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)

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)

알레르기 질환 환자에서의 알레르기 반응도와 인성 특성의 관계

김조자,김용순,박지원,강성숙,홍천수,이기영,박인용,민성길 대한천식알레르기학회 1989 천식 및 알레르기 Vol.9 No.2

The differences of psychologic tests were found between groups of allergic diseases, who noted the degree of skin reactivity on allergy skin test. In the present study the MMPI and allergy evaluations were given to 115 patients with bron- chial asthma, allergy rhinitis, both of them and other allergic diseases, who visted at Allergy Clinic in Severance Hospital, Yonsei University College of Medicine from March 1988 to September 198K There were differences of personality charac- teristics between groups of allergic reactions. The weak skin reactivity group scored higher on depression, psychasthenia, social introversion (p<0.05) and feminity (in male patients)(p<0.01) and scored lower on psychopathic deviste than those of strong skin reactivity group. Therefore these findings confirm the previous conclusion that there are measurable, important psychological differences within groups of allergy patients, related to degree of demonstrable allergy reactivity. And allergy p a.tients had neurotic tendence. The patients who noted that their allergic simptom- developed on psychic stresses showed higher scores on hypochondriasis (p<0.05), depression (p 0.05) and hyste'ria (p<0.05) than those of the patients who did not note any relationship between development of allergy symptoms and psychic stresses. And the patients who noted that their allergy simptoms were relapsed by psye4ic stresses showed higher scores on hypochondriasis (p,0.05), depression (p <0.05), hysteria(p<0.01) and social introversion (p <0.05) than those of patients who noted that the relapse of their allergy symptoms was not related to psychic stresses. The results repremnt that psychic factors in addition to pure antigen-antibody reactions will participate in development and aggravation of allergy symptoms.

성인 기관지천식 환자에서 알레르기 비염에 대한 평가와 비염이 천식에 미치는 영향

김철우 ( Cheol Woo Kim ),이찬우 ( Chan Woo Lee ),허규영 ( Gyu Young Hur ),예영민 ( Young Min Ye ),박해심 ( Hae Sim Park ),( Carina Study Group ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.4

Background: Allergic rhinitis (AR) is the most common comorbid condition in bronchial asthma (BA), which is associated with increased morbidity and difficulty in asthma control. Recent guidelines have emphasized an integrated approach in the management of patients with both BA and AR. Objective: This study evaluated the prevalence of AR in patients with BA and evaluated its impact on asthma. Method: Adult patients with BA who visited outpatient clinics of general hospitals and primary clinics for asthma management were enrolled sequentially between October 2005 and March 2006. The prevalence and symptom scores of AR and BA were assessed using an ISAAC questionnaire. The severity of BA and AR was classified according to the GINA and ARIA guidelines, respectively. Result: A total of 460 patients with BA were recruited from two university hospitals (n=109) and 49 primary care units (n=351). The prevalence of AR symptoms was 72.6% (334/460). Although the prevalence was higher in younger patients, AR symptoms were also prevalent in elderly patients (59.1% in patients aged ≥ 65 years). Of the 334 patients with concomitant BA and AR symptoms, 59 (17.7%) were not diagnosed with AR, even though the patients reported AR symptoms. The cure-rate of AR in patients with both BA and AR was 65.3% (218/334). The most common level for AR severity was mild intermittent (38.3%) followed by moderate-severe intermittent (26.6%), mild persistent (24.3%) and moderate-severe persistent (10.8%). The prevalence of AR was not different according to the asthma severity. The patients experienced AR symptoms more frequently in November, followed by October, March and April. The BA patients combined with AR tended to present higher asthma symptom sores and suffered from significantly higher night symptoms than those with BA alone (P<0.05). Conclusion: The prevalence of AR was 73% in adult asthma patients; however, AR has been underdiagnosed and under-managed. AR should be evaluated and managed properly in all asthmatic patients to achieve a better asthma control. (Korean J Asthma Allergy Clin Immunol 2007;27:248-256)

조영제 과민반응

오미정 ( Mi Jung Oh ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.5

의료영상기기의 발전과 보급으로 환자뿐 아니라 일반인에서도 건강검진 등으로 영상검사를 받는 사람들의 수가 늘어나고 1970년도에 저삼투압성, 비이온성 조영제가 나온 이래로 조영제를 이용한 영상검사가 급속하게 증가함에 따라 조영제 유해반응이 적지 않게 발생하며 간혹 사망 사고와 같은 중증 유해반응이 발생하여 사회적인 문제가 되고 있다. 이에 2011년 대한영상의학회와 대한천식알레르기학회에서 임상진료지침서1)가 발간되었으며 최근 국내에서 조영제 과민반응에 대한 관심과 연구가 활발해지고 있다.

대한천식알레르기학회 알레르기비염 진료지침: 파트 1. 약물치료의 업데이트

김민지 ( Minji Kim ),강성윤 ( Sung-yoon Kang ),양송이 ( Song-i Yang ),이일환 ( Il Hwan Lee ),류광희 ( Gwanghui Ryu ),김미애 ( Mi-ae Kim ),이상민 ( Sang Min Lee ),김현정 ( Hyun-jung Kim ),박도양 ( Do-yang Park ),이용주 ( Yong Ju Le 대한천식알레르기학회 2023 Allergy Asthma & Respiratory Disease Vol.11 No.3

The prevalence of allergic rhinitis (AR) and the socioeconomic burden associated with the medical cost and quality of life of AR have progressively increased. Therefore, practical guidelines for the appropriate management of AR need to be developed based on scientific evidence considering the real-world environment, values, and preferences of patients and physicians. The Korean Academy of Asthma, Allergy and Clinical Immunology revised clinical guidelines for AR to address key clinical questions of the management of AR. Part 1 of the revised guideline covers the pharmacological management of patients with AR in Korea. Through a meta-analysis and a systematic review, we made 4 recommendations for AR pharmacotherapy, including intranasal corticosteroid (INCS)/intranasal antihistamine combination therapy, oral antihistamine/INCS combination therapy, leukotriene receptor antagonist treatment in AR patients with asthma, and prophylactic treatment for patients with pollen-induced AR. However, all recommendations are conditional because of the low or very low evidence of certainty. Well-designed and strictly executed randomized controlled trials are needed to measure and report appropriate outcomes. (Allergy Asthma Respir Dis 2023;11:117-125)

부천지역 초등학생의 식품알레르기 발생 실태 및 다른 알레르기질환과의 연관성

박재영 ( Jae Young Park ),박가영 ( Ga Young Park ),한영신 ( Young Shin Han ),신미용 ( Mee Yong Shin ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Purpose: This study was performed to evaluate the current status of food allergy (FA) and to analyze the relationship between allergy to individual foods and other allergic diseases in elementary school children. Methods: We performed a questionnaire survey for FA, asthma, allergic rhinitis, and atopic dermatitis using International Study of Asthma and Allergies in Childhood questionnaires. A total of 1,929 students in 3 elementary schools were enrolled. Results: A total of 324 students (16.8%) had ever suffered from FA symptoms more than once. Only 64 out of 324 students (19.8%) were diagnosed with FA by doctors. The presence of soy allergy was associated with the increased risk of bronchial asthma (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 1.87 to 18.59). The presence of egg (aOR, 1.91; 95% CI, 1.04 to 3.52) and wheat allergy (aOR, 5.45; 95% CI, 1.94 to 15.36) were associated with the increased prevalence of allergic rhinitis. The allergic symptoms to fruits/tomato was associated with the increased risk of allergic rhinoconjunctivitis symptoms (aOR, 2.98; 95% CI, 1.18 to 7.47). The allergic symptoms to egg (aOR, 2.29; 95% CI, 1.22 to 4.29), wheat (aOR, 4.91; 95% CI, 1.86 to 12.95), and shrimp/crab (aOR, 2.48; 95% CI, 1.37 to 4.49) were associated with the presence of atopic dermatitis. Conclusion: The prevalence of FA of elementary school students in Bucheon-city was 16.8%. A significant positive association between the suspected foods and the other allergic diseases was found. Soy allergy was significantly correlated to having bronchial asthma and fruits/tomato allergy correlated with allergic rhinoconjunctivitis. (Allergy Asthma Respir Dis 2013;1:266-273)

한국인 성인 알레르기 환자에서 국내산 농산물에 대한 감작률 및 교차반응성

윤성호 ( Sung Ho Yoon ),강영미 ( Young Mi Kang ),예영민 ( Young Min Ye ),김승현 ( Seung Hyun Kim ),서창희 ( Chang Hee Suh ),남동호 ( Dong Ho Nahm ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2005 천식 및 알레르기 Vol.25 No.4

Background: Agricultural products have been mainly consumed food in Korea. However, there have been no published data to observe the IgE-sensitization rate, cross-reactivity and allergenic risks to home-made agricultural food in adult allergy patients. Objective: The aim of this study was to evaluate the IgE sensitization rate and cross-reactivity to home-made agricultural products and to establish a basic data for planning treatment and prevention methods of food allergy in adult allergy patients. Method: Five thousand three hundred forty allergy patients complaining of various allergic diseases and visiting the Allergy Clinic of Ajou University Hospital were enrolled. Skin prick tests were performed with home-made agricultural products including soybean, corn, buckwheat, chestnut, rye grain, potato, nut, wheatflour, carrot, onion and rice. If A/H ratio for each agricultural product showed more than 2+ on skin prick test, it was considered a positive response. ELISA inhibition tests were performed for cross-reactivity to agricultural products. Result: The sensitization rate to home-made agricultural products ranged from 2.2% to 9.5% in adult allergy patients. Sixty-five (3.8%) and sixty-four (3.7%) out of the one thousand seven hundred sixteen patients showed positive responses (A/H≥2+) to soybean and corn, positive responses to buckwheat and chestnut were noted in 84 (4.8%) and 66 (3.8%) patients respectively, followed by rye grain (9.5%), potato (5.7%), nut (5.4%), wheatflour (5.1%), carrot (5.1%), onion (3.3%) and rice (2.2%). Wheat flour and rye grain inhibited IgE binding to each other. Soybean, corn, Hop. J, wheatflour and rye grain extracts inhibited IgE binding to potato extracts in potato sensitized subjects sera. There was a strong inhibition between corn and soybean extract. Conclusion: The sensitization rate to major agricultural products ranges from 2.2% to 9.5% in adult allergy patients, and buckwheat and soybean were the most prevalent ones among the home-made agricultual products in this country. Agricultural products-specific IgE antibody that cross reacted with other agricultual products can cause allergic reaction in foods allergy. (Korean J Asthma Allergy Clin Immunol 2005;25:269-275)

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.

대한천식알레르기학회 알레르기 면역요법 진료지침

이화영 ( Hwa Young Lee ),강성윤 ( Sung-yoon Kang ),김경훈 ( Kyunghoon Kim ),김주희 ( Ju Hee Kim ),류광희 ( Gwanghui Ryu ),민진영 ( Jin-young Min ),박경희 ( Kyung Hee Park ),박소영 ( So-young Park ),성명순 ( Myongsoon Sung ),이영수 대한천식알레르기학회 2024 Allergy Asthma & Respiratory Disease Vol.12 No.3

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.