Clinical Characteristics of Oral Allergy Syndrome in Children with Atopic Dermatitis and Birch Sensitization: a Single Center Study

BACKGROUND: Oral allergy syndrome (OAS) is an immunoglobulin E (IgE)-mediated hypersensitivity that occurs frequently in older children with pollen sensitization. This study focused on the clinical characteristics of OAS in children with atopic dermatitis (AD) and birch sensitization. METHOD: s: A total of 186 patients aged 2–18 years with AD and birch sensitization were enrolled in this study between January 2016 and March 2017. Their levels of serum total IgE and birch- and ragweed-specific IgE (sIgE) were measured using ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden). Information regarding causative foods and symptoms were obtained via interviews. The patients were divided into 3 groups according to their ages (group 1, 2–6 years; group 2, 7–12 years; and group 3, 13–18 years). RESULTS: Eighty-one of the 186 (43.5%) children with AD who were sensitized to birch pollen were diagnosed as having OAS. The prevalence of OAS in group 1 (the children who had AD and birch sensitization aged 2–6 years) was 36.6%. A greater predominance of men was noted in the non-OAS group (77.1%) compared to the OAS group (60.5%). Apples were the most common causative food in group 2 and 3 while kiwis were the most common cause of OAS in group 1. There was a statistically significant correlation between birch-sIgE levels and the prevalence of OAS (P = 0.000). The cut-off value was 6.77 kUA/L with 55.6% sensitivity and 79.0% specificity (area under the curve 0.653). CONCLUSION: In our study, the prevalence of OAS in children with AD and birch sensitization was 43.5%. Even in the preschool age group, the prevalence of OAS was considerable. Patients with high levels of birch-sIgE were more likely to have OAS. Clinicians should therefore be vigilant about OAS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.

The current status and issue of food allergen labeling in Korea

With increasing need to prevent serious food allergy reactions, Korean food allergen labeling regulation has been revised repeatedly. This paper aims to summarize current statuses of food allergen labeling in Korea and foreign countries and to analyze the issue of food allergen labeling regulation. Korean food labeling regulation currently requires 19 items and 22 foods to be reported on labels (eggs, milk, buckwheat, peanut, soybean, wheat, mackerel, crab, shrimp, pork, peach, tomato, sulfite, walnut, chicken, beef, squid, shellfish, and pine nut). However, some common food triggers (for example, almond, cashew nut, and kiwi fruit) are not included in the current labeling regulation. Another issue is that the Korean labeling regulation has not yet been fully implemented for nonprepacked foods; thus, consumers still have difficulty in correctly identifying allergenic ingredients in food. It should be assessed whether warning statements for cross-contamination are reasonable. To prevent the occurrence of serious reactions from accidental ingestion, efforts must be made to solve recently raised issues including the items required to be listed on food labels, the system of standards for labeling and display methods.

Age-Based Causes and Clinical Characteristics of Immediate-Type Food Allergy in Korean Children

PURPOSE: Age-based causes and clinical characteristics of immediate-type food allergy (FA) have not been sufficiently studied. Therefore, we investigated age-dependent clinical profiles of FA in Korean children through an extensive multicenter investigation. METHODS: Using a case report form developed by the authors, a retrospective medical record review was performed of patients (0-18 years old) diagnosed with immediate-type FA between September 2014 and August 2015 in 14 tertiary hospitals in Korea. RESULTS: A total of 1,353 children and adolescents, 93% younger than 7 years, were enrolled in the present study, and 1,661 cases of immediate-type FA were recorded in these patients. The 7 major causative foods were cow's milk (28.1%), hen's eggs (27.6%), wheat (7.9%), walnuts (7.3%), peanuts (5.3%), buckwheat (1.9%), and shrimps (1.9%). Categorizing the patients into 4 age groups revealed that the most common causative food was different for each age group: cow's milk (<2 years), walnuts (2–6 years), walnuts (7–12 years), and buckwheat (13-18 years). The onset time of symptoms was less than 10 minutes in 49%, between 10 and 30 minutes in 17%, and between 30 minutes and 2 hours in 34% of cases. Food-induced anaphylaxis was reported in 506 (30.5%) out of 1,661 cases, and the 7 major causes of food-induced anaphylaxis was cow's milk (27.5%), hen's eggs (21.9%), wheat (11.3%), walnuts (10.5%), peanuts (5.9%), buckwheat (4.2%), and pine nuts (3.0%). The proportion of anaphylaxis was highest in the patients allergic to buckwheat (67.7%), followed by those allergic to pine nuts (57.7%), walnuts (43.8%), wheat (43.5%), and peanuts (34.1%). CONCLUSIONS: The 5 major causative foods of immediate-type FA in Korean children were cow's milk, hen's eggs, wheat, walnuts, and peanuts. The distribution of causative foods was considerably distinctive according to different age groups. Anaphylaxis was reported in 30.5% of immediate-type FA cases.

A Multicenter Retrospective Case Study of Anaphylaxis Triggers by Age in Korean Children

PURPOSE: Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. METHODS: We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. RESULTS: A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. CONCLUSIONS: The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age.

Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.

The impact of climate change on aeroalleregen and pediatric allergic diseases

The etiology of allergic diseases has been considered multi-factorial, comprising genetic, epigenetic, developmental, and environmental factors, as well as their complex interactions. The rising prevalence of allergic disease in recent decades could be explained by changes in environmental factors rather than genetic factors. Climate change has many significant impacts on aeroallergens such as pollen and mold. Therefore, climate changes are considered to be a key environmental factor affecting not only the prevalence but also the severity of allergic disease. In addition, these environmental factors might be more important for young children than for adults. While the concept that environmental factors including climate change would affect the characteristics of allergic disease is generally accepted, it is not enough to explain the mechanisms of the increase in the prevalence and severity of allergic diseases. Nevertheless, evidence exists that climate change has spurred changes in aeroallergens such as pollen and outdoor fungi, and that these changes are associated with the increased incidence of pediatric allergic disease.

Multicenter Analysis of the Current Status of Unproved Complementary/Alternative Medicine Other than Herbal Medication in Allergy Patients / 대한내과학회지

BACKGROUND/AIMS: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. METHODS: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. RESULTS: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included "improved" in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but "worse" in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was 'hope to improve my constitution'. CONCLUSIONS: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed.

An Investigation into the Actual Condition of Outbreak and Treatment in Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Social concern about atopic dermatitis is increasing these days, and there is much informations from the mass media. However, we have difficulties to diagnose and treat atopic dermatitis because there is no general guideline. So these studies were done to help establish guidelines for proper diagnosis and treatment of atopic dermatitis. METHODS: The authors made up a questionnaire consisting of symptoms, environment, birth, diet, family history, previous treatment and common knowledge about atopic dermatitis. We studied moderate to severe atopic dermatitis patients, from February to August, 2003, using a survey containing 40 questions. We tested serum total IgE, specific IgE (Pharmacia, uni CAP), skin culture, complete blood counts, AST/ALT, and IgA. RESULTS: In our study results, the onset of atopic dermatitis, which was over moderate, was averaged 13 months after birth, and the earliest onset was 1 week after birth. The locations of skin lesion were lower extremities, face, buttocks, neck, and body, according to frequency. The most common type of housing was apartments. Many were getting breast milk feeding, had family members who smoke and most had no pets. Regardless of the severity of clinical manifestations, many patients did not have allergic tests and took just oriental medicine. Secondary infections were more common in patients who had fewer baths. CONCLUSION: Therefore the education of patients and their parents about etiology and progress of atopic dermatitis is needed. And for pediatricians, a general guideline of diagnosis and treatment needs to be established.

Survey on the Pattern of Food Intake during Early Childhood and Allergic Disease / 소아알레르기및호흡기학회지

PURPOSE: Change of foods intake during infancy and early childhood is being indicated as a causal factor for recent dramatic increase in the number of allergic diseases in children. The food allergens may have an important role for the development of allergic diseases including atopic dermatitis in children. Early prevention and treatment of atopic dermatitis are important to prevent of allergic disease later in life. METHODS: The questionaire survey about the diet patterns of their children and the parents' awareness and knowledge on the relationship between food and allergy was performed for the parents of 316 patients aged under 48 month old at 7 university hospitals (4 allergy clinics and 3 general clinics) or 4 private clinics in September, 2002. RESULTS: Formular fed is more common in all age group and it comprised over 70% in the group under age 6 month old in compare with breast milk fed. The mean age of the start of weaning was 5.2+/-1.8 months in a child with a history of allergy, and 4.6+/-2.0 months who had no allergy history. The most common reason to start weaning was nutritional supplement and the next was to train for adult foods. Fruit juice was the first introduced weaning food in most cases. Among 316 children, 108 children had experience of having grain diet, live diet or natural diet for better nutrition. More than half of the parents had relatively correct knowledge about allergy such as the relationship between food and allergy especially in the group with a allergic disease. Many parents started grain diet, live diet, a soup of bone, and the white of an egg to their children under 12 months of age. CONCLUSION: In general, most of the parents enrolled had relatively correct information about the time and the purpose of weaning. However, their knowledge about the kinds of food and time of first exposure is at issue to be pointed out. Especially as a point of view for early intervention of allergic disease, continued more active education about the food allergens and their relation to allergic diseases are strongly recommended.

Aerobiological Study of Pollen and Mold in the 10 States of Korea / 소아알레르기및호흡기학회지

PURPOSE: As outdoor allergen, pollen and mold are increasely drawing attention all over the country in Korea. The peninsula is located in a temperate zone and has four distinct seasons. In this study, we described the seasonal variation of the pollen and mold distributions in Korea, which may be used to evaluate the pollenosis prevalence for the first time. METHODS: Rotorod samplers were installed on the 10 stations at each state in Korea. Outdoor allergens were collected daily in each station from July 1, 1997 to June 30, 1999. After staining they were identified, counted and recorded with the weather in each state. RESULTS: The pollens were found in the beginning of February through the middle of December. The earliest pollen was found from Pusan which is a south region, and followed by Chonju, Daegu which are midsouth. The peak season for pollen was from the end of April to the middle of May(major pollen: Tree, Grasses), the second peak was depicted from the end of August to the middle of September (major pollen : sagebrush, ragweed) the outdoor molds were largely collected from the July to the middle of October. Cladosporium and Alternaria were prevalent all year round and Ascospores of Leptospheria was peak in monsoon season. CONCLUSION: The pollens were found during the whole year except from middle of the December through the middle of the January. Molds were found all year round.