Acute eosinophilic pneumonia(AEP) is one of uncommon causes of fatal respiratory failure. Since first reported in 1979, AEP is considered as different disease entity from chronic eosinophilic pneumonia. Recently, consensus is evolving in regard to diagnostic criteria. We experienced a 21-year old male patient presenting typical clinical and radiological characteristics of AEP. Bronchoalveolar lavage showed eosinophilia and transbronchial lung biopsy revealed infiltration of eosinophils and lymphocytes in interstitium and alveoli. This patient completely recovered within three weeks without corticosteroid. We report this case with brief review of literature.
Biopsy ; Bronchoalveolar Lavage ; Consensus ; Eosinophilia ; Eosinophils* ; Humans ; Lung ; Lymphocytes ; Male ; Pulmonary Eosinophilia* ; Respiratory Insufficiency ; Young Adult

We experienced two cases of occupational asthma induced by Elk dander in Elk-feeders and confirmed these cases by the bronchial provocation test with Elk dander. Both of them showed dual asthmatic response. They also showed positive reaction to the skin prick test with EIK dander. Now one of them has no asthmatic symptoms at all after complete avoidnce of EIK dander.
Asthma, Occupational* ; Bronchial Provocation Tests ; Dander ; Skin

BACKGROUND: Eosinophils are suggested to play a deleterious role in the inflammatory disease of the respiratory mucosa by releasing granule substances such as major basic prorein and eosinophil cationic protein. To investigate the contribution of eosinophils in the pathogenesis of nasal polyps and the mechanism of their accumulation and activation, we observed the eosinophil inhllration and expression of endotjelial and epithelial cell adhesion molecules in the nasal polyp tissues. MATERIALS AND METHODS: Polyp and inferior turbinate mueosal specimens (polyp group) taken out of 20 patients and 10 inferior turbinate mucosa specimens of non-allergic and non-infectious controls (control group) were immunohistochemically stained using EG1, EG2, and mAb for the ICAM-1, VCAM-1 and E-seleetin. The number of EG1 (+) and EG2 (+) cells within lmm2 of tissue and the expression of ICAM-1, VCAM-1 and E-seleetin on the vessels (% of total vessel) and epithelial eelis (area x intensity) were compared among three groups. RESULTS:The inferior turbinate mucosae of nasal polyp patients .were infiltrated by signifieantly higher number of eosinophils (EG1:17, EG2:16/mm2) compared with those of controls (EGi:0, EG2:0/mm2) (p<0.05), and the polyp tissue revealed much more eosinophils (EG1: 213, EG2:154/mm2) than inferior turbinates of same patients and those of controls (p<0.001). ICAM-1 expression in the vessels was frequenly observed both in polyps and in the turbinate mucosae with significant difference (median:85% vs. 67%, p<0.05), and ICAM-1 expression in the epithelial ceils was significantly different between the polyp and turbinate groups (median:9 vs. 2.5, p<0. 01). VCAM-1 was moderately expressed on the vessels of both polyps and turbinate mucosac (median:37%, 14%, respectively) and their expressions were significantly different (p<0.01). E-selectin expression was moderate to low both in the polyps and in the turbinate mucosae (median:18%, 10% respectively) and their expressions were not significantly different (p>0.05). CONCLUSION: Most of the eosinophils infiltrated into nasal tissue as well as nasal polyps were activated forms and they were significantly increased in the nasal polyps compared to the inferior turbinate mueosae of the same patients and control subjects. Significantly increased expression of ICAM-1 and VCAM-1 on the vessels and increased epithelial ICAM-1 expression in the nasal polyps indicate that interactions of eosinophils with ICAM-1 and VCAM-1 participate in the pathogenesis of nasal polyps.
E-Selectin ; Eosinophil Cationic Protein ; Eosinophils* ; Epithelial Cells ; Humans ; Intercellular Adhesion Molecule-1 ; Mucous Membrane ; Nasal Polyps* ; Polyps ; Respiratory Mucosa ; Turbinates ; Vascular Cell Adhesion Molecule-1

32 year-old male patient has experienced the repeated swelling of the skin on the eyelid, both hand, foot, lower and upper extrimities and testicle spontaneously without any trauma since 17 years old. This happening has subsided with or without treatment after 2-3 days. His great grandfather had suffered from the same events but grandfather or father or even his two brothers and one sister didn't have any swellings like him. Two days after this attack, he visited emergency room, his serum complement level was decreased such as C1q 9.7mg/dl (10-20mg/dl), C3 52mg/dl (55-120mg/dl), C4 4mg/dl (20-50mg/dl) measured by single radial immunodiffusion (SRID), but two weeks after full recovery, C1q 11.2mg/dl, C3 79mg/dl, C4 5mg/dl. The level of C1 esterase inhibitor was decreased upto 8.1 mg/dl (> 11 mg/dl) measured by nephlemeter(Mitshibishi Co., Japan). Now he is just under the close observation without androgen treatment because the attack of HAE(hereditary angioedema) happens much less and less severe after adolescence.
Adolescent ; Adult ; Angioedemas, Hereditary* ; Complement C1 Inhibitor Protein ; Complement System Proteins ; Emergency Service, Hospital ; Eyelids ; Fathers ; Foot ; Hand ; Humans ; Immunodiffusion ; Male ; Siblings ; Skin ; Testis

Glucocorticoid hormones have been identified as one of the B cell activating signals necessary in IgE synthesis in the presence interleukin 4(IL-4). One question to be addressed in IgE synthesis is whether there is difference between atopics and non-atopics. In the present study, we aimed at looking the different effects of interleukin 4(IL-4) and hydrocortisone(HC) in IgE synthesis by peripheral blood monounclear cells (PBMCs) from 12 atopic patients and 6 non-atopic controls. PBMCs were cultured with IL-4 and/or HC for 14 days, and net IgE production was measured in the supernatant. Significant spontaneous IgE production by PBMCs was oberserved only in atopics. IL-4 increased net IgE synthesis by PBMCs from both atopics and non-atopics by similar amounts, whereas HC had that effect only in some atopics who showed high spontaneous IgE production. HC acted synergically with IL-4 in a narrow range of concentration which is individually different. This effect was more remarkable in subjects with low total serum IgE levels. These data suggest that atopic patients may have larger numbers of B cells committed to produce IgE, and that the effect of HC on IgE synthesis in vitro may be due to the priming effect of IL-4 in vivo.
Antibodies* ; B-Lymphocytes ; Humans ; Hydrocortisone* ; Immunoglobulin E* ; Interleukin-4* ; Interleukins*

OBJECTIVES: Allergen is closely related with local features and cultural environment and a new approach method regarding causes triggering aggravation is especially required due to complex and variety of ordinary residence and pollution of living environment recently. We, therefore, performed this study to inspire the necessity of identification of causative afeuts in aothmatic patients in pusan area. METHODS: We measured serum specific IgE antibody by means of chemiluminescent analyzer employing MAST, classified the level from class 0 to 4 and interpreted the result in order to identify allergen on total 262 patients consisted of inpatients and outpatients who had been presumed as extrinisic asthma and treated in this hospital during 2 and a half years from June of 1994 to December of 1996. RESULTS: 1. With regard to sex and age distribution, the rate of men versus women was 1 : 1.3, while in the distribution by age, the twenties and the thirties were the most as 29% and 26% respectively. 2. The result of interpretation of the test showed positive in 75%, 78% of which showed positive reaction compounded of 2 kinds or more. 3. If we take a look at the distribution of total IgE class in the positive area, we can find that ; Class III and class II showed the highest frequency as 47% and 37% respectively. 4. If we take a look at the distribution by age and allergen, the twenties(32%) and the thirties(30%) showed the highest frequency, the fifties, the forties and the teens showed middle frequency as 10~13% and the sixties and the seventies showed the lowest frequency as about 1%. The causative allergen appeared in the order of pollen(40%), dust(20%), food(18%), fungus(13%) and epidermis(8%). 5. The distribution of allergen by season generally showed high rate of positive appearance in spring and fall as pollen appeared in spring(44%) and fall(27%), dust appeared in fall(32%) and summer(23%), food appeared in spring(34%) and fall(29%), fungus appeared in fall(30%) and spring(28%) and epidermis appeared in spring(30%) and fall(28%). 6. With regard to the allergen: (1) In pollen allergens, trees showed higher positive frequency than weeds and trees were in the order of birch(14%), alder(13%) and hazelnut mix(12%) and weeds showed similar positive values. (2) In dust allergens, mite(D. pteronyssinus and D. farinae) showed high positive rate as 39% each. (3) In epidermal allergens, it also showed relatively even positive value among which cat's halr-dandruff was the highest as 40%. (4) In food allergens, shrimp showed the highest as 22% and others were similar as evenly positive values. (5) In fungus allergens, Candida and Stemphylium showed the highest value as 19% each. CONCLUSION: The analysis of allergen by means of MAST could be used as a valuable guide post for identifing cousative antigens for active treatment of extrinsic asthma.
Adolescent ; Age Distribution ; Allergens ; Asthma* ; Busan* ; Candida ; Corylus ; Dust ; Epidermis ; Female ; Fungi ; Humans ; Immunoglobulin E ; Inpatients ; Male ; Outpatients ; Pollen ; Seasons ; Trees

To detect causative allergens in type I hypersensitivity diseases, several methods have been used. Among those, skin prick test is easy to perform and sensitive. Several criteria presenting positive reactions have been used. Therefore, we tried to find out more sensitive and specific criteria for deciding a positive reaction on skin prick test in 57 patients(allergic rhinitis; 39, bronchial asthma ; 5, acute urticaria ; 2, chronic urticaria ; 11) with 69 allergens and compared the reproducibility between each positive criteria. We calculated the ratio of wheal size caused by each allergen to that of histamine and defined as "A" in case of it's ratio was over 0.5, "B" in case of over 0.7, "C" in case of over 1.0. The results were as follows, 1. The positive rate of house dust on skin prick test was the highest, and D. farinae, cat fur, D. pteronyssinus, mixture of cat fur, house dust, horse hair, dog hair in order. 2. Mean reproducibilities of four common allergens in each positive criteria were 91% in criteria A, 88% in criteria B, and 82% in criteria C. 3. Comparing between mean reproducibilities by earth positive criteria, in positive criteria between 0.5 and 0.7 and positive criteria between 0.7 and 1.0, there were no significant differences, but in positive criteria between 0.5 and 1.0, statistical significant difference was noted. In conclusion, it was suggested that the ratio of wheal sizes of allergen to histamine greater than 0.7 might be ideal for a positive skin prick test.
Allergens ; Animals ; Asthma ; Cats ; Dogs ; Dust ; Hair ; Histamine ; Horses ; Hypersensitivity, Immediate* ; Rhinitis ; Skin Tests* ; Skin* ; Urticaria

It has been suggested that Alternaria is the most prevalent fungal allergen based upon previous reports of airborne spore survey and allergy skin prick test. In order to observe the clinical features of Alternaria-sensitive asthmatic patients, and to evaluate a diagnostic value of allergy skin prick lest, serum specific IgE antibody, and bronchoprovocation test to Alternaria antigen, we performed allergy skin prick test with two sources of Alternaria antigens as well as 80 common inhalant and food allergens, and serum specific IgE antibody was determined by Ala-STAT(DPC, USA). To confirm bronchial sensitization, bronchoprovocation test with Alternaria alternata antigen from Allergophama (Germany) was performed on 15 asthmatic subjects sensitized to any of Alternaria spp. antigen, and compared between positive and negative responders. Eleven among 15 patients showed early (7) or dual (4) asthmatic responses. Four (36.4%) of 11 positive responders showed an positive response to one kind of Alternaria antigen on skin prick test. Four (36.3%) of them had a positive response to only Alternaria antigen with all negative responses to other fungal allergens. Seven (63.6%) of them showed positive responses to other fungal allergens such as Fusarium spp., Cladosporium spp., Aspergillus spp. All except one of 11 positive responders had high specific IgE antibody to Alternaria alternata on AlaSTAT. These results suggest that more than two sources of Alternaria spp. antigen should be used for screenig a causative fungal allergen. Determination of serum specific IgE can be helpful to complete the sensitivity of skin prick test in case of asthmatic patients sensitized to Alternaria antigen. Further studies will be needed to evaluate allergenic relationships with other fungal allergens appearing cocurrently on skin prick test.
Allergens ; Alternaria* ; Aspergillus ; Asthma* ; Cladosporium ; Fungi* ; Fusarium ; Humans ; Hypersensitivity ; Immunoglobulin E ; Skin ; Spores

Salmeterol is a long acting, highly selective, beta2-adrenergic agonist. It prevents asthma symptoms in patients with mild or moderate disease and improves nocturnal asthma and sleep quality. We evaluated the bronchodilator and bronchoprotective effect and duration of action of inhaled salmeterol in patients wlth asthma. We compared the bronchodilator and bronchoprotective effects of salmeterol with salbutamol in 34 patients with asthma. Diagnosis of asthma was confirmed with methacholine challenge test or airway reversibility test. We performed the symptom index questionnaire, peak expiratory flow rate, pulmonary function test and methacholine challenge test. Symptom scores were more improved with salmeterol treatment than salbutamol treatment. After salmeterol inhalation, mean FEV1 increased from 1.95L(pre-treatment) to 2.04L(early stage in the treatment), 2.06L(late stage), 2.03L(follow up). There was no difference in FEV1 between early stage and late stage after salmeterol treatment. With salmeterol, there was a significant increases in PC30 on methacholine challenge test ( PC20 4.96 : 16.42). Salmeterol is a potent, long-acting bronchodilator, with a slower onset and longer duration of bronchodilation than salbutamol. It also has bronchoprotective effect and shows low incidence of adverse effects.
Albuterol ; Asthma ; Diagnosis ; Humans ; Incidence ; Inhalation ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Salmeterol Xinafoate ; Surveys and Questionnaires

OBJECTIVES: Chronic asthma has a number of characteristic feature; the increased airway responsiveness and bronchial inflammation. Although these mechanisms are not clear, activated T-cell has had an important role in migration and activation of inflammatory cells. In order to evaluate the role of T-lymphocyte and T-cell subsets in the development of asthmatic symptoms and the posibility for predicting the therapeutic response, we performed bronchoalveolar lavage from asymptomatic and symptomatic asthmatic subjects and inflammatory cell count, T-cell subset, activated T-lymphocyte were analysed and they were compared with healthy controls. METHOD: 76 bronchial asthmatics and 54 healthy controls were enrolled in this study. Asthmatic patients were classified into symptomatic and asymptomatic group according to symptom severity. Symptomatic group was divided into two groups according to therapeutic response ; early responder(ER) and late responder(LR). Lymphocytes(T-lymphocytes subsets and activation marker) in bronchoalveolar lavage(BAL) cells were analyzed using a flow-cytometry. RESULTS: The counts of eosinophil and neutrophil in BAL fluid were significantly higher in both asymptomatic and symptomatic asthmatic patient than those of healthy controls (p<0.05). The number of T3, T4, and T8 lymphocytes were significantly higher in symptomatic asthmatic patient than those of healthy controls, and the counts of T3-IL2R+, T4-IL2R+, and T8-IL3R+ lymphocytes were significantly higher in symptomatic subsets than in healthy controls(p<0.05). Although there were no significant differences in the number of lymphocyte, eosinophil and neutrophil between the ER and LR of symptomatic patients(p>0.05), the numbers of T3 and T4 lymphocyte subsets were significantly higher in LR than in healthy controls, and the number of T3-IL2R+, T4-IL2R+ lymphocytes were significantly higher in ER than in healthy controls(p<0.05). CONCLUSION: We could conclude that the infiltration and activation of T-lymphocytes might be associated with the development of asthmatic symptoms and responsiveness to therapy.
Asthma ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; CD4-Positive T-Lymphocytes ; CD8-Positive T-Lymphocytes ; Cell Count ; Emigration and Immigration ; Eosinophils ; Humans ; Inflammation ; Lymphocytes ; Neutrophils ; T-Lymphocyte Subsets ; T-Lymphocytes*