Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity.

BACKGROUND: Atopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea. METHODS: AD patients aged 6-18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient's allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschool-onset (2-5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups. RESULTS: A total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancy-onset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group. CONCLUSION: This study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

Airway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide in children with asthma.

OBJECTIVE: Asthma is characterized by airway hyperresponsiveness (AHR), inflammation, and obstruction. AHR to stimuli that indirectly cause bronchial smooth muscle (BSM) contractions via release of endogenous mediators is thought to better reflect airway inflammation than AHR to stimuli that act directly on BSM. Fractional exhaled nitric oxide (FeNO) is a useful parameter for noninvasive clinical airway inflammation assessments. Accordingly, this study aimed to examine the relationships of mannitol and methacholine challenge test outcomes with FeNO and the influence of inhaled corticosteroid treatment in children with asthma. METHODS: One hundred thirty-four asthmatic children (89 males; ages: 5-17 years, median: 9 years) underwent spirometry, FeNO measurement, serum total/specific IgE testing, and blood eosinophil count. All subjects were challenged with mannitol dry powder (MDP; AridolH, Pharmaxis, Australia) and methacholine at 7-day intervals. Data of steroid-treated and steroid-naïve children were compared. RESULTS: Positive responses to MDP and methacholine challenge tests were observed in 74.6% and 67.2% of total subject group, respectively, and 72 children had positive response to both challenge tests. The median FeNO level, response-dose ratio (RDR) of PC20 methacholine, and RDR of PD15 MDP were significantly higher in the steroid-treated group than in the steroid-naïve group (p < 0.001, 0.226, and 0.004, respectively). FeNO levels associated significantly with PD15 MDP and RDR PD15 MDP in total subject populations (p = 0.016 and 0.003, respectively); however, a significant correlation between FeNO and RDR PD15 MDP was observed only in the steroid-naïve group. CONCLUSIONS: Compared with AHR to methacholine, AHR to MDP more closely reflected the level of FeNO in steroid-naïve asthmatic children.

Serum clusterin level in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease. Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a marker to assess inflammatory diseases. The clusterin levels in AD have not been evaluated thus far. OBJECTIVE: We evaluated serum clusterin levels in children with AD and assessed the relationship between serum clusterin levels and the severity of AD. METHOD: The study enrolled a total 140 children, of whom 100 had AD (n = 100) and 40 were healthy (n = 40). The severity of AD was scored by using the SCORing Atopic Dermatitis (SCORAD). Total serum immunoglobulin E and specific immunoglobulin E levels against egg whites, cow's milk, peanuts, soybeans, wheat, and Dermatophagoides farinae were measured. Clusterin levels in serum were measured by enzyme-linked immunosorbent assay. RESULTS: The mean (interquartile range) age of the children was 5.1 years (1.3-8.4 years), and 92 (69.3%) of the children were boys. The mean (standard deviation) SCORAD index was 50.4 ± 17. The mean (standard deviation) clusterin level of children with AD was higher than that in the healthy control group children (148.13 ± 4.3 pg/mL versus 144.85 ± 5.1 pg/mL; p = 0.001). Serum clusterin levels were correlated with the SCORAD index (r = 0.327, p = 0.002). CONCLUSIONS: The serum clusterin level was higher in children with AD than in the healthy control group and increased with the severity of AD. Serum clusterin may be a candidate molecule that reflects AD and its severity.

Characteristics and Treatment of Anaphylaxis in Children Visiting a Pediatric Emergency Department in Korea.

Anaphylaxis is a serious life-threatening allergic disease in children. This study is aimed at determining the characteristics of pediatric patients who experienced anaphylaxis along with treatments administered in order to determine the usefulness of tryptase level assessment as a marker of anaphylaxis in Korean children. A total of 107 patients who were diagnosed with anaphylaxis in a single pediatric emergency center over a 3-year period were included in the study. Patient clinical characteristics, symptoms, signs, allergy history, trigger factors, treatments, and laboratory findings, including serum tryptase levels, were included in the analysis. Food allergies (39.3%) were the most commonly reported patient allergic history, and 58 patients (54.2%) were triggered by food. Among this group, nuts and milk exposure were the most common, affecting 15 patients (25.9%). History of anaphylaxis and asthma were more common in severe anaphylaxis compared to mild or moderate anaphylaxis cases. Epinephrine intramuscular injection was administrated to 76 patients (71.0%), and a self-injectable epinephrine was prescribed to 18 patients (16.8%). The median tryptase level was 4.80 ng/mL (range: 2.70-10.40) which was lower than the 11.4 ng/mL value commonly documented for standard evaluation in adults with anaphylaxis. The most common cause of pediatric anaphylaxis was food including nuts and milk. The rate of epinephrine injection was relatively high in our pediatric emergency department. The median tryptase level associated with anaphylaxis reactions in children was lower than 11.4 ng/mL. Further studies are needed to help improve diagnostic times and treatment accuracy in pediatric patients who develop anaphylaxis.

Relationship Between Serum Interleukin-17F Level and Severity of Atopic Dermatitis in Children.

Background: Recent discovery of the Th17 pathway is providing new opportunities for understanding chronic immune-mediated diseases. The Th17 pathway has been historically associated with chronic inflammatory diseases such as psoriasis, multiple sclerosis, and rheumatoid arthritis. Among Th17 cytokines, pathogenic roles of IL-17A and IL-17F in asthma have been well described. Recently, the number of peripheral blood Th17 cells was found to correlate with disease severity in patients with atopic dermatitis (AD). This study aimed to investigate serum IL-17F levels in children with AD and to correlate this with severity of the disease. Methods: Enzyme-linked immunosorbent assay was used to measure IL-17F levels in the sera of 228 patients with AD and 62 control children. The SCORing Atopic Dermatitis (SCORAD) tool was used to determine the severity of disease. Results: The mean serum level of IL-17F in children with AD was significantly higher than that in the control group (p<0.05) Serum IL-17F levels were also higher in patients with severe AD than in those with mild AD (p<0.001), and IL-17F levels and SCORAD scores were positively correlated (p<0.05). Conclusions: Serum IL-17F level might be a useful marker in children with AD.

Clinical outcome of transcatheter closure of patent ductus arteriosus in small children weighing 10 kg or less.

PURPOSE: Transcatheter closure has become an effective therapy in most patients with patent ductus arteriosus (PDA). However, there are difficulties in transcatheter closure of PDA in small children. We reviewed clinical outcomes of transcatheter closure of PDA in children weighing less than 10 kg in a single center. METHODS: Between January 2003 and December 2009, 314 patients with PDA underwent transcatheter closure in our institute. Among them, 115 weighed less than 10 kg. All of these patients underwent transcatheter closure of PDA using either COOK Detachable Coil®, PFM Nit-Occlud®, or Amplatzer duct occluder®. A retrospective review of the treatment results and complications was performed. RESULTS: The mean age of patients was 9.1±5.9 months (median, 8 months), and mean weight was 7.6±1.8 kg (median, 7.8 kg). The mean diameter of PDA was 3.2±1.4 mm (median, 3 mm). Complete occlusion occurred in 113 patients (98%). One patient was sent to surgery because of a failed attempt at device closure, and another patient had a small residual shunt after device placement. The average mean length of hospital stay was 3.0±3.3 days, and mean follow-up duration was 21.0±19.6 months. There were no major complications in any of the patients. CONCLUSION: Transcatheter closure of PDA is considered safe and efficacious in infants weighing less than 10 kg. With sufficient experience and further effort, transcatheter closure of PDA can be accepted as the gold standard of treatment for this group of patients.

Esophageal thermal injury by hot adlay tea.

Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.