Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome

PURPOSE: Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis. MATERIALS AND METHODS: Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130). RESULTS: The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25–10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79–15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70–51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03–9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15–1.37; p<0.001) were related to the development of anaphylaxis in PFAS. CONCLUSION: The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.

A study on the correlation between outbreak of allergic rhinitis and airborne pollen in September

PURPOSE: Various studies have investigated factors related to the prevalence of allergic rhinitis (AR). We studied the correlation between the outbreaks of AR and airborne pollen in September. METHODS: According to data from the National Health Insurance Service, the number of AR cases was increased from 2012 to 2016. During the same period, the number of patients with upper respiratory tract infection, respiratory virus detection rate, air pollutants, and concentration of airborne pollen were correlated with the occurrence of AR in correlation analysis. RESULTS: The number of patients with AR showed increasing biphasic patters in the spring and fall with the peak reached in September (278,487±12,894), while April marked the fifth-highest figure with 241,570±132,677. The concentration of airborne pollen was highest at 4,450 grains/m³ in May, followed by 3,597 grains/m³ in April, marking its peak in the spring. September marked the third-highest level at 1,619 grains/m³. According to the monthly correlation between the number of patients with AR and pollen, Seoul and Daejeon showed correlations of ρ=0.929 (P=0.022) and ρ=0.955 (P=0.011), respectively, in September. There were no significant correlations among AR, air pollutants, and respiratory virus detection rate. CONCLUSION: Based on this study, the monthly number of patients with AR was the highest in September. In September, we found the correlation between allergic rhinitis and pollen, although there are regional limitations, regarding outbreaks in the number of patients with AR. Further research and attention are needed to prepare measures against airborne weed pollen during the fall.

Pollen-Food Allergy Syndrome in Korean Pollinosis Patients: A Nationwide Survey

PURPOSE: Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergy in pollinosis patients caused by raw fruits and vegetables and is the most common food allergy in adults. However, there has been no nationwide study on PFAS in Korea. In this study, we investigated the prevalence and clinical characteristics of PFAS in Korea. METHODS: Twenty-two investigators participated in this study, in which patients with allergic rhinoconjunctivitis and/or bronchial asthma with pollen allergy were enrolled. The questionnaires included demographic characteristics, a list of fruits and vegetables, and clinical manifestations of food allergy. Pollen allergy was diagnosed by skin prick test and/or measurement of the serum level of specific IgE. RESULTS: A total of 648 pollinosis patients were enrolled. The prevalence of PFAS was 41.7% (n = 270). PFAS patients exhibited cutaneous (43.0%), respiratory (20.0%), cardiovascular (3.7%) or neurologic symptoms (4.8%) in addition to oropharyngeal symptoms. Anaphylaxis was noted in 8.9% of the PFAS patients. Seventy types of foods were linked to PFAS; e.g., peach (48.5%), apple (46.7%), kiwi (30.4%), peanut (17.4%), plum (16.3%), chestnut (14.8%), pineapple (13.7%), walnut (14.1%), Korean melon (12.6%), tomato (11.9%), melon (11.5%) and apricot (10.7%). Korean foods such as taro/taro stem (8.9%), ginseong (8.2%), perilla leaf (4.4%), bellflower root (4.4%), crown daisy (3.0%), deodeok (3.3%), kudzu root (3.0%) and lotus root (2.6%) were also linked to PFAS. CONCLUSIONS: This was the first nationwide study of PFAS in Korea. The prevalence of PFAS was 41.7%, and 8.9% of the PFAS patients had anaphylaxis. These results will provide clinically useful information to physicians.

Regional Difference of Causative Pollen in Children with Allergic Rhinitis

The aim of this study was to investigate role of common pollen in Korean school-aged children with allergic rhinitis (AR) in 5 provinces (Incheon Metropolitan City-Gyeonggi Province, Chungcheongbuk-do, Gwangju Metropolitan City, Busan Metropolitan City, and Jeju Special Self-Governing Province), using a questionnaire and skin prick test, and to assess the differences among the residential regions. Among the enrolled 14,678 total children, 1,641 (22.0%) had AR. The sensitization rate to pollen (38.7%) was the second highest among examined allergens and significant differences were in the sensitization rates to trees, weeds, and grasses among the 5 provinces (P < 0.05). The sensitization to trees (25.2%) was the highest common among the pollen types and significant differences also were observed in the sensitization rates to alder, birch, Japanese cedar, oak, and elm among the 5 provinces. The sensitization rate to weeds (19.9%) was the second highest and significant differences were observed in the sensitization rate to Japanese hop, mugwort, and ragweed among the 5 provinces. The sensitization rate to house dust mite was 86.8%, the highest among examined allergens and that to Dermatophagoides farinae exhibited regional differences (P = 0.003) but not to D. farinae (P = 0.584). The sensitization rate to mold (13.5%) was the highest in Jeju and lowest in Busan, and a statistically significant difference was detected among the 5 provinces. These results support that examined pollen allergens are strongly associated with residential region due to regional causative pollen differences among children with AR within Korea to investigate the main pollen allergens.

Characteristics of airborne pollen in Incheon and Seoul (2015–2016)

BACKGROUND: Pollen allergens are one of the main contributors to the development and/or aggravation of allergic rhinitis, allergic conjunctivitis, and asthma. OBJECTIVE: An examination of the airborne pollen in residential areas should be conducted to aid the diagnosis and treatment of allergic diseases. METHODS: Airborne pollen samples were collected from 2 sites in Incheon and 2 in Seoul from 2015 to 2016. RESULTS: The highest monthly concentration of airborne pollen was observed in May and September each year. Pollen from 32 families and 50 genera was identified over the 2 years; of these, Pinus spp. showed the highest pollen concentration (41.6%), followed by Quercus spp. (25.3%), and Humulus spp. (15.3%), the latter of which had the highest concentration among weed pollen. The total pollen concentration was significantly higher in Incheon than in Seoul (p = 0.001 in 2015, p < 0.001 in 2016) and higher in 2016 than in 2015. The concentrations of pollen from weed species (Cupressaceae, Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae) and grass species (Gramineae) were significantly higher (p < 0.001) than those from tree species. Pollen was distributed from February to November. The first pollen identified in both regions in each year was Alnus spp. Overall, the total concentration of Quercus spp., Betula spp., Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae pollen increased significantly over the 2 years. CONCLUSION: Region-specific differences exist in the pollen of major allergenic plants. Continuous monitoring of pollen is thus essential for management of pollen-related allergic disorders in each region.

Prevalence and allergens of allergic rhinitis in children and adolescents in Gwangju

PURPOSE: Allergic rhinitis (AR) is one of the most common childhood diseases in Korea. In this study, we aimed to investigate the prevalence and allergens of childhood AR in Gwangju. METHODS: From April 2013 to September 2013 in Gwangju, skin prick test and questionnaire survey were performed targeting 2,330 children in total (350 kindergartners, 930 elementary school students, 589 middle school students, and 461 high school students). RESULTS: The overall prevalence of AR was 23.5% (female 21.3%, male 26.1%). According to age groups, prevalence of AR was 14.9% (female 10.7%, male 19.8%) in kindergartners, 24.5% (female 18.8%, male 29.4%) in elementary school students, 23.3% (female 18.1%, male 27.6%) in middle school students, 26.2% (female 27.7%, male 23.2%) in high school students. The most common allergen was Dermatophagoides pteronyssinus (79.7%), followed by Dermatophagoides farina (72.2%), birch (14.0%), alder (12.0%), Japanese hop (9.2%), Alternaria (8.9%), cat fur (7.2%), Japanese cedar (6.9%), ryegrass (6.6%), willow (6.0%), pine (5.4%), oak (4.9%), mugwort (4.3%), orchard grass (4.0%), sheep fescue (3.7%), fat hen (3.4%), ragweed (3.4%), and maple (3.4%). CONCLUSION: This research figures out the prevalence and the detailed allergens of AR in Gwangju children. We suggest that more vegetation data of Japanese cedar should be surveyed in recent future.

Clinical features of allergic rhinitis in Korean children

PURPOSE: The characteristics of allergic rhinitis can be different among countries and areas because causative allergens and aggravating factors depend on the living environment. However, there have been few studies on the clinical feature of Korean children with allergic rhinitis, as well as on clinical characteristics in different age groups. The aim of this study was to investigate the clinical characteristics of Korean children with allergic rhinitis. METHODS: The medical records of children under 12 years of age who had rhinitis symptoms were analyzed in terms of clinical symptoms and positive allergens. Subjects were classified into 2 groups: those with allergic rhinitis (AR group) and nonallergic rhinitis (NAR group). Both groups were subdivided into 3 categories: the 1-4 years, 5-8 years, and 9-12 age groups. RESULTS: Among 516 children, 397 (76.94%) belonged to the AR group and 119 (23.06%) belonged to the NAR group. The male to female ratios were 2:1 in both groups. There were significant differences in sneezing and itching between the AR and NAR groups across different age subgroups. There were significant differences in nasal obstruction between the AR and NAR groups in the 9-12 age group. The incidence of AR was 77.8 % in chronic sinusitis patients. Sensitized allergens were house dust mites, animal hair, pollen, and mold in decreasing order in the AR group. Children who were sensitized to animal hair more frequently had sneezing than those who were not. CONCLUSION: Sneezing and itching strongly suggest allergic rhinitis in Korean children. Clinical characteristics of allergic rhinitis in Korean children would helpful in early diagnosis and adequate treatment of disease.

Epidemiology of allergic rhinitis in Korean children

PURPOSE: The diagnosis of allergic rhinitis (AR) is based upon the concordance between a history of allergic symptoms and diagnostic tests. This study is to investigate the epidemiology of AR by using data from National Health Insurance Corporation (NHIC) and data according to the AR definition in general students health screening. METHODS: We examined medical insurance claims data of NHIC from 2004 to 2010 according to age, area, and gender. We investigated the results of Korean International Study of Asthma and Allergies in Childhood questionnaires and skin prick tests of 14,133 students participated in health screening from 2010 to 2012. RESULTS: The prevalence of AR according to the NHIC data was elementary school students (24.34%); middle school students (13.75%) and high school students (12.17%). The prevalence of AR was higher in boy than in girl, annually. In health screening, the prevalence of AR was elementary school students (19.50%+/-0.26); middle school students (23.19%+/-0.30) and high school students (24.11%+/-0.31). The prevalence of AR had peaking at the age late teens (P<0.0001) and was higher in boy (26.49%+/-0.38) than in girl (17.43%+/-0.35) (P<0.0001). Sensitization rate of allergen in students with AR was house dust mite (86.71%+/-0.48); pollen (41.26%+/-1.01) and molds (14.80%+/-0.52). CONCLUSION: The prevalence according to the AR definition tended to be increased with aging in Korean children. There are some differences in the prevalence of AR in the data of NHIC and health screening study. Further investigation will be needed to reveal the causes of this difference.

Sensitization rates of airborne pollen and mold in children / 소아과

PURPOSE: Aeroallergens are important causative factors of allergic diseases. Previous studies on aeroallergen sensitization rates investigated patients groups that had visited pediatric allergy clinics. In contrast, we investigated sensitization rates in a general population group of elementary school to teenage students in Incheon, Jeju, and Ulsan. METHODS: After obtaining parental consent, skin-prick tests were performed on 5,094 students between March and June 2010. Elementary school students were tested for 18 common aeroallergens, whereas middle and high school students were tested for 25 allergens. The 25 allergens included Dermatophagoides pteronyssinus, Dermatophagoides farinae, pollen (birch, alder, oak, Japanese cedar, pine, willow, elm, maple, Bermuda grass, timothy grass, rye grass, orchard grass, meadow grass, vernal grass, mugwort, Japanese hop, fat hen, ragweed, and plantain), and mold (Penicillatum, Aspergillus, Cladosporium, and Alternaria). RESULTS: The sensitization rates in descending order were 25.79% (D. pteronyssinus), 18.66% (D. farinae), 6.20% (mugwort), and 4.07% (willow) in Incheon; 33.35% (D. pteronyssinus), 24.78% (D. farinae), 15.36% (Japanese cedar), and 7.33% (Alternaria) in Jeju; and 32.79% (D. pteronyssinus), 30.27% (D. farinae), 10.13% (alder), and 8.68% (birch) in Ulsan. The dust mite allergen showed the highest sensitization rate among the 3 regions. The sensitization rate of tree pollen was the highest in Ulsan, whereas that of Alternaria was the highest in Jeju. The ragweed sensitization rates were 0.99% in Incheon, 1.07% in Jeju, and 0.81% in Ulsan. CONCLUSION: The differences in sensitization rates were because of different regional environmental conditions and distinct surrounding biological species. Hence, subsequent nationwide studies are required.

A case of acquired acrodermatitis enteropathica with a normal serum zinc level but a low level in the hair / 소아과

Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder of early infancy, and is characterized by periorificial dermatitis, alopecia, and intractable diarrhea. Serum zinc levels are usually low in untreated patients and the oral administration of zinc sulfate can clear skin lesions and other symptoms. Although premature and cow`s milk-fed infants are at particular risk of developing AE, there have been a few reports about AE in term and breast-fed infants. We report a case of transient AE in a 4-month-old breast-fed infant. This patient suffered from diarrhea and dermatitis for more than a month. Her skin lesions were erythematous, scaly, crusted, psoriasiform, eczematous, with an eruption at the chin, and a periorificial disposition with involvement of the flexural areas of lower extremities. Her serum zinc level was almost normal at 129 microgram/dL (reference range: 60-121 microgram/dL), but the zinc level in her hair was low: 8 mg percent (reference range: 10-21 mg percent). Skin biopsy findings were consistent with AE. Seven days after zinc supplementation, the skin lesions and diarrhea improved. The authors recommend that a clinical trial of zinc supplementation be considered in cases where there are suspicious of AE, even when the serum zinc level is normal.