Purpose: Few meta-analyses of head-to-head comparisons between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) for perennial allergic rhinitis (AR) have been performed so far. This study aimed to compare the efficacy, safety, and adherence of SCIT and SLIT in patients with house dust mite (HDM)-sensitized AR through a meta-analysis of head-to-head comparative studies. Methods: A meta-analysis based on direct comparisons of SCIT and SLIT in HDM-sensitized AR was performed, using randomized controlled trials (RCTs) and nonrandomized studies (NRSs), on efficacy, safety, and adherence, which had been published until April 30, 2021. Treatment efficacy was calculated as the standardized mean difference in symptoms and medication scores after treatment between SCIT and SLIT. Safety and adherence to treatment were compared with the relative risk (RR) of SCIT and SLIT. Results: Six RCTs and 3 NRS scores were analyzed. No statistically significant difference was noticed in improvement in symptoms and medication scores between SCIT and SLIT groups. Systemic adverse events occurred more frequently in SCIT than in SLIT in both RCT (RR, 3.97; 95% confidence interval [CI], 0.50–31.57) and NRS (RR, 5.48; 95% CI, 1.94–15.50). SCIT showed significantly higher adherence than did SLIT (RR, 1.16; 95% CI, 0.92–1.47). Conclusion No significant difference in efficacy was noticed between the 2 modalities for HDM-sensitized AR. However, SLIT had significantly lower number of systemic adverse reactions, and SCIT had more preferable adherence.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

A high level of particulate matter (PM) in air is correlated with the onset and development of chronic respiratory diseases. We conducted a systematic literature review, searching the MEDLINE, EMBASE, and Cochrane databases for studies of biomarkers of the effect of PM exposure on chronic respiratory diseases and the progression thereof. Thirty-eight articles on biomarkers of the progression of chronic respiratory diseases after exposure to PM were identified, four of which were eligible for review. Serum, sputum, urine, and exhaled breath condensate biomarkers of the effect of PM exposure on chronic obstructive pulmonary disease (COPD) and asthma had a variety of underlying mechanisms. We summarized the functions of biomarkers linked to COPD and asthma and their biological plausibility. We identified few biomarkers of PM exposure-related progression of chronic respiratory diseases. The included studies were restricted to those on biomarkers of the relationship of PM exposure with the progression of chronic respiratory diseases. The predictive power of biomarkers of the effect of PM exposure on chronic respiratory diseases varies according to the functions of the biomarkers.

Purpose: Little is known about blood markers related to eosinophils in healthy individuals. We aimed to identify blood markers from routine tests associated with blood eosinophil count (BEC) in healthy individuals. Methods: Based on the complex interactions among blood markers, we used comprehensive analysis methods (regression, Bayesian network [BN], and partial correlation) and a health check-up database. To test consistency, we repeated the analysis using data from 3 check-ups of the same healthy individual. Results: A total of 12,625 individuals were enrolled in this study. Four groups were defined according to sex and smoking status: nonsmoking men (n=1,737), smoking men (n=6,518), nonsmoking women (n=3,995), and smoking women (n=375). The blood bilirubin and γ-glutamyltransferase levels showed significant associations with BEC by regression analysis. However, BN analysis found that only the bilirubin node was directly connected to the BEC node. By partial correlation analysis, the blood bilirubin level showed significantly negative association with BEC. The same results were obtained across all the 3 health check-ups, except in smoking women. In addition, a lower blood bilirubin level predicted a significantly elevated BEC (especially ≥200/µL). The blood bilirubin levels measured at 3 time-points were significantly associated with BEC in men and nonsmoking women. Conclusion The blood bilirubin level, which is easily obtained by routine test in clinical practice, may be a useful marker for BEC.

Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and nonmedical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the “KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy” in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on nonpharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.

Oxygen therapy (OT) can relieve head pain in certain primary headache disorders, including cluster headache (CH). The exact underlying mechanism is currently uncertain, but suggested mechanisms include inhibition of the trigeminoautonomic reflex, modulation of neurotransmitters, and cerebral vasoconstriction. OT is the standard for acute treatment of CH, but patients with CH often experience considerable difficulties accessing home OT due to problems with insurance coverage. Inhalation of 100% oxygen at 6–12 L/min for 15–30 min using a non-rebreather face mask is one of the most effective acute therapies for CH, but several trials have indicated the superiority of higher oxygen flow rates of up to 15 L/min and/or using a demand-valve oxygen mask that can produce very high flow rates. Two randomized controlled trials have demonstrated the efficacy of OT in migraine, but obtaining reliable evidence is considered difficult because of different inhalation protocols, varying outcome measures, and small samples. There are some reports on the efficacy of OT as an adjuvant therapy in hypnic headache, primary headache in the emergency department, and even postdural puncture headache. The goal of this review article is to expand the knowledge regarding the use of oxygen in the treatment of headache disorders.

Background: Adverse drug reactions (ADRs) to first-line anti-tuberculosis (TB) drugs are common; however, there have been few reports of nationwide epidemiologic studies on ADRs to anti-TB drugs in Korea. This study aimed to investigate the clinical characteristics of various ADRs to first-line anti-TB drugs using a nationwide database of ADRs. Methods: We used the Korea Adverse Event Reporting System (KAERS) database (2009– 2018). The study subjects were selected using the Korean Standard Classification of Diseases codes for pulmonary and extrapulmonary TB and electronic data interchange codes for isoniazid (INH), rifampicin (RIF), ethambutol (ETB), and pyrazinamide (PZA). The causality assessment of “possible,” “probable,” or “certain” by World Health Organization-Uppsala Monitoring Center System causality category was selected. Results: A total of 1,562,024 ADRs were reported in the KIDS-KAERS database from 2009 to 2018, where ADRs to first-line anti-TB drugs were 17,843 cases (1.14%). The most common causative drugs were RIF (28.7%), INH (24.0%), ETB (23.4%), and PZA (23.9%) in that order. 48.5% of cases were reported in the older patients (≥ 60 years). According to organ system, gastro-intestinal system disorder was most common (32.0%), followed by skin and appendage (25.9%), liver and biliary system (14.2%). Nausea was the most common ADR (14.6%), followed by hepatic enzyme elevation (14.2%), rash (11.7%), pruritus (9.1%), vomiting (8.9%), and urticaria (4.2%). Most ADRs appeared within 1 month, but ADRs such as neuropathy, paresthesia, hematologic abnormalities, renal function abnormalities and liver enzyme abnormality were also often reported after 2 months. Conclusion Our data are clinically informative for recognizing and coping with ADRs of antiTB drugs.

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.