Background: The distribution of species and characteristics of non-tuberculous mycobacteria (NTM) differ, and surveillance data for changes in antimicrobial susceptibilities of NTM is insufficient. This study analyzed the changes in antimicrobial susceptibility trends across NTM species and assessed the appropriateness of empirical antimicrobial drugs for NTM. Materials and Methods: We retrospectively analyzed the clinical characteristics, including demographics, distribution of NTM species, antimicrobial drug susceptibilities, and outcomes, at a teaching hospital in Jeju Island from 2009 - 2022. Results: Overall, 342 patients were included in the analysis; 93.0% were classified into the pulmonary group (PG) and 7.0% into the extrapulmonary group (EPG). The isolation rate of Mycobacterium avium was significantly higher in PG (36.8% vs. 0%, P = 0.001), while that of Mycobacterium fortuitum was significantly higher in EPG (4.5% vs.31.3%, P = 0.001). The antimicrobial susceptibility rate is higher against clarithromycin (89.9%) and amikacin (83.3%) and lower against rifampin (54.7%) and ethambutol (28.1%). The susceptibility rate to clarithromycin was over 80%, but those to rifampin and ethambutol showed decreasing annual trends. Of the 162 patients who received empirical antimicrobial therapy, actual antimicrobial susceptibility rates were high (90.1%) using empirical macrolide, and relatively low using ethambutol and rifampin (28.0% and 58.8%, respectively). Conclusion This is the first study of analysis of the distribution, baseline characteristics, and antimicrobial susceptibility of isolated NTM species in pulmonary and extrapulmonary patients in Jeju Island over 10 years. Policies that continuously monitor changes in susceptibility rate are required to ensure effective treatment strategies.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a major culprit of drug-induced hypersensitivity. No reliable diagnostic tests other than a direct challenge are available. Cross-reactivity among NSAIDs that inhibit cyclooxygenase-1 is common. However, in rare cases, the mechanism underlying hypersensitivity is immunologically understood, without involving cross-reactivity of NSAIDs or even with a positive skin test for an NSAID. A 55-year-old woman was referred to the Emergency Department for anaphylaxis. She suffered from generalized hives, chest tightness, and hypotension a few minutes after intramuscular diclofenac injection. One year before, she had experienced a similar reaction after intramuscular injection of aceclofenac. Thereafter, she had been taking naproxen as needed to relieve her osteoarthritis pain, without having an adverse reaction. To confirm drug hypersensitivity and to find alternative drugs, provocation tests were performed with acetaminophen, celecoxib, and lysine-aspirin. All tests were negative, and a skin prick test with diclofenac was also negative. However, intradermal injection of 0.05 mL (37.5 mg/mL) diclofenac provoked an anaphylactic shock and resulted in her admission. Here, we report a rare case of single NSAID-induced anaphylaxis, which was only triggered by acetic acid derivatives of NSAIDs, presumably by an immunoglobulin E-mediated reaction.

Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.

Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research. Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed. Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones. Conclusions BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits.

Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.

Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research. Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed. Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones. Conclusions BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits.

Purpose: Red meat allergy has recently been described as rare food hypersensitivity with unique pathogenesis and clinical relevance of delayed anaphylaxis. The culprits are various mammal meats containing oligosaccharide epitope (galactose-α-1,3-galactose, α-gal). Interestingly, hard tick bites precede the onset of this allergic condition. The clinical characteristics of red meat allergy had never been reported in Korea. Methods: Among patients diagnosed with food hypersensitivity in a hospital located in Jeju, Korea, those with red meat allergy were recruited. Clinical characteristics were retrospectively reviewed and additionally interviewed. Results: Five patients (mean age, 57±4 years; 4 males and 1 female) were diagnosed as having red meat allergy. They suffered from hives, as the most common symptom, followed by shortness of breath from 10 minutes to 6 hours after exposure to the culprits. Four patients visited the emergency department for anaphylaxis. Culprits included beef, pork, dog, ham, goat, and roe deer. Chicken, duck, bacon, or horse did not cause clinical symptoms. In 4 patients, hard tick bites preceded the onset. Detection of specific IgE to α-gal and culprits such as beef and pork facilitated the confirmative diagnosis. They were advised to avoid mammal meats and to receive a prescription for self-injectable epinephrine. Conclusion Red meat allergy is one of the food hypersensitivities, characterized by severe and delayed allergic reactions to various meats. Red meat allergy may be a tick-borne illness in Jeju, Korea.

Metoclopramide is prokinetic drug that inhibits dopamine receptors, and it is commonly used in emergency rooms because of its anti-emetic effect. A 71-year-old man visited the hospital with upper abdominal pain and nausea, but agitation and cold sweating were observed after 5 minutes of metoclopramide injection. The vital signs were blood pressure: 120/70 mmHg, heart rate: 170/minute, respiration: 23 breaths/minute, and temperature: 37.5。C, and the electrocardiogram (ECG) showed ventricular tachycardia. One hour after the injection of amiodarone, normal sinus rhythm was shown on the ECG and the vital signs were stable. Metoclopramide is known to be relatively safe, but rarely causes serious cardiovascular side effects. Therefore, emergency physicians should be aware that metoclopramide can cause serious side effects.

PURPOSE: Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis. MATERIALS AND METHODS: Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130). RESULTS: The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25–10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79–15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70–51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03–9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15–1.37; p<0.001) were related to the development of anaphylaxis in PFAS. CONCLUSION: The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.
Alnus ; Ambrosia ; Anaphylaxis ; Arachis ; Cross-Sectional Studies ; Demography ; Dermatitis, Atopic ; Food Hypersensitivity ; Fruit ; Humans ; Hypersensitivity ; Juglans ; Nuts ; Panax ; Pollen ; Prunus persica ; Rhinitis, Allergic, Seasonal ; Risk Factors ; Salix ; Vegetables