Thymic carcinoid tumors are very rare and grow slowly with low grade of malignancy. It can manifest flushing, diarrhea, and bronchial constriction with secretion of serotonins, histamines or neuropeptides. We experienced a case of thymic carcinoid tumor, which aggravated asthma. A 59-year-old male had been in a well-controlled state, until he was admitted for status asthmaticus 2 years ago. Since then, he had suffered from frequent dyspnea and had severe asthma attack leading to ICU care twice in spite of full optimal anti-asthma therapy. Nine months ago, anterior mediastinal tumor was found incidentally, which was diagnosed as carcinoid tumor. After resection, his asthmatic symptoms and signs were improved and controlled in a persistent mild state. Taken together, this case indicates that asthma might be aggravated by carcinoid syndrome caused by thymic carcinoid tumors.
Asthma* ; Bronchoconstriction ; Carcinoid Tumor* ; Diarrhea ; Dyspnea ; Flushing ; Humans ; Male ; Middle Aged ; Neuropeptides ; Serotonin ; Status Asthmaticus ; Thymus Gland

Exercise-induced anaphylaxis (EIA) is a medical emergency in that it derives from a physical allergy. We reported a case of food-independent EIA based on history and laboratory data. A 40-year-old male patient was presented with generalized urticaria, angioedema, and syncope after jogging. He had suffered from allergic rhinitis for 25 years. Increased level of serum tryptase was noted. Mast cell activation might be suggested in the pathophysiologic mechanism of EIA.
Adult ; Anaphylaxis* ; Angioedema ; Emergencies ; Humans ; Hypersensitivity ; Jogging ; Male ; Mast Cells ; Rhinitis ; Syncope ; Tryptases* ; Urticaria

Fluoroquinolones are antimicrobial agents that have a broad range of activity against both gram-negative and gram-positive organisms. Anaphylactoid reactions have been sporadically reported with fluoroquinolones. There have been a few reports that describes cross-reactivity between fluoroquinolones. We experienced a case of ofloxacin-induced anaphylactoid reaction, and confirmed cross-reactivity between ofloxacin and ciprofloxacin with the oral challenge test. Cross-reactivity between fluoroquinolones may be important, and avoidance of any fluoroquinolones should be mandatory for patients with hypersensitivity reaction to one of these drugs.
Anti-Infective Agents ; Ciprofloxacin ; Fluoroquinolones* ; Humans ; Hypersensitivity ; Ofloxacin*

Storage mites are believed one of the most important allergens in farmers and rural regions. Tyrophagus putrescentiae, belonging to storage mites, is found not only within storehouses but also in the house dust, and the third most common mites following Dermatophagoides farinae and Dermatophagoides pteronyssinus in house dust in Korea. The sensitization rate to Tyrophagus putrescentiae was reported as high as that of house dust mite in patients visiting the allergy clinic in large cities in Korea. We experienced a 69-year-old man who had suffered from dyspnea, wheezing, and coughing for 10 years. He retired from the teaching profession, and had lived in a large city, Deajeon. The skin prick test showed a positive reaction to Tyrophagus putrescentiae and negative reactions to house dust mites. The bronchial challenge test with Tyrophagus putrescentiae showed late asthmatic reaction. We confirmed a Tyrophagus putrescentiae-induced asthma in non occupational setting.
Acaridae ; Aged ; Allergens ; Asthma* ; Bronchial Provocation Tests ; Cough ; Daejeon ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Dust ; Dyspnea ; Humans ; Hypersensitivity ; Korea ; Mites ; Pyroglyphidae ; Respiratory Sounds ; Skin

Isopropylantipyrine is one of the pyrazolon derivatives which are nonsteroidal anti-inflammatory drugs (NSAIDs) with potent antipyretic and pain-relieving properties. It has been known that pyrazolon-hypersensitive patients, in contrast to ASA-sensitive patients, could safely use other NSAIDs. We describe two Korean patients with isopropylantipyrine hypersensitivity without ASA/NSAID hypersensitivity.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Hypersensitivity*

BACKGROUND: IL-5 and eotaxin are the most important cytokines/chemokines responsible for regulating eosinophil locomotion. OBJECTIVE: We investigated the role of IL-5 and eotaxin in airway eosinophilic inflammation in patients with chronic cough by analyzing sputum from patients. METHODS: Thirty-one patients who had chronic cough and seven normal control subjects were enrolled. Patients were divided into two groups, asthma group (n=15) and non-asthma group (n=16). Sputum was induced by inhalation of hypertonic saline. Total cell counts and differentials were determined. The levels of IL-5 and eotaxin were measured by ELISA, and the levels of EDN and MBP were measured by RIA. RESULTS: Patients in the asthma group showed higher percentage of eosinophils and higher levels of EDN and IL-5 (P<.001, P<.05 and P<.05, respectively) compared to subjects in the control group and higher % eosinophils, higher levels of EDN and MBP (P<.001, P<.05 and P<.05, respectively) compared to subjects in the control group. Non-asthma group patients also showed higher percentage of eosinophils and increased IL-5 levels (P<.05 and P<.05, respectively) compared to the control group. The eotaxin level correlated positively with percentage of eosinophils (Rs = 0.60, P<.001), the EDN (Rs = 0.59, P<.001) and MBP (Rs = 0.73, P<.01) levels, and correlated inversely with FEV1 % pred. (Rs = -0.71, P<.01). Unexpectedly, the IL-5 levels did not correlate significantly with any of sputum eosinophil indices or FEV1 % pred. CONCLUSION: Good correlation of eotaxin with sputum eosinophil indices or pulmonary function and no correlation of IL-5 with them suggest that eotaxin may play a more important role in the specific recruitment and degranulation of airway eosinophils, although both IL-5 and eotaxin are involved in local eosinophilic inflammation.
Asthma ; Cell Count ; Cough ; Enzyme-Linked Immunosorbent Assay ; Eosinophils* ; Humans ; Inflammation* ; Inhalation ; Interleukin-5* ; Locomotion ; Sputum

BACKGROUND: Dehydroepiandrosterone (DHEA), an adrenal androgen, may regulate Th1/Th2 cytokines. OBJECTIVE: To determine whether DHEA have a preventive effect against the development of asthma, a Th2-associated disease. MATERIALS AND METHODS: Female BALB/c mice were fed with a standard diet incorporated with 0.1% (w/w) of DHEA for 1 week before sensitization with ovalbumin (OVA, 20 microgram i.p. twice with 2-week intervals). Enhanced pause (Penh) was monitored after 1% OVA inhalations for 3 successive days, and then the methacholine bronchoprovocation tests were performed using a whole-body plethysmography system. Analyses of inflammatory cells, cytokines, and OVA-specific IgE were carried out. RESULTS: Both the excessive airway narrowing (maximum Penh) and the airway hypersensitivity (PC200, mg/mL) to methacholine were significantly suppressed with the DHEA pretreatment (P<.05 and P<.01, respectively). However, the numbers of the inflammatory cells and the levels of interleukin (IL)-4, IL-5, and interferon (IFN)-gamma in the bronchoalveolar lavage fluid, the production of IL-4, IL-5, and IFN-gamma by Con A-stimulated splenocytes, and the serum IgE level in DHEA group were not significantly different from those in asthma group. CONCLUSION: DHEA pretreatment could suppress the development of asthmatic airway hyperresponsiveness without suppression of Th2 cytokines and airway inflammation.
Animals ; Asthma ; Bronchoalveolar Lavage Fluid ; Cytokines ; Dehydroepiandrosterone* ; Diet ; Female ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Interferons ; Interleukin-4 ; Interleukin-5 ; Interleukins ; Methacholine Chloride ; Mice* ; Ovalbumin ; Ovum ; Plethysmography

OBJECTIVE: Allergic rhinitis is one of the most common diseases in the field of otorhinolaryngology. Correct diagnosis for allergic rhinitis is important for its optimal management. Many studies have been reported for the diagnosis with allergens. This study was performed to identify the relationship between MAST, the skin test, and the nasal provocation test. We attempted to find an appropriate diagnostic method for finding causative allergens. METHOD: We reviewed the medical records of patients with allergic rhinitis symptoms and physical findings from August 2001 through July 2002 at Inha University Hospital. We selected 197 patients who were examined with MAST, the skin prick test, and the nasal provocation test. The relationship between these tests was determined with SPSS (Ver10.0). RESULTS: There was a significant correlation between MAST and the skin prick test(P<.05). There were also significant correlations between MAST and the nasal provocation test, and between the skin prick test and the nasal provocation test(P<.05). CONCLUSION: MAST might be a useful diagnostic method for finding causative allergens, especially in children and patients with skin hypersensitivity and other skin disorders.
Allergens ; Child ; Diagnosis ; Humans ; Hypersensitivity ; Medical Records ; Nasal Provocation Tests* ; Otolaryngology ; Rhinitis* ; Skin Tests ; Skin*

BACKGROUND: During the past few decades, the prevalence of allergic disorders has increased worldwide. We attempted to reveal the sensitization rate of dust mite allergens, which is one of the most important allergens in Korea, and the prevalence of mite-sensitized asthma in healthy young women who had no history of allergic diseases. METHODS: We performed the skin prick test with two mites (Dermatophagoides farinae, Df; Dermatophagoides pteronnyssinus, Dp) in 24-26 years old 172 women who had no history of allergic diseases. We also performed the methacholine bronchial provocation test (MBPT) and the questionnaire survey of positive skin responders. RESULTS: The 55.2% of subjects showed positive skin responses to house dust mites. The positive rate to MBPT was 54.7% with average PC20 of 15.97+/-7.68 mg/ml and 48.4% had asthma symptoms in the questionnaire survey. Among the methacholine positive population, 6.3% had no asthma symptoms. The history of 3-week cough after upper airway infection was most important, but the most specific item was wheezing. CONCLUSION: The prevalence of dust mite-sensitive bronchial asthma in healthy young women is 26.7%, which is higher than that of previous studies.
Allergens ; Asthma* ; Bronchial Provocation Tests ; Cough ; Dust* ; Female ; Humans ; Korea ; Methacholine Chloride ; Mites ; Prevalence* ; Pyroglyphidae* ; Respiratory Sounds ; Skin ; Surveys and Questionnaires

BACKGROUND: Objective tests including the methacholine bronchial provocation test and the induced sputum examination are now crucial in the detection of causes of chronic cough. On the other hand, carefully taken history of characteristics, complications, or duration of cough are known not useful in diagnosing causes of chronic cough. OBJECTIVES: To determine whether ever wheeze history can be an important clue in the diagnosis of cough variant asthma. METHODS: Patients with a history of cough lasting more than 3 weeks were enrolled. Patients who were current smokers, who had been receiving an angiotensin-converting enzyme inhibitor, who had basal FEV1 less than 70% of predicted value, who had adventitial sound on auscultation, or who had experienced resting dyspnea were all excluded. We divided the patients into two groups according to the ever wheeze history. The methacholine test (reference value of PC20 = 25mg/ml) and the induced sputum eosinophil percentile (reference value = 3%) were compared between the two groups. All patients were evaluated by an anatomic diagnostic protocol, and the prevalence of cough variant asthma was compared. RESULTS: Three hundred eighty-two patients (138 males and 244 females) with mean age of 48.2 years met the inclusion criteria. The mean duration of cough was 30.4 months (range, 3 weeks to 600 months). Ever wheezers were 154 (40.3%), and non-wheezers were 228 (59.7%). Ever wheeze group showed higher positive methacholine test (37.7% vs. 14.5%, p<0.001) and increased sputum eosinophils (43.5% vs 11.4%, P<.001) compared to non-wheeze group. The prevalence of cough variant asthma was significantly higher in ever wheeze group (33.8% vs. 6.1%, P<.001), and that of eosinophilic bronchitis showed similar result (13.6% vs. 4.8%, P<.01). The positive predictive value of the methacholine test was lower in non-wheeze group compared to ever wheeze group (42.4% vs 86.2%, P<.01). CONCLUSION: Ever wheeze history might be very important in suspecting cough variant asthma as a cause of chronic cough. In chronic cough patients without ever wheeze, prevalence of cough variant asthma and positive predictive value of methacholine test were low.
Asthma* ; Auscultation ; Bronchial Provocation Tests ; Bronchitis ; Cough* ; Diagnosis ; Dyspnea ; Eosinophils ; Hand ; Humans ; Male ; Methacholine Chloride ; Prevalence ; Sputum