Therapeutic Effects of Fermented Red Ginseng in Allergic Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE: Allergic rhinitis is clinically defined as a disorder of the nose induced by IgE mediated inflammation after allergen exposure of the nasal mucosa. Many reports have stated that Panax ginseng and fermented red ginseng have anti-inflammatory effects, especially against Th2-type inflammation. This study was conducted to evaluate the therapeutic effects of fermented red ginseng in allergic rhinitis. METHODS: In this 4-week, double-blind, placebo-controlled study, 59 patients with persistent perennial allergic rhinitis were randomly divided into two groups: those receiving fermented red ginseng tablets (experimental group) and those receiving placebo (control group). The primary efficacy variable was the total nasal symptom score (TNSS; rhinorrhea, sneezing, itchy nose, and nasal congestion). Secondary efficacy variables were the Rhinitis Quality of Life (RQoL) score and skin reactivity to inhalant allergens, as determined by the skin prick test. RESULTS: There was no significant difference in the TNSS score and TNSS duration score between the experimental and placebo groups in weeks 1, 2, 3, or 4. For nasal congestion, fermented red ginseng was significantly effective (P<0.005), while placebo caused no change. The activity and emotion of RQoL improved markedly secondary to treatment with fermented red ginseng (P<0.05), while placebo caused no change. Additionally, fermented red ginseng reduced skin reactivity to sensitized perennial allergens (P<0.05). Fermented red ginseng was well tolerated. CONCLUSIONS: Fermented red ginseng improved nasal congestion symptoms and RQoL in patients with perennial allergic rhinitis.

Chinese Bellflower Root Anaphylaxis: IgE-Binding Components and Cross-Reactivity With Mugwort and Birch

A 56-year-old man who had suffered from seasonal rhinitis in spring and autumn experienced recurrent generalized urticaria and an oral burning sensation after eating several cooked herbs for 3 months. A skin-prick test showed positive responses to various pollens, celery, Chinese bellflower, and arrowroot. The Chinese bellflower-specific IgE ELISA OD value was 1.547. Oral challenge with unprocessed raw Chinese bellflower root provoked oral burning sensation, eyelid swelling, generalized urticaria, and hypotension. In an ELISA inhibition test, IgE binding to Chinese bellflower was significantly inhibited by Chinese bellflower, mugwort, and birch pollen extract. SDS-PAGE and immunoblot assay revealed nine IgE-binding components, and common protein bands were detected in the range of 40~55 kDa (Chinese bellflower-mugwort-birch) and 14 kDa (Chinese bellflower-birch). Chinese bellflower root can cause anaphylaxis and may have cross-reactivity with mugwort and birch.

Korean Ginseng-Induced Occupational Asthma and Determination of IgE Binding Components

A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzymelinked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism.

Occupational Asthma and Rhinitis Induced by a Herbal Medicine, Wonji (Polygala tenuifolia)

Occupational asthma is induced by many agents, including herbal materials, that are exposed in working places. Although there are a few case reports for occupational allergy induced by herbal materials, there is none for that induced by Wonji (Polygala tenuifolia). This study was conducted to evaluate clinical characteristics and immunologic mechanism of Wonji-induced asthma in a exposed-worker. A patient who complained of asthma and rhinitis symptoms, and who had worked in a herbal manufacturing factory for 8 yr, underwent a skin prick test with crude extract of Wonji under the impression of occupational asthma induced by the agent. The patient had a strong positive response to the extract on the skin prick test. Allergen bronchial challenge to the extract demonstrated a typical dual response. Serum specific IgE level to the extract was higher in the patient than in healthy controls, and ELISA inhibition test revealed complete inhibition of IgE binding with the extract, but no inhibition with Der p 2 or mugwort extracts. Six IgE binding components to the extract (10, 25, 28, 36, 50, and 90 kDa) were detected using SDS-PAGE and immunoblot analysis. These findings suggest that Polygala tenuifolia, a herbal material, can induce IgE-mediated bronchoconstriction in exposed workers.

Specific IgE determination to shrimp (Metapenaeus joyneri) and identification of its allergen / 대한내과학회지

BACKGROUND: Shrimp is one of the major causative crustacean food allergen. An investigation has been reported that tropomyosin belonged to muscle protein is a major allergen within shrimp. But there have been a few investigations on shrimp allergen in Korea. The aim of this study is to evaluate skin reactivity and specific IgE sensitization to Metapenaeus joyneri which is one of the major shrimp in this country, and to identitify IgE binding components and evaluate allergenic relationship with other species. METHODS: We performed skin prick test with M. joyneri extract in 1,738 patients. ELISA was performed for detection of serum specific IgE antibody. To evaluate the cross allergenecity between M. joyneri and other crustaceans (crab, lobster, crayfish), Dermatophagoides pteronyssinus (Dpt), triton shell, abalone and buckwheat. ELISA inhibition tests were performed with each four patient's sera showing high specific IgE antibody. To identify IgE binding components, SDS-PAGE followed by IgE-Immunoblot were applied. RESULTS: 211 patients (12.2%) showed positive responses (A/H >or=2+) on skin prick test. Serum specific IgE antibodies were detected in 61 patients (37.2%) of 164 sensitzed patients. ELISA inhibition test using four patient's sera showed significant inhibitions by M. joyneri. and other crustaceans including lobster, crab and crayfish, partial inhibitions were noted by Dpt, triton shell, buckwheat and abalone. SDS-PAGE and IgE-imunoblot with patients' individual sera sensitized to M. joyneri showed 12 IgE binding components (31, 32, 38-44, 57, 70, 81 kDa) and two (31, 32 kDa) were bound to IgE in more than 50% of sera tested. Five (43, 44, 57, 70 and 81 kDa) were bound to IgE in more than 25% of sera tested. CONCLUSION: Specific IgE was detected in 37.2% of allergy patients sensitized to M. joyneri. Twelve IgE binding components and two (31, 32 kDa) major allergens were indentified. Cross allergenecity was noted with other crustaceans.

Buckwheat allergy in adults: comparison of specific IgE between homemade ELISA and CAP system, and identification of IgE-binding components / 천식및알레르기

BACKGROUND AND OBJECTIVE: Ingestion and inhalation of buckwheat flour can induce IgE-mediated bronchoconstriction and anaphylaxis in sensitized individuals, especially in childhood. The aim of this study was to determine the sensitization rate of buckwheat allergen, measure the level of specific IgE to buckwheat, and identify IgE-binding components in adult patients with various allergic diseases. METHODS: 1,738 allergy patients and 40 healthy controls were enrolled. Skin prick tests were performed using homemade buckwheat extract. The specific IgE level to homemade buckwheat allergen was measured by ELISA, and results were compared to those of the CAP system. ELISA inhibition tests were done to evaluate allergenic relationships with major food allergens and IgE binding components were identified using IgE immunoblot analysis. RESULTS: Among 1,738 patients tested, 60 patients (3.5%) showed more than a 2+ response on skin prick tests to buckwheat. The prevalence of serum specific IgE to buckwheat ranged from 24% in patients with a 2+ response to buckwheat skin prick test, to 50% in patients with a 4+ response. The mean absorbance value increased with skin reactivity although it was not statistically significant. However, CAP results were significantly correlated with skin reactivity (p<0.05). A significant correlation was noted between (the) results by homemade ELISA and CAP. IgE immunoblot demonstrated 20 IgE binding components ranging from 20 to 114 kDa, and 10 components were bound to IgE in more than 50% of the patients tested. CONCLUSION: Natural buckwheat allergens should be considered as one of the causative food allergens in exposed adults. Specific IgE results by homemade ELISA were comparable with those of CAP system. Twenty IgE binding components and 10 major allergens were noted within natural buckwheat allergen. Further studies will be needed to evaluate the allergenic relationships with other food allergens.

Sensitization rates for inhalant allergens in Korea; a multi-center study / 천식및알레르기

BACKGROUND AND OBJECTIVE: There are many differences in common inhalant allergens between countries and regions. We need to determine the major inhalant allergens in this country with geographical characteristics. To observe the major inhalant allergens and establish essential ones for the skin prick test in Korea, a nation-wide multicenter study was performed. METHOD: The skin prick tests were performed with the same kits of 43 allergens on 2,554 allergy patients who visited their regional hospitals for one year. RESULT: There are significant differences in the sensitization rate to common inhalant allergens among the centers. Twenty three allergens showed > or=5% sensitization rate: D. pteronyssinus, D. farinae, Tyrophagus putrescentiae, Tetranychus urticae, Panonychus citri, Alternaria alternata, Cladosporium tenuis, cat fur, dog hair, American and German cockroach, tree pollen mixture I, alder, hazel, tree pollen mixture II, birch, beech, oak, plane tree, ragweed, mugwort, hop Japanese and chrysanthemum. CONCLUSION: We suggest the major allergens such as D. pteronyssinus, D. farinae, T. putrescentiae, T. urticae, P. citri, outdoor molds, indoor molds, cat fur, dog hair, German and American cockroaches, tree pollens, mugwort, and hop Japanese pollen should be included in skin test battery in Korea.

The sensitization rates of food allergens in a Korean population: a multi-center study / 천식및알레르기

BACKGROUND: Sensitization to food allergens is associated with development of food allergy. Although rates of sensitization to food allergens are different according to countries, there has not been surveyed on the sensitization rate to each food allergen in Korean population. The aim of this study was to evaluate the food allergen sensitization rate among patients who visited allergy clinics at several university hospitals in Korea. METHODS: This study was carried out on 1,425 patients who visited allergy clinics with various allergic symptoms. They had skin prick test for 62 items to evaluate sensitization to food allergens. RESULT: The food allergens of which sensitization rate was above 1% were pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flour, buckwheat, cabbage, mackerel, abalone, lobster, turban shell, arrowroot in decreasing order. The sensitization rate of pupa was highest among them by 9.4% and that of shrimp followed by 5.8%. The sensitization rates of food allergens were generally higher in males and young adults than in those of females and old people. Atopic patients for inhalant allergens showed higher sensitization rates of food allergens than non-atopic patients for inhalant allergens. CONCLUSION: Common food allergens sensitized in a Korean population were different from those in other countries. Pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flourbuckwheat, cabbage, mackerel were the 10 most common food allergens sensitized in Korean population above 10 years old.

Prevalence of asthma and atopy in children living in rural areas of Cheju island for an interval of three years / 천식및알레르기

BACKGROUND: The prevalence of asthma has been increasing due to changes in lifestyles. OBJECTIVE: The aim of this study was to evaluate the prevalence of asthma and atopy for an interval of three years in children living in rural areas of Cheju island. METHODS: A total of 1,055 and 755 subjects aged 7-15 years in South Cheju County were enrolled for an interval of three years, respectively. They responded to the modified ISAAC questionnaire, and underwent allergy skin prick test with locally common aeroallergens and methacholine bronchial provocation test. Children who had asthma symptom as reported on the questionnaire and bronchial hyperresponsiveness to methacholine were diagnosed as current asthma. Atopy was defined as the positive skin responses to one or more aeroallergens. RESULTS: The prevalence of current asthma had increased from 4.4% to 7.0% during the three years, especially among children aged 13 to 15 years (3.9% vs. 7.6%), although the asthma prevalence was similar between the two intervals among children aged 7 to 12 years (5.2% vs. 6.8%). The atopy rate had significantly increased from 37.7% to 45.9% during the three years. As for common sensitizing aeroallergens, sensitization rate to citrus red mite had significantly increased among both the young and the old age groups. The sensitization rates to house dust mites, such as D. pteronyssinus and D. farinae, had increased among the old age groups, but not among the young age groups, although the sensitization rates to cockroach and Japanese cedar pollen were similar among both the young and old age groups at the two intervals. CONCLUSION: The prevalence of current asthma and atopy had increased among children living in rural areas of Cheju island during the three year interval. The sensitization to house dust mite and citrus red mite had increased during the three years, and may play an important role in the increased prevalence of current asthma.

Prevalence of atopic rhinitis and causative allergens in children living in rural areas of Cheju island / 천식및알레르기

BACKGROUND: Atopic diseases have been increasing according to changes in life style and indoor environments. Atopic rhinitis is a prevalent atopic disease in children, but the prevalence has been reported differently according to geographic areas. OBJECTIVE: This study was conducted to elucidate the prevalence of childhood atopic rhinitis and to identify the distribution of causative allergens in total children living in rural areas of Cheju island. METHOD: A total of 7,145 subjects aged 7-15 years in South Cheju County was recruited in this study. They responded to an ISAAC questionnaire and underwent allergy skin prick test with common aeroallergens. Chronic rhinitis was positive in this respect if subjects experienced two or more rhinitis symptoms such as sneezing, runny nose, itchy nose and nasal blockage, which were not related to the common cold. Atopy was regarded as positive when the wheal caused by one or more of the common allergens was the same or larger than that caused by histamine. RESULTS: The prevalence of chronic rhinitis was 10.5%. The prevalence of chronic rhinitis was the same between girls and boys, but higher as the ages of the subjects were older (7-9 years: 7.7%; 10-12: 10.6%; 13-15: 12.3%, p< 0.001). The atopy rate was 59.7%, meaning that the prevalence of atopic rhinitis was 6.2% and non-atopic rhinitis 4.2%. The common sensitizing allergens in decreasing order were Dermatophagoides pteronyssinus (40.4%), D. farinae (36.3%), citrus red mite (16.4%), cockroach (14.4%), outdoor Fungi (9.8%), Hop Japanese (5.6%) and Japanese cedar (4.5%) pollens. CONCLUSION: The prevalence of atopic rhinitis was 6.2% and the causative allergens such as citrus red mite and Japanese cedar pollen were different from the Korean mainland area.

Changes of atopy prevalence among asthmatics visiting tertiary referral hospital (1983, 1990, 1997) / 천식및알레르기

BACKGROUND: The prevalence of atopy and atopy-related disease has been known to increase during the past decade. OBJECTIVE: This study was designed to evaluate the changes of atopy prevalence among asthmatic patients and the causative allergens. METHOD: A total of 698 asthmatic patients visiting Seoul National University Hospital in 1983, 1990 and 1997 was recruited. Skin prick test with common inhalant allergens was carried out and interpreted as positive when the mean wheal size formed by allergen was larger than 3mm. Atopy was defined when skin reaction to one or more allegens was positive. RESULT: The prevalence of atopy among asthmatic patients was 54% in 1983, 48.8% in 1990 and 53% in 1997, respectively. The prevalence of atopy decreased as the age of patients increased. Recently, old asthmatic patients (>55 years) showed a higher tendency to visit the tertiary referral hospital. When the data were analyzed according to age, the prevalence of atopy significantly increased among asthmatic patients aged 15-35 years, in whom the prevalence was 60.4% in 1983 and 81.3% in 1997 (p<0.05). The positive rate of skin test to Dermatophagoides pteronyssinus, cat fur, mugwort, ragweed, and grass pollen were significantly higher in 1997 than in 1983 (p<0.05). CONCLUSION: The prevalence of atopy among asthmatic patients aged 15-35 years showed significant increase in 1997 compared to 1983. The changes of skin response to Dermatophagoides pteronyssinus, cat fur, mugwort, ragweed, and grass pollen contributed to the increase of atopy.

Relationship of eosinophils in induced sputum with bronchial responsiveness to methacholine or capsaicin and with responses to anti-asthmatic treatment in chronic cough patients / 천식및알레르기

BACKGROUND: The value of the induced sputum examination in chronic cough has not been determined. We performed this study to investigate the relationship between eosinophil percentage on induced sputum and bronchial responsiveness to methacholine or capsaicin, and responses to anti-asthmatic treatment in chronic cough patients. SUBJECTS AND METHODS: Forty-seven patients with chronic cough persisting for more than 1 month without current wheezing or dyspnea were studied. According to the eosinophil percentage on induced sputum, the subjects were divided into two groups: group A (sputum eosinophil > or = 3%) and group B (sputum eosinophil < 3%). Methacholine bronchial provocation test (MBPT) and capsaicin challenge, and responses to anti-asthmatic treatment were compared between the two groups. RESULTS: Group A consisted of 26 subjects and group B consisted of 21 subjects. There were no differences in sex, clinical characteristics of cough, atopy prevalence, and peripheral eosinophil counts except serum IgE level between the two groups. MBPT positivity was much higher in group A than group B (46.2% vs 0%, p<0.001), but there was no difference in capsaicin test positivity (44.0% vs 50.0%). Group A showed much higher response rates to anti-asthmatic treatments than in group B (73.1% vs 19.0%, p<0.001). CONCLUSION: Eosinophilic airway inflammation in chronic cough was related to methacholine bronchial hyperresponsiveness, but not to capsaicin cough threshold. Induced sputum eosinophil percentage was a good indicator in predicting the response to anti-asthmatic treatment in most chronic cough patients.

Prevalence of allergic rhinitis and its causative allergens in people in rural area of Cheju IsIand / 천식및알레르기

OBJECTIVE: Cross-sectional survey was performed to evaluate prevalence of allergic rhinitis and its causative allergens in people in rural area of Cheju Isl~and. Subject and METHOD: A total of 1,236 people with 1,055 children and 181 adults in rural area of Cheju Island were enrolled in this study. In children, 544 were males and 511 were females, and their mean age was 12.3(ranging from 7 to 16) years. In adults, 78 were males and 103 were females, and their mean age was 50.1 (ratging from 18 to 87) years. Evaluations included a questionnaire survey, and skin prick test with extracts of Japanese cedar (Cryptomera japonica, J cedar) pollen and citrus red mite (Panonychus citri, CRM) as well as eleven common inhalant allergens. RESULTS: Prevalence of chronic nasal symptoms was 40.6% (429/1,055) in children, and 45.8 % (83/181) in adults. Prevalence of allergic rhinitis based on positive nasal symptoms on the questionnaire and positive skin response to one or more of the 13 inhalant allergens were 15.4 % (159/1.035) in children, and 19.3% (35/181) in adults. Of 1,035 children, skin-test response was positive in 37.6%, and common sensitizing allergens in order of decreasing frequency were Dermatophagoides pteronpssinus (DP) (26.6%), D. farinae (DF)(22.6%), CRM(14.2%), cockroach(11.3%) and J cedar(9.7%). Of 181 adults, skin-test response was positive in 25.9%, and t,he most common sensitizing allergen was CRM(16.5%), followed by cockroach(11.0%), DP(9. 9%), DF(9.4%), and J cedar(6.6%). Of 159 children with allergic rhinitis, the common sensitizing allergens in order of deereasing frequency were DP(79.2%), DF(67.3%), CRM(35.8%), J cedar(32.7%), and cockroach(27.0%). Of 35 adults with allergic rhinitis, the most common sensitizing allergen was CRM(68.6%), followed by DP(40%), DF(34.3%), cockroach(34.3%), and J cedar(28.9%). CONCLUSION: Allergic rhinitis is a very common disease with a prevalence of 15.4% in children and 19.3% in adults in rural area of Cheju island, and common sensitizing allergens include house dust mite, citrus red mite, cockroach, and Japanese cedar pollen.

Prevalence of bee venom allergy in children and adults living in rural area of Cheju Island / 천식및알레르기

BACKGROUND: Prevalence of bee venom allergy in Korea is unknown, OBJECTIVE: We performed a cross-sectional study to evaluate the prevalence of bee venom allergy and importance of risk factors, such as age, sex, and atopy, in the development of the allergic reaction in children and adults living in rural area of Cheju Island. Swbject and METHOD: The prevalence was investigated in subjects with 1,054 children and 370 adults (701 male, 723 female), aged 7-87 years, living in rural area of Cheju Island. A history particularly focused on the systemic reactions after the bee stings was taken in all subjects. Skin prick test,s to common inhalant allergens, including house dust mites, fungi, tree, grass, mugwort and ragweed pollen, cockroach, animal epithelium, Japanese cedar pollen, and citrus red mite were performed. RESULT: The prevalence of bee venom allergy was 5.8% (mild systemic reactions 5.0%, severe systemic reactions 0.8% ). The prevalence was higher in adults than in children (10.2% vs. 5.0%, g = 12.0, p0.05). The prevalence of bee venom allergy was not significantly different between subjects with positive skin reaction and those with negative skin reaction to inhalant allergens (6.4% vs. 5.4% ), Conclasion'. The prevlence of bee venom allergy in inhabitants of rural area of Cheju Island is 5.8% (mild systemic,' 5.0%, severe systemic reaction. 0.8%), and bee venom allergy was more common in adults than in children, and in male children than in female children.