KAAACI Allergic Rhinitis Guidelines: Part 2. Update in nonpharmacotherapy

Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and nonmedical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the “KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy” in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on nonpharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.

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.

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.

Effect of Chronic Obstructive Pulmonary Disease on Swallowing Function in Stroke Patients

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). METHODS: The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. RESULTS: Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67+/-2.15) compared to the control group (2.89+/-1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance. CONCLUSION: This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.

Three cases of ciprofloxacin treatment failure in imported typhoid fever / 대한내과학회지

Recently, the role of ciprofloxacin in the empirical treatment of typhoid fever has been limited with the increased incidence of nalidixic acid-resistant Salmonella enterica serovar Typhi in South-central and Southeast Asia, as well as multidrug-resistant strains. We experienced three cases of imported typhoid fever that did not respond to ciprofloxacin. All of the blood isolates were susceptible to ciprofloxacin in vitro, but the patients failed to achieve clinical improvement with ciprofloxacin and were treated with ceftriaxone or azithromycin. Although nalidixic acid-resistant strains may be reported as susceptible to ciprofloxacin on disk diffusion tests, they frequently show a poor clinical response to ciprofloxacin because of the increased minimum inhibitory concentration of ciprofloxacin. Therefore, if clinical improvement is delayed or fails with ciprofloxacin, imported typhoid fever from South-central or Southeast Asia should be considered as being due to nalidixic acid-resistant strains and should be treated with high-dose ciprofloxacin, ceftriaxone, or azithromycin.

The Effects of Arnica Montana Gel for the Decreasing on the Swelling and Bruise

Homeopathic medicine is becoming increasingly popular in this country and abroad. Arnica montana has been known since the 16th century as an acute topical treatment of sprains, bruises, painful swellings, and wounds. Although arnica has a long history in folk medicine and is widely used, efficacy in a decreasing of swelling and bruise has never been clinically studied. This study investigated the safety and efficacy of an Arnica montana gel, applied the twice daily, in 15 patients(6 men and 9 women) who had trauma with swelling and bruise without external wound of the face from April of 2006 through December of 2006. The trauma with swelling and bruise was made on the dorsum of the rat, and then applied the twice daily for 1 week divided in control site and arnica-applied site on the dorsum. On the patients' subjective assessment of efficacy, 15 patients felt an effect in 1 week, and time to onset of effect averaged 2.8 days. On the experimental study of efficacy, microscopic finding of control site showed the dermis is mildly widened interstitial spaces, the interstitial fluid is mildly increased, but arnica-applied site showed the interstitial edema is not evident, the dermal collagen fibers are relatively well preserved. Topical application of Arnica montana gel for 1 week was a safe, well-tolerated, and effective treatment of swelling and bruise of the face.

Retrospective Study of Magnetic Resonance Imaging & Vestibular Function Testing in Patients Suggestive of Central Vestibular Disorders

BACKGROUND AND OBJECTIVES:There were many tools to evaluate dizzy patients with various causes. Our aim was to find the relationship between the magnetic resonance imaging(MRI) and vestibular function testing(VFT) in patients who are supposed of central vestibular disorders and to evaluate their effects. MATERIALS AND METHODS:We selected 183 patients retrospectively by standardized questionnaires, physical examinations, chart reviews from 3,825 patients who visited otorhinolaryngology via department of emergency and out patient clinic with chief complaints of dizziness. Among them, 13 patients were supposed to have MRI in relation to dizziness. We analyzed the result of VFT, MRI findings and then classified them in according to lesion locations, pathologic findings in MRI & optokinetic tests, caloric tests, step velocity tests, vestibulo-ocular tests, visual fixation tests in VFT. RESULTS:There were 9 ischemic findings, 1 hemorrhagic finding, 3 neoplasms in pathologic findings. There were 5 pons lesions, 4 cerebellum lesions, 3 thalamus lesions, 2 medulla lesions, 2 pituitary lesions and 1 caudate nucleus lesions in locations. CONCLUSIONS:Dizzy patients visiting otorhinolaryngology OPD had 0.34%(13/3825) central origin vertigo, and vascular disease is most common. Therefore we supported that careful readings of VFT findings in identifying central vestibular disorders were valuable and might well represent the gold standard. MRI was an important tool for evaluating the central nervous system, and we should use MRI to assess central vestibular dysfunction. We concluded MRI correlated well with VFT findings of central vestibular dysfunction.

Post-operative Adjuvant Chemotherapy with 5-Fluorouracil, Leucovorin, and Mitomycin C (MLF) for Gastric Cancer / 대한암학회지

PURPOSE: The surgical resection has been still the only curative treatment modality for the gastric cancer, but the overall prognosis has not been so satisfactory because of high relapse rate. So the necessity of adjuvant chemotherapy has been increased. We evaluated the effect of MLF (5-fluorouracil, leucovorin and mitomycin C) regimen on the prevention of relapse and survival benefit after postopertive adjuvant chemotherapy. MATERIALS AND METHOD: The MLF regimen consisted of 5-FU 375 mg/m2 IV on days 1 through 5; LV 20 mg/m2 IV just before 5-FU infusion on days 1 through 5; and MMC 9 mg/m2 IV on day 1 (7 mg/m2 from the 2nd cycle). RESULTS: One hundred patients were entered into the trial; 56 were male & 44 female, and the range of age was 20 to 82. The total number of chemotherapy cycles was 514. According to AJCC staging, 4 cases were in stage IA, 14 IB, 23 II, 42 IIIA, 15 IIIB, respectively and 2 cases were in stage IV. The estimated median survival was 32 months in stage IIIA, and 28 months in IIIB. The 5 year survival was 90% in stage IB, 76% in II, 29.6% in IIIA and 21.8% in IIIB. Severe neutropenia (WHO grade > or = 3) was observed in 11.8%, and throbocytopenia 0.4%. Severe nausea and vomiting was observed in 1.8%, diarrhea in 1.7%, and mucositis in 1.5%, but there was no toxic death. CONCLUSION: The MLF adjuvant chemotherapy may be effective for resectable gastric cancer with minimal toxicities, but phase III study is needed to confirm its efficacy.