Allergen immunotherapy (AIT) has been used for over a century and has been demonstrated to be effective in treating patients with various allergic diseases. AIT allergens can be administered through various routes, including subcutaneous, sublingual, intralymphatic, oral, or epicutaneous routes. Sublingual immunotherapy (SLIT) has recently gained clinical interest, and it is considered an alternative treatment for allergic rhinitis (AR) and asthma. This review provides an overview of the current evidence-based studies that address the use of SLIT for treating AR, including (1) mechanisms of action, (2) appropriate patient selection for SLIT, (3) the current available SLIT products in Korea, and (4) updated information on its efficacy and safety. Finally, this guideline aims to provide the clinician with practical considerations for SLIT.

Allergen immunotherapy (AIT) is a causative treatment of allergic diseases in which allergen extracts are regularly administered in a gradually escalated doses, leading to immune tolerance and consequent alleviation of allergic diseases. The need for uniform practice guidelines in AIT is continuously growing as the number of potential candidates for AIT increases and new therapeutic approaches are tried. This updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT, published in 2010, proposes an expert opinion by specialists in allergy, pediatrics, and otorhinolaryngology. This guideline deals with the basic knowledge of AIT, including mechanisms, clinical efficacy, allergen standardization, important allergens in Korea, and special consideration in pediatrics. The article also covers the methodological aspects of AIT, including patient selection, allergen selection, schedule and doses, follow-up care, efficacy measurements, and management of adverse reactions. Although this guideline suggests the optimal dosing schedule, an individualized approach and modifications are recommended considering the situation for each patient and clinic.

BACKGROUND/AIMS: This study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF) monotherapy in nucleos(t)ide analogue (NA)-naive and NA-experienced chronic hepatitis B (CHB) patients. METHODS: CHB patients treated with TDF monotherapy (300 mg/day) for > or =12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks. RESULTS: In total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis) were included. Sixty-two patients were nucleos(t)ide (NA)-naive, and 74 patients had prior NA therapy (NA-exp group), and 31 patients in the NA-exp group had lamivudine (LAM)-resistance (LAM-R group). The baseline serum hepatitis B virus (HBV) DNA level was 4.9+/-2.3 log IU/mL (mean+/-SD), and was higher in the NA-naive group than in the NA-exp and LAM-R groups (5.9+/-2.0 log IU/mL vs 3.9+/-2.0 log IU/mL vs 4.2+/-1.7 log IU/mL, P<0.01). The complete virological response (CVR) rate at week 48 in the NA-naive group (71.4%) did not differ significantly from those in the NA-exp (71.3%) and LAM-R (66.1%) groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898), while the CVR rate did not differ with the NA experience. CONCLUSIONS: TDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.
Adult ; Aged ; Aged, 80 and over ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Drug Resistance, Viral ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*drug therapy ; Humans ; Lamivudine/therapeutic use ; Liver Cirrhosis/etiology ; Male ; Middle Aged ; Nucleotides/*chemistry/therapeutic use ; Retrospective Studies ; Tenofovir/*therapeutic use ; Treatment Outcome

PURPOSE: We created an 'AAPM TG18 Evaluation Tool' and we determined its usefulness for the quality control of a diagnostic monitor. MATERIALS AND METHODS: We created an evaluation tool (the AAPM TG18) for conducting quality control of a diagnostic monitor, and we evaluated the measurement items of the AAPM TG18 evaluation tool. The measurement items were geometric distortion, fixed quantity assessment and visual assessment of the veiling glare, and we carried out adjustment for the luminance meter 0% calibration, which was used to revise the diagnostic monitor DICOM LUT. RESULTS: With the AAPM TG18 Evaluation Tool, we measured the 2-dimensional length when evaluating the quantitative geometric distortions in the TG18-QC test pattern, and we measured the veiling-glare ring response function, which provided information regarding the spatial extent of the luminance spread, and this measurement of the can be performed using the TG18-GV pattern. Additionally, the AAPM TG18 Evaluation Tool can be used for sensor calibration to standardize the basic rate of 0% luminance when performing periodic calibration. CONCLUSION: The evaluation tool is a very useful for easily evaluating many of the examination items of the AAPM TG18 for performing quality control of a diagnostic monitor.
Calibration ; Computer Terminals ; Glare ; Organothiophosphorus Compounds ; Quality Control ; Radiology Information Systems ; Total Quality Management

BACKGROUND AND PURPOSE: This study compared the cognitive effects of 1 year of treatment with lamotrigine (LTG) and oxcarbazepine (OXC) in epilepsy patients. METHODS: This retrospective study investigated 60 epilepsy patients undergoing neuropsychological tests who were either newly diagnosed or untreated in the preceding 6 months. The cognitive function in 30 patients receiving LTG monotherapy and 30 age-matched patients receiving OXC monotherapy was compared after 1 year. The neuropsychological scores at baseline and all of the epilepsy-relevant variables except seizure type did not differ between the groups. The mean daily dosages of LTG and OXC at 1 year were 93 mg and 825 mg, respectively. RESULTS: The posttreatment list-learning performance was better in the LTG group than in the OXC group (p<0.05). The incidence of cognitive complaints did not differ between the two groups. The list-learning performance and Trail Making Test scores were better in each group after treatment. CONCLUSIONS: LTG and OXC monotherapies have similar, slightly beneficial effects on cognitive function, and are probably not harmful.
Cognition ; Epilepsy* ; Humans ; Incidence ; Neuropsychological Tests ; Retrospective Studies ; Seizures ; Trail Making Test

PURPOSE: To identify cognitive effects of lamotrigine (LTG) compared with valproate (VPA) in epilepsy patients after 1 year of treatment. METHODS: Cognitive tests and subjective complaints of 22 patients with LTG monotherapy (50-200 mg/day) were retrospectively compared with those of 22 patients with VPA monotherapy (500-1300 mg/day) at 1 year of medication. RESULTS: LTG group did not show any significant difference in the performance of cognitive tests compared with VPA group. The incidence of cognitive complaints between two drugs were also not different. Both groups showed a better performance of list learning and Trail Making Test type A after antiepileptic drug medication. CONCLUSION: The impact of LTG and VPA monotherapy on cognitive functioning is similar. Both drugs may not be harmful or rather slightly beneficial for cognitive functions.
Cognition ; Epilepsy* ; Humans ; Incidence ; Learning ; Retrospective Studies ; Trail Making Test ; Valproic Acid*

BACKGROUND AND PURPOSE: Low-dose topiramate (TPM) monotherapy has recently been found effective for seizure control in newly diagnosed epilepsy. In higher dosages, TPM has been associated with relatively high rates of adverse cognitive effects; similar side effects have been seen after rapid titration or polytherapy. However, its cognitive effects during low-dose monotherapy have not been established. We evaluated the cognitive effects of low-dose TPM compared with oxcarbazepine (OXC), a drug that does not appear to affect cognitive function. METHODS: Cognitive tests and subjective complaints of 30 patients with low-dose TPM monotherapy (50-200 mg/day) were retrospectively compared with those of 30 patients with OXC monotherapy at 1 year of medication. The two groups did not differ with respect to epilepsy-relevant variables, nor on baseline neuropsychological tests. RESULTS: The TPM group showed a significant difference in the performance of delayed word recall (P<0.05), backward digit span (P<0.01), and verbal fluency (P<0.05) compared with the OXC group. The TPM group showed worse performances of digit span and verbal fluency. The OXC group showed better performances of delayed word recall. The incidence of cognitive complaints was higher in the TPM group (50%) than in the OXC group (20%) (P<0.05). These cognitive effects shown in the TPM group were dose-related. The cognitive dysfunction was trivial with patients taking 50 mg/day TPM. CONCLUSIONS: Even at low-dose, TPM has a negative effect on working memory and verbal fluency compared with OXC. It can be demonstrated at 1 year of treatment.
Cognition ; Epilepsy* ; Humans ; Incidence ; Memory, Short-Term ; Neuropsychological Tests ; Retrospective Studies ; Seizures

PURPOSE: Although acute bronchiolitis is the most common lower respiratory tract infection in the first year of life, the use of pharmaceutical agents has been debated. The purpose of this study was to examine the current management practice of acute bronchiolitis by pediatricians in Incheon and to compare this with management internationally. METHODS: We sent postal questionnaires to all pediatricians in Incheon to assess their current practice for treating acute bronchiolitis. We analyzed the frequency of bronchodilators, steroids, xanthines use. These results were compared with international management. RESULTS: Of a total 131 questionnaires, 80(61 percent) were returned. Ninety percent of pediatricians used bronchodilator inhalation, either routinely(41 percent) or occasionally(43 percent). Steroid were used by 93 percent of the respondents, always(23 percent) or sometimes (65 percent). Pediatricians in Incheon tended to use pharmaceutical agents more frequently than Australian pediatricians who have consensus guidelines for the management of acute bronchiolitis, and as frequently as Swiss pediatricians who do not. CONCLUSION: Pharmaceutical agents are frequently used in the management of acute bronchiolitis by pediatricians in Incheon. Better therapeutic approaches are needed for bronchiolitis care.
Bronchiolitis* ; Bronchodilator Agents ; Consensus ; Incheon* ; Inhalation ; Surveys and Questionnaires ; Respiratory Tract Infections ; Steroids ; Xanthines

PURPOSE:Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN. METHODS:Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI. RESULTS:Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage. CONCLUSION:Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.
Arterial Pressure ; Echocardiography ; Heart ; Hemorrhage ; Humans ; Hypertension, Pulmonary* ; Hypotension ; Infant ; Infant, Newborn* ; Meconium Aspiration Syndrome ; Medical Records ; Milrinone* ; Mortality ; Nitric Oxide ; Oxygen ; Respiratory Insufficiency ; Retrospective Studies ; Ventilation

BACKGROUND: Chronic liver disease is a common cause of metabolic neurologic deterioration. We analyzed the clinical features and MRI findings of patients with liver cirrhosis who showed rapidly progressing cerebral dysfunction. METHODS: From August 2001 to July 2003, we had 9 liver cirrhosis patients hospitalized due to acutely developed and rapidly progressed neurologic symptoms that were caused not by other metabolic disturbances. Blood tests and liver ultrasonography were performed to assess the severity of liver cirrhosis. A brain MRI study was done in all patients. RESULTS: The causes of liver cirrhosis were viral hepatitis (n=6), chronic alcoholism (n=2), and autoimmune disease (n=1). Serum ammonia and electrolyte levels were within the normal range. Truncal or limbs ataxia and dysarthria were the most common symptoms. The corpus callosum and dentate nucleus of the cerebellum were commonly involved on diffusion- and T2-weighted MRI. In spite of intensive investigation and treatment, all patients had a rapidly deteriorating course with the appearance of uncontrolled abnormal movements and a decreased consciousness level. Their deaths occured within 1 month of the onset of symptoms. CONCLUSIONS: We present nine liver cirrhosis patients with characteristic clinical features and diffusion- and T2-weighted MRI findings for the first time. It is assumed that some neurologic circuit plays a role in pathogenesis.
Alcoholism ; Ammonia ; Ataxia ; Autoimmune Diseases ; Brain Diseases, Metabolic* ; Brain* ; Cerebellar Nuclei ; Cerebellum ; Consciousness ; Corpus Callosum ; Dysarthria ; Dyskinesias ; Extremities ; Hematologic Tests ; Hepatitis ; Hepatolenticular Degeneration ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver* ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Reference Values ; Ultrasonography