (P< 0.05) CONCLUSION: Female was more predominant in non IgE-mediated atopic dermatitis patients and IgE-mediated atopic dermatitis patients showed higher total eosinophil count and more frequency of allergic rhinitis.
Allergens ; Asthma ; Child* ; Classification* ; Dermatitis, Atopic* ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Diagnosis ; Egg White ; Eosinophils ; Female ; Humans ; Hypersensitivity, Immediate ; Immunoglobulin E* ; Milk ; Rhinitis ; Skin Diseases ; Soybeans