OBJECTIVETo investigate the clinical value of combined determination of in vitro allergens and fractional exhaled nitric oxide (FeNO) in indentifying children at a high risk of asthma among those with recurrent wheezing.

METHODSA total of 148 children with recurrent wheezing (0.5-6 years old) were enrolled as study subjects, and 80 healthy children who underwent physical examination were enrolled as the control group. Pharmacia UniCAP immunoassay analyzer was used to measure specific immunoglobulin E (sIgE). Nano Coulomb Nitric Oxide Analyzer was used to measure FeNO. The asthma predictive index (API) was evaluated.

RESULTSThe recurrent wheezing group had a significantly higher proportion of children with positive sIgE than the control group [68.9% (102/148) vs 11.3% (9/80); P<0.05]. The recurrent wheezing group also had significantly higher levels and positive rate of FeNO than the control group (P<0.05). The overall positive rate of API in children with wheezing was 32.4%, and the API-positive children had a significantly higher FeNO value than the API-negative children (51±6 ppb vs 13±5 ppb; P<0.05). The detection rate of API was 40.2% (41/102) in positive-sIgE children and 50.1% (38/73) in FeNO-positive children, and there was no significant difference between these two groups. The children with positive sIgE and FeNO had a significantly higher detection rate of API (81.4%) than those with positive sIgE or FeNO (P<0.05).

CONCLUSIONSCombined determination of FeNO and in vitro allergens is more sensitive in detecting children at a high risk of asthma than FeNO or in vitro allergens determination alone and provides a good method for early identification, diagnosis, and intervention of asthma in children.

Allergens ; immunology ; Asthma ; diagnosis ; Breath Tests ; Child ; Child, Preschool ; Female ; Humans ; Immunoglobulin E ; blood ; Infant ; Male ; Nitric Oxide ; analysis ; Recurrence ; Respiratory Sounds ; diagnosis

OBJECTIVETo investigate the risk factors for recurrent wheezing in infants and young children suffering from dust mite allergy after their first wheezing.

METHODSA total of 1 236 infants and young children who experienced a first wheezing episode and were hospitalized between August 2014 and February 2015 were enrolled, among whom 387 were allergic to dust mites. These infants and young children were followed up to 1 year after discharge. A total of 67 infants and young children who experienced 3 or more recurrent wheezing episodes within 1 year were enrolled as the recurrent wheezing group, while 84 infants and young children who did not experience recurrent wheezing during follow-up were enrolled as the control group. Univariate analysis and multivariate logistic stepwise regression analysis were performed to investigate the risk factors for recurrent wheezing in these patients.

RESULTSThe univariate analysis showed that the age on admission, wheezing time before admission, Mycoplasma pneumoniae infection rate, and influenza virus infection rate were associated with recurrent wheezing. The multivariate logistic stepwise regression analysis showed that the older age on admission (OR=2.21, P=0.04) and Mycoplasma pneumoniae infection (OR=3.54, P=0.001) were independent risk factors for recurrent wheezing.

CONCLUSIONSInfants and young children who are allergic to dust mites, especially young children, have a significantly increased risk of recurrent wheezing if they are complicated by Mycoplasma pneumoniae infection during the first wheezing episode.

Animals ; Child, Preschool ; Female ; Humans ; Hypersensitivity ; complications ; Infant ; Logistic Models ; Male ; Pyroglyphidae ; immunology ; Recurrence ; Respiratory Sounds ; etiology ; Risk Factors

OBJECTIVETo investigate the percentage of T lymphocyte subsets and allergen screening results in infants and young children with Mycoplasma pneumoniae (MP) infection complicated by wheezing.

METHODSFlow cytometry was used to measure the percentage of peripheral blood T cell subsets in 354 infants and young children with MP infection complicated by wheezing (MP wheezing group), 336 infants and young children with MP infection but without wheezing (MP non-wheezing group), and 277 children with recurrent wheezing (recurrent wheezing group). Allergen screening was also performed for these children.

RESULTSBoth the MP wheezing group and recurrent wheezing group had significantly lower percentages of CD3and CD3CD8lymphocytes than the MP non-wheezing group (p<0.05). The MP groups with or without wheezing had a significantly higher percentage of CD3CD4lymphocytes than the recurrent wheezing group (p<0.05). Both the MP wheezing group and recurrent wheezing group had significantly higher percentages of CD3CD19and CD19CD23lymphocytes than the MP non-wheezing group (p<0.05), and the recurrent wheezing group had the highest percentages (p<0.05). The overall positive rate of food allergens was significantly higher than that of inhaled allergens (30.3% vs 14.7%; p<0.05). The positive rates of food and inhaled allergens in the recurrent wheezing group and MP wheezing group were significantly higher than in the MP non-wheezing group (p<0.05), and the recurrent wheezing group had the highest rates.

CONCLUSIONSImbalance of T lymphocyte subsets and allergic constitution play important roles in the pathogenesis of MP infection complicated by wheezing in infants and young children.

Allergens ; immunology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pneumonia, Mycoplasma ; complications ; immunology ; Respiratory Sounds ; etiology ; T-Lymphocyte Subsets ; immunology

OBJECTIVETo study the possible immunological mechanism of wheezing attack in children with cytomegalovirus (CMV) infection.

METHODSA total of 25 under-5-year-old children with wheezing following CMV infection were enrolled. The expression of serum regulatory T cells (Treg)/T helper 17 (Th17) cytokines interleukin (IL)-10, IL-6, and IL-17, and peripheral blood lymphocyte subsets were determined. Twenty age-matched healthy children were selected as the control group.

RESULTSThe wheezing group had a significantly reduced serum IL-10 level, significantly increased IL-6 and IL-17 levels, significantly reduced levels of natural killer cells, and significantly increased levels of CD8+ T cells and CD19+ B cells, as compared with the control group.

CONCLUSIONSWheezing children with CMV infection have Treg/Th17 imbalance and cellular immune dysfunction, which may be an important immunological mechanism of the development of wheezing in children after CMV infection.

Child, Preschool ; Cytokines ; blood ; Cytomegalovirus Infections ; immunology ; Female ; Humans ; Infant ; Male ; Respiratory Sounds ; etiology ; immunology ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology

Allergic diseases such as asthma are increasing. The prevalence of adult asthma is about 3% in Korea. However, asthma becomes more prevalent with age: 6.8-12% in the elderly. In terms of socioeconomic burden, asthma is the 6th important chronic disease in Korea. The symptoms of asthma such as dyspnea, wheezing, cough, and chest discomfort may vary according to time and season. Reversible airflow limitation and airway hypersensitivity are the characteristic features of asthma. Inhaled corticosteroid is the mainstay in the management of asthma as chronic airway inflammation is the underlying mechanism. Stepwise approach is recommended according to the severity and the control status. Physicians should be aware of the control status, lung function, and the risk factors of future risk including asthma exacerbations. Doctor-patient relationship is always important to increase the adherence and treatment outcome. Patients should learn how to use inhalers: video clips on inhalers are available at the websites such as Gyeonggi-do Atopy Asthma Education Information Center. In this review, the practical approach of asthma management was described mainly referring to the Korean guideline for asthma which has been published, revised, and updated by the Korean Academy of Asthma, Allergy, and Clinical Immunology and recently published in 2015.
Adult ; Aged ; Allergy and Immunology ; Asthma* ; Chronic Disease ; Cough ; Disease Management ; Dyspnea ; Education ; Gyeonggi-do ; Humans ; Hypersensitivity ; Inflammation ; Information Centers ; Korea ; Lung ; Nebulizers and Vaporizers ; Prevalence ; Respiratory Sounds ; Risk Factors ; Seasons ; Thorax ; Treatment Outcome

OBJECTIVETo determine the frequencies and significance of myeloid-derived suppressor cells (MDSCs) and T-helper 17 (Th17) cells in peripheral blood of young children with recurrent wheezing.

METHODSThirty young children with an acute exacerbation of recurrent wheezing were randomly enrolled. Twenty age-matched children with bronchopneumonia (pneumonia group) and 23 age-matched preoperative children with non-infectious or non-neoplastic diseases (hernia or renal calculus) (control group) were selected. The frequencies of MDSCs and Th17 cells in the peripheral blood were measured using flow cytometry and their correlation was determined by the Spearman's correlation coefficient.

RESULTSThe percentage of MDSCs in nucleated cells was significantly higher in the wheezing group than in the pneumonia and control groups (P<0.05), and it was significantly higher in the pneumonia group than in the control group (P<0.05). The percentage of Th17 cells in mononuclear cells was significantly higher in the wheezing group than in the pneumonia and control groups (P<0.05), but it showed no significant difference between the pneumonia and control groups (P>0.05). The frequency of MDSCs was positively correlated with the frequency of Th17 cells in the wheezing group (r=0.645, P<0.01).

CONCLUSIONSMDSCs and Th17 cells may contribute to the pathogenesis of recurrent wheezing in young children.

Child, Preschool ; Female ; Humans ; Infant ; Leukocytes, Mononuclear ; immunology ; Male ; Myeloid Cells ; immunology ; Recurrence ; Respiratory Sounds ; immunology ; Th17 Cells ; immunology

OBJECTIVETo study whether infantile wheezing pneumonia has similar immune mechanisms to asthma by determining the levels of serum inflammatory factors in wheezing infants with community-acquired pneumonia (CAP).

METHODSForty-two infants with CAP but without wheezing, 47 infants with CAP and wheezing, and 30 healthy infants as a control were recruited in the study. The peripheral blood levels of C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cell-l, interferon-γ, interleukin-4, interleukin-10, and periostin were compared in the three groups.

RESULTSThe serum levels of procalcitonin, soluble triggering receptor expressed on myeloid cell-l, interleukin-4 and interleukin-10 in the two CAP groups were higher than in the control group (P<0.05). The ratio of interferon-γ/interleukin-4 in the wheezing pneumonia group was lower than in the non-wheezing pneumonia and control groups (P<0.05). The serum level of periostin in the wheezing pneumonia group was higher than in the non-wheezing pneumonia and control groups (P<0.05).

CONCLUSIONSThe unbalanced ratio of interferon-γ/interleukin-4 and airway eosinophilic inflammation in wheezing infants with pneumonia suggest infantile pneumonia with wheezing may has similar immune mechanisms to asthma.

Child, Preschool ; Community-Acquired Infections ; immunology ; Female ; Humans ; Infant ; Interferon-gamma ; blood ; Interleukin-10 ; blood ; Interleukin-4 ; blood ; Male ; Membrane Glycoproteins ; blood ; Pneumonia ; immunology ; Receptors, Immunologic ; blood ; Respiratory Sounds ; immunology ; Triggering Receptor Expressed on Myeloid Cells-1

OBJECTIVETo study myeloid-derived suppressor cells (MDSC) levels in peripheral blood of infants with recurrent wheezing, and the role of MDSC in the development of recurrent wheezing.

METHODSThirty-one infants with recurrent wheezing at wheezing attacks were randomly enrolled in the study. Twenty-seven infants with bronchopneumonia and 27 preoperative infants (hernia or renal calculus), without infectious or neoplastic diseases, were selected as controls. The proportion of MDSC in peripheral blood mononuclear cells (PBMC) was measured by flow cytometry.

RESULTSThe proportion of MDSC in PBMC in infants with wheezing was significantly higher than in those with bronchopneumonia and preoperative infants (P<0.05).

CONCLUSIONSMDSC levels increase in infants with recurrent wheezing, suggesting that MDSC may play a crucial role in the development of this disorder.

Child, Preschool ; Female ; Humans ; Infant ; Leukocytes, Mononuclear ; immunology ; Male ; Myeloid Cells ; immunology ; Recurrence ; Respiratory Sounds ; immunology

OBJECTIVETo study the characteristics of allergic reactions to common aeroallergens in young children with wheezing or allergic diseases by examining the results of skin prick test in children under 5 years old.

METHODSA total of 196 children under 5 years old, from a district of Changsha City sampled between September 1 to December 31, 2010, were assigned into two groups according to the presence of wheezing or allergic diseases: allergen screening (n=102) and control (n=94). Skin prick tests were performed on both groups.

RESULTSThe positive rate of skin prick test in the allergen screening group was 61.8% (63/102), and this was significantly higher than in the control group (9.6%, 9/94; P<0.05). In the allergen screening group, the positive rate of skin prick test in children with both recurrent wheezing and allergic rhinitis was significantly higher than in children with wheezing alone (P<0.05). The frequency of wheezing was positively correlated with a positive skin prick test (r=0.91; P<0.05). The positive rate of skin prick test for mites was significantly higher than for other aeroallergens (24.2% vs 3.5%; P<0.05) in the allergen screening group. Skin prick testing of the children for dermatophagoides farinae showed a higher positive rate than for dermatophagoides pteronyssinus (50.0% vs 14.7%; P<0.05).

CONCLUSIONSWheezing in early childhood may be associated with the occurrence of asthma. Skin prick testing contributes to the diagnosis of allergic diseases and assessment of allergic reactions to aeroallergens in children with wheezing.

Asthma ; etiology ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Respiratory Sounds ; diagnosis ; immunology ; Rhinitis, Allergic, Perennial ; diagnosis ; immunology ; Rhinitis, Allergic, Seasonal ; diagnosis ; immunology ; Skin Tests

The objective of this study was to evaluate the prevalence of asthma, allergic rhinitis, and atopic dermatitis, as well as the risk factors of wheezing among young adults in the Korean military. Young military conscripts in five areas completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. For subjects with current wheeze in one sample area, baseline spirometry and bronchodilator response were measured. For subjects without a significant response to bronchodilator (improvement in FEV1 of more than 200 mL and 12%), methacholine challenge tests (MCT) were also performed. Of 3,359 subjects that completed the questionnaire, 354 (10.5%) had current wheeze, 471 (14.0%) had current allergic rhinitis, and 326 (9.7%) had current eczema. Current wheeze was associated with family history of allergic disease, overweight, current smoking, allergic rhinitis, and atopic dermatitis. Of 36 subjects with current wheeze who underwent PFT with or without MCT in the Anyang area, 24 (66.7%) were confirmed to have current asthma. In conclusion, the prevalence of allergic disease in young adults of Korean military is not low, and the risk factors of wheezing include family history of allergic disease, overweight, current smoking, allergic rhinitis, and atopic dermatitis.
Adult ; Asthma/*complications/epidemiology/*immunology ; Bronchial Provocation Tests ; Humans ; Hypersensitivity/*epidemiology/*immunology ; *Military Personnel ; Prevalence ; Questionnaires ; Republic of Korea/epidemiology ; Respiratory Function Tests ; Respiratory Sounds/*etiology ; Risk Factors ; Young Adult