Characteristics of the Elderly Asthma

( Deok In Kim ),( Hyouk Soo Kwon ),( Woo Jung Song ),( Sang Min Lee ),( Sae Hoon Kim ),( Seong Wook Sohn ),( Chang Han Park ),( Heung Woo Park ),( Sun Sin Kim ),( Sang Heon Cho ),( Kyung Up Min ),( Yo 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.2

배경: 노인 천식은 한 보고에서 우리나라 유병률이 12.7%에 달하며 전세계에서 가장 빠르게 고령화 사회로 진입하고 있는 우리나라에서 점차 더 임상적으로 중요한 위치를 차지할 것이다. 노인 천식에 대한 다각적인 연구가 필요한 시점이다. 목적: 노인 천식에서 성별, 발병 연령 등에 따른 임상적 차이를 알아보고자 하였다. 방법: 분당서울대학교병원 천식 및 알레르기 클리닉을 방문한 65세 이상의 환자들을 대상으로 성별, 발병 연령에 따른 임상 양상에 대해 연구하였다. 65세 이전 발병의 경우를 조기 발병 천식, 65세 이후 발병의 경우를 후기 발병 천식으로 분류하였다. 결과: 총 180명 중, 81명이 조기 발병 천식, 99명이 후기 발병 천식이었다. 조기 발병 천식의 유병 기간은 18.8±17.1년, 후기 발병 천식은 3.4±3.5년이었다. 조기 발병 천식에서 천명음, 피부단자검사 양성, 기관지확장 소견이 더 높게 나타났으며, 기도 폐쇄 정도가 더 심하였으나, 천명 외의 다른 호흡기계 증상, 약물 요구 정도, 혈청 총 IgE에는 차이가 없었다. 일부 환자에서 유도객담을 분석하였고 후기 발병 천식에서 호중구 분율이 높았다. 결론: 65세 이상의 천식 환자를 일반적으로 노인 천식 환자라 부르고 있으나, 발병 연령에 따라 임상적인 차이가 있으며 후기 발병 천식에서는 호중구의 역할을 시사하는 연구결과를 보였다. 따라서 관련 연구 진행이나 진료에 있어 발병 연령에 따른 고려가 필요할 것으로 사료된다. (Korean J Asthma Allergy Clin Immunol 2008;28:98-104)

구강알레르기증후군

최정희 ( Jeong-hee Choi ),이창률 ( Chang Youl Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Oral allergy syndrome (OAS) is an IgE-mediated allergy caused by cross-reacting antigenic determinants in pollens and various fruits, vegetables, and nuts which are known as the most common food allergy in adults. Cross-reactive antigenic proteins include pathogenesis-related-10 protein, profilin, cross-reactive carbohydrate determinant and lipid transfer protein. The prevalence of OAS has been reported at up to 70% of birch pollen allergy. A nationwide multicenter study in our country has recently reported that the prevalence of OAS in Korea is 41.7% of pollen allergy. Typical symptoms of OAS are tingling, itching sense and edema of lips, mouth, and throat immediately after ingestion of raw fruits, vegetables, or nuts. These can progress to systemic symptoms including anaphylaxis. The diagnosis can be made by typical clinical history in patients with pollen allergy. Skin prick test using fresh fruits extracts can be helpful in confirming sensitization to foods, which has better sensitivity than commercial skin prick test or serum specific IgE test. Treatment of OAS is to avoid causative foods. Self-injectable epinephrine should be considered in the case of anaphylaxis. Allergen-specific immunotherapy to pollens has also been tried. (Allergy Asthma Respir Dis 2018;6:85-89)

대한 소아알레르기 호흡기학회 창립 30년 - 소아알레르기 분야 연구 활동의 발자취(1945-1981년)

김규언 ( Kyu Earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.S

소아 천식 환자에서 비염과 천식과의 관계: 알레르기비염과 비알레르기비염 비교

권은별 ( Eun Byul Kwon ),백지현 ( Ji Hyeon Baek ),김형윤 ( Hyeong Yun Kim ),윤정원 ( Jung Won Yoon ),신윤호 ( Youn Ho Shin ),지혜미 ( Hye Mi Jee ),최선희 ( Sun Hee Choi ),한만용 ( Man Yong Han ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Purpose: We aimed to determine the prevalence of allergic rhinitis and nonallergic rhinitis, difference in symptoms between allergic rhinitis and nonallergic rhinitis, and the association between lung function and the degree of asthma control in children with asthma. Methods: One hundred seventy patients who were followed-up for asthma treatment at the department of pediatrics of CHA Bundang Medical Center were enrolled in this study. We conducted the questionnaire regarding coexistence of rhinitis, childhood asthma control test (C-ACT), and the basic lung function test. The patients were classified as allergic rhinitis group and nonallergic rhinitis group according to the response to 11 common inhalation and food allergens, and assessed the degree of asthma control and the severity of rhinitis. Results: One hundred thirty patients (73%) were found to have rhinitis. Of these, 79 patients (53%) had allergic rhinitis and 34 patients (20%) had nonallergic rhinitis. The allergic rhinitis group was older than the nonallergic rhinitis group or the nonrhinitis group (7.73±2.85 vs. 5.97±2.48 vs. 6.12±2.70, P<0.001). Nasal itching sense was more prevalent in the allergic-rhinitis group than in the nonallergic rhinitis group (3.23±1.90 vs. 2.44±1.56, P=0.036). There was an inverse correlation between the rhinitis and C-ACT (r= -0.329, P<0.05). Of note, nasal obstruction symptom was highly correlated with C-ACT (r=-0.334, P<0.001). Conclusion: Allergic rhinitis and nonallergic rhinitis were highly prevalent in the pediatric patients with asthma and both of them had a significantly adverse impact on asthma control by rhinitis-itself. Therefore, regardless of atopic status, clinicians should focus on relieving rhinitis symptoms. (Allergy Asthma Respir Dis 2013;1:241-247)

영유아 식품알레르기 예방을 위한 최신 의견: 수유와 이유식을 중심으로

송태원 ( Tae Won Song ),안강모 ( Kang Mo Ahn ),이수영 ( Soo Young Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.5

Food allergy is common with the prevalence of 5%-7% in Korean children. The development of food allergy is likely to reflect interactions between genetic factors and environmental exposure. To prevent food allergy, early exposure to food allergens through maternal and infant diet have been investigated. Recently, guidelines for primary prevention of food allergy have been updated, and consensus communication on early peanut introduction has been demonstrated. For the first 4-6 months after birth, exclusive breast-feeding is recommended, and if impossible, extensively or partially hydrolyzed infant formula can be recommended in high-risk infants. Introducing complementary foods is recommended between 4 and 6 months of age, even in case of potentially allergenic foods such as egg, milk, and wheat. For the prevention of peanut allergy, early peanut introduction could be better than late peanut introduction in selected high-risk infants. However, infants who developed food allergy should avoid ingestion of specific offending foods. (Allergy Asthma Respir Dis 2015;3:320-325)

성인에서 발생한 우유 알레르기 환자에서 쇠고기와 돼지고기 알레르기를 동시에 나타낸 환자

최성진 ( Sung Jin Choi ),허규영 ( Gyu Young Hur ),신승엽 ( Seung Youp Shin ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.3

Cow`s milk has been recognized for many years as one of the leading causes of food allergy. The prevalence of cow`s milk allergy is reported to be 1% to 2%. It has been reported that 13∼20% of milk allergy children react to beef. We experienced a case of 47-year-old female patient presenting with severe food allergy symptoms including abdominal pain, dizziness, dyspnea, nasal stuffiness and vaginal spotting 2∼3 hours after ingestion of cow`s milk, beef, or pork which developed 8 months ago. Laboratory findings showed high total IgE levels (1,295 kU/L) and high specific IgE levels to milk, beef, and pork (3.04 kU/L, 9.26 kU/L, and 4.58 kU/L, respectively) using the immuno-CAP system, while allergy skin tests for milk, beef, and pork showed negative results. In bovine serum albumin (BSA) IgE ELISA test, the patient showed a high serum specific IgE binding activity to the BSA compared to healthy controls. She received regular inhaled corticosteroid and antihistamines and restricted ingestion of cow`s milk, beef and pork meats. We report a rare case of adult-onset milk allergy showing concurrent reactivity to beef and pork. (Korean J Asthma Allergy Clin Immunol 2007;27:200-203)

아토피피부염이 영유아의 식품알레르기 자연경과에 미치는 영향

박지선 ( Ji Sun Park ),문순정 ( Soon Jeong Moon ),임대현 ( Dae Hyun Lim ),장해지 ( Hae Ji Jang ),황선영 ( Sun Young Hwang ),박윤성 ( Yoon Sung Park ),김정희 ( Jeong Hee Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.5

Purpose: There have been studies showing that food allergy plays a role in the pathogenesis of atopic dermatitis. However, there have been few studies about the effect of atopic dermatitis on remission of food allergy. Thus, this study aimed to evaluate the dif-ference in remission according to the presence of atopic dermatitis in infants and young children with milk or egg allergy. Methods: A retrospective study was performed on 109 infants and young children with IgE-mediated food allergy in a tertiary hos-pital. They divided into food allergy with atopic dermatitis (FA with AD) and without atopic dermatitis (FA without AD). Results: In the milk allergy group, initial milk-specific IgE levels were 21.16±27.98 kU_A/L and 11.36±22.88 kU_A/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of milk allergy at 36 months of age were 64.9% and 90.0%, respectively, in FA with AD and FA without AD. In the egg allergy groups, initial egg-specific IgE levels were 34.48±36.72 kU_A/L and 15.66±28.60 kU_A/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of egg allergy at 36 months of age were 61.2% and 90.0% in children with FA with AD and FA without AD. Conclusion: Atopic dermatitis may play an important role in the natural history of food allergy in infants. Different strategies are needed for the management of food allergy in young children with atopic dermatitis. (Allergy Asthma Respir Dis 2017;5:256-261)

메타콜린 기관지유발검사 시행방법: 대한천식알레르기학회 의견서

손경희 ( Kyoung-hee Sohn ),김환수 ( Hwan Soo Kim ),김병근 ( Byung-keun Kim ),김주희 ( Joo-hee Kim ),이상민 ( Sang Min Lee ),이재현 ( Jae-hyun Lee ),우성일 ( Sung-il Woo ),김철홍 ( Cheol Hong Kim ),정재원 ( Jae Won Jung ),김세훈 ( 대한천식알레르기학회 2023 Allergy Asthma & Respiratory Disease Vol.11 No.2

메타콜린 기관지유발검사는 천식의 감별 진단 및 기관지과민증을 측정하기 위해 널리 시행되어온 검사이다. 정확한 진단을 위해 표준화된 프로토콜로 검사가 이루어져야 하나, 최근 검사 장비의 변경 및 2017년 ERS가이드라인에서 프로토콜이 변경되었음에도 불구하고, 진료 일선에서는 과거 프로토콜이 여전히 사용되고 있다. 현재 국내에서 사용 가능한 APS 장비에서는 기존 KoKo dosimeter에서 사용되던 프로토콜을 적용할 수 없으므로 더 간소화되고 고도화된 프로토콜을 제안한다. 학회는 본 전문가 의견서를 통해 새로운 메타콜린 기관지유발검사 프로토콜을 제시하였으며, 개정된 프로토콜의 타당성과 정확성에 대해서는 향후 전향적인 다기관연구가 필요하다. The Korean Academy of Asthma, Allergy, and Clinical Immunology task force report aims to provide new protocols for methacholine challenge test (MCT). Although new devices have different delivery system compared to old ones, previous protocols are still used, which cannot guarantee adequate diagnoses of asthma. Another important issue is the recent recommendation in European Respiratory Society (ERS) technical standard guideline to use a delivered methacholine dose that causes a 20% decrease in forced expiratory volume in 1 second (FEV₁) (PD₂₀). Although the previous protocol based on the methacholine concentration causing a 20% decrease in FEV₁ (PC₂₀) has been used globally, several studies have reported that PD₂₀ is more reliable and applicable for new protocols of MCT. Indeed, a tidal breathing inhalation protocol using a breath-actuated or continuous nebulizer is recommended. Herein, we recommend 3 protocols for the MCT using new devices and provide a brief summary of the change in strategy based on the updated ERS guideline. (Allergy Asthma Respir Dis 2023;11:56-62)

소아천식환자에 대한 RAST 및 알레르기 피부검사의 진단적 가치 평가

이기영 대한천식알레르기학회 1987 천식 및 알레르기 Vol.7 No.2

RAST has been used frequently as a test to detect specific IgE for the diagnosis of atopic allergic diseases. But many reports have shown that RAST is correlated well with allergy skin test and not better than the latter in its significance for confirming causative allergens. The purpose of this study is to know whether RAST can detect the patients who could not be detected by allergy skin test. 108 cases who had asthma like symptoms and shown negative or equivocal reactions to D. farinae or D. pteronyssinus by allergy skin test as a screc.,'ng test were performed RAST with about 10 allergens which are frequently positive in Korean children including house dust mite allergen. In cases who were positive by RAST, allergy skin test with same allergens were performed and the results were analyzed. The results obtained from this study were as fol- lows: 1. Ninty-nine cases(91.6%) were negative to house dust mite allergen and only 9 cases(8.4%) showed equivocal or positive reactions to same allergen by RAST. 2. Seven out of 9 cases who had equivocal or positive reactions to house dust mite by RAST were per- formed allergy skin test with same allergen as a follow-up study. The result of allergy skin test on house dust mite was correlated very well with RAST. The possibility of correlation with RAST on the other 2 cases who had not performed allergy skin test were also discussed. 3. Twenty-one allergens other than house dust mite were equivocal or positive reactions by RAST. Allergy skin tests were performed with same allergens on these cases. Seven allergens (cat hair in 5 cases, house dust and ragweed in each case) were negative by allergy skin test. Therefore, it can be concluded that detection of house dust mite allergen by allergy skin test in the diagnosis of atopic respiratory diseases is reliable method because skin test is correlated very well with RAST. But it is recommendable to perform allergy skin test more than once in suspicious cases in diagnosis.

우리나라 신문 기사를 통해 살펴본 알레르기질환 (1920-1972년)

김규언 ( Kyu Earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.S

Purpose: This study aimed to investigate which Korean newspaper articles were reported on allergic diseases before the establishment of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI). Methods: This study was performed in 3 newspapers, Chosun Ilbo, DongA Ilbo, and JoongAng Ilbo, which were founded and used the databases established before the establishment of KAAACI in 1972. The databases were searched using 42 keywords associated with allergic diseases (allergy, asthma, rhinitis, etc.). Results: Among the 42 keywords, there were only 7 that were able to search: allergy, urticaria, asthma, dermatitis, rhinitis, pollen and eczema. The total number of articles related to allergic diseases were 62, as follows: allergy (n=21), urticaria (n=15), asthma (n=8), dermatitis (n=8), rhinitis (n=5), pollen (n=3), and eczema (n=2). There were 31 articles in Chosun Ilbo, 9 in DongA Ilbo, and 22 in JoongAng Ilbo. The first allergic disease published in the newspapers was asthma on the article entitled “Treat the cause of asthma” (on page 8 of November 10, 1960 DongA Ilbo). The first article that used the term allergy appeared in a column entitled, “Childhood illness and allergy” (on page 4 of May 30, 1960 DongA Ilbo). Conclusion: Since 1920, articles related to allergic diseases published in the Korean newspapers increased every year. These articles may have appeared due to the increase in the prevalence of allergic disease and the pioneering efforts of senior allergy researchers. (Allergy Asthma Respir Dis 2018;6 Suppl 1:S85-89)