Etiology and clinical feature of oral allergy syndrome in children

PURPOSE: Oral allergy syndrome (OAS) is a unique allergic reaction to fresh fruits or vegetables, which is caused by cross-reactivity between foods and pollens. This study was conducted to investigate the clinical feature of OAS and relevant pollen allergens as well as the association between them in Korean children. METHODS: This single-center study included 290 children who were sensitized to pollens at Severance Hospital, and the clinical characteristics of children with and without OAS were compared. A multicenter study included 97 children who were diagnosed with OAS at 3 hospitals between January 2008 and June 2014. The details of clinical features were collected by retrospective medical record reviews using a standardized case report form. The relevant pollen allergens were identified by skin prick tests and/or serum specific IgE levels. RESULTS: The most commonly sensitized allergen was Japanese hop in pollen-sensitized children. Children with OAS were most commonly sensitized to birch and oak, and 12.4% of the pollen-sensitized children had OAS in the single center. The number of children who were newly diagnosed with OAS has increased over the past 7 years. The most common causative food of OAS was apple. More than 60% of patients with OAS had oral allergic reactions to multiple foods. CONCLUSION: OAS may be relatively common in pollen-sensitized children. OAS should be considered in children with allergic disease and sensitization to pollens.

Allergic disease-related articles in Korean newspapers (1920–1972 year)

PURPOSE: This study aimed to investigate which Korean newspaper articles were reported on allergic diseases before the establishment of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI). METHODS: This study was performed in 3 newspapers, Chosun Ilbo, DongA Ilbo, and JoongAng Ilbo, which were founded and used the databases established before the establishment of KAAACI in 1972. The databases were searched using 42 keywords associated with allergic diseases (allergy, asthma, rhinitis, etc.). RESULTS: Among the 42 keywords, there were only 7 that were able to search: allergy, urticaria, asthma, dermatitis, rhinitis, pollen and eczema. The total number of articles related to allergic diseases were 62, as follows: allergy (n=21), urticaria (n=15), asthma (n=8), dermatitis (n=8), rhinitis (n=5), pollen (n=3), and eczema (n=2). There were 31 articles in Chosun Ilbo, 9 in DongA Ilbo, and 22 in JoongAng Ilbo. The first allergic disease published in the newspapers was asthma on the article entitled “Treat the cause of asthma” (on page 8 of November 10, 1960 DongA Ilbo). The first article that used the term allergy appeared in a column entitled, “Childhood illness and allergy” (on page 4 of May 30, 1960 DongA Ilbo). CONCLUSION: Since 1920, articles related to allergic diseases published in the Korean newspapers increased every year. These articles may have appeared due to the increase in the prevalence of allergic disease and the pioneering efforts of senior allergy researchers.

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.

The safety of influenza vaccination in children with egg allergy

PURPOSE: Although influenza vaccine contains some residual egg protein (ovalbumin), recent studies have been reported that the influenza vaccine is even safe for patients with egg allergy. The object of this study was to assess the safety of influenza vaccination and estimate the risk factors of allergic reactions to influenza vaccination in children with egg allergy. METHODS: The medical records of 108 children were reviewed retrospectively, those were diagnosed as egg allergy at Department of Pediatrics in Severance Children's Hospital between January 2006 and December 2011. All of them were vaccinated with very low ovalbumin concentration (< or =0.12 microg/mL). Patients were vaccinated in graded doses by the international guideline. Subjects without allergic reactions to influenza vaccine among egg allergy patients were recruited as control subjects. RESULTS: Only 12 subjects of patients had adverse reactions to influenza vaccination. There were no significant relationships between adverse reactions to influenza vaccine and their own history of other allergy, history of breast feeding or graded vaccination. The egg allergy symptoms or egg-specific IgE levels were not associated with adverse reactions to influenza vaccination. CONCLUSION: These results show that patients with egg allergy may have adverse reactions with influenza vaccine, but severe adverse reactions are rare as general population. Therefore, the patients with egg allergy can be safe vaccinated with influenza vaccine, regardless of severity of allergic reaction after egg ingestion or methods of vaccination.

Relationship between the Prevalence of Allergic Rhinitis and Allergen Sensitization in Children of Songpa Area, Seoul / 소아알레르기및호흡기학회지

PURPOSE: We investigated the relationship between allergic rhinitis (AR) and allergen sensitization in students at an elementary school in Seoul. METHODS: A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire survey was administered to 1,376 elementary school children in the Songpa area of Seoul. Serum total IgE, blood eosinophils, and skin prick tests for 18 common allergens were performed. RESULTS: The prevalence of AR symptoms during the last 12 months and the current AR, defined as having AR symptoms during last 12 months with a history of AR diagnosis from the doctor, were 39.0% and 24.2%, respectively. Males were more likely to have current AR than females (26.6% vs. 21.5%, P =0.04). Independent risk factors for current AR were parental allergic disease (adjusted odds ratio [aOR], 3.78, 95% CI, 2.76-5.18), history of atopic dermatitis (AD; aOR, 1.47; 95% CI, 1.05-2.04), history of asthma (aOR, 3.48; 95% CI, 2.15-5.61), and higher maternal education (aOR, 1.42; 95% CI, 1.02-1.99). The subjects with higher quartiles of serum total IgE (P value for trend <0.001), more than 4% of eosinophil fraction (aOR 1.76; 95% CI, 1.24-2.48), and allergen sensitization house dust mites [aOR, 1.54; 95% CI, 1.10-2.15], dog [aOR, 2.95; 95% CI, 1.38-6.28], cat [1.85; 95% CI, 1.02-3.34], Alternaria [aOR, 2.37; 95% CI, 1.06-5.32] and late-blooming tree pollen mixture [aOR 2.26; 95% CI, 1.12-4.57] were more likely to have current AR. CONCLUSION: The prevalence of AR in children has increased during the last decade. The sensitization to common allergens and increased sensitization were associated with the development of current AR. House dust mites, dog, cat, alder, and Alternaria were the important allergens for current AR.

Effect of Cosensitization with Buckwheat Flour Extract on the Production of House Dust Mite-specific IgE

There are studies reporting food sensitization in infancy increases the risk of sensitization to inhalants later in life. We performed a study to evaluate whether cosensitization with buckwheat (BW) has an effect on the production of house dust mite-IgE. C3H/HeJ mice (4 weeks, female) were sensitized with house dust mite (HDM)/Al (OH)3, intraperitoneally on day 0, followed by 4 intranasal sensitizations (on days 14, 15, 16, and 21). Group 1 was cosensitized intragastrically with BW/cholera toxin (CT) (on days 0, 1, 2, 7, and 18) during sensitization with HDM, group 2 was cosensitized intragastrically with CT only (on days 0, 1, 2, 7, and 18), and group 3 was used as controls. HDM- and BW-IgE and antigen-specific T-cell proliferation and cytokine production were evaluated. In Group 1, BW-IgE levels were highest at week 4, and the HDM-IgE at week 3 (98.45+/-64.37 ng/mL and 169.86+/-55.54 ng/mL, respectively). In Group 2, HDM-IgE levels reached a peak at week 3, remarkably higher (810.52+/-233.29 ng/mL) compared to those of Group 1 (169.86+/-55.54 ng/mL). The interleukin (IL)-4 and interferon (IFN)-gamma in the HDM-stimulated culture supernatants of splenocytes were not significantly different among groups. We postulate that the cosensitization with BW may down-regulate the specific IgE response to HDM.

The Correlation between Increased Sensitization Rate to Weeds in Children and the Annual Increase in Weed Pollen in Korea / 소아알레르기및호흡기학회지

PURPOSE: Recently allergic diseases have gradually increased in schools and among preschool aged childhood. Pollen amount of weeds also, especially ragweed, were increased. We evaluated the increased pollen count of weed was associated with the sensitization rate to weed in childhood. METHODS: Airborne particles carrying allergens were collected daily from eight stations nationwide(Seoul, Guri, Cheongju, Daegu, Kwangju, Busan, Kangneung, and Jeju) by using 7 days-Burkard sampler(Burkard Manufacturing Co Ltd, Hertfordshire, UK), for 7 years in South Korea(July 1, 1997-June 30, 2004). They were counted and recorded along with the weather. Data was collected through pediatric patients with allergic symptoms, who visit the pediatrics allergy clinics and capable of allerfy skin test among hospitals that have pollen collecting centers. RESULTS: Airborne pollen has two peak seasons:May and September in Korea. There were the tree pollen seasons from the middle of February to late July, then followed the grasses and weed season from the middle of July to the end of October. Ragweed was one of the most common pollens of autumn in Korea. In skin prick tests, Mugwort was the highest sensitization rate(7.6 percent), followed by ragweed(7.1 percent), birch(6.1 percent), alder, grasses mix among the pollen extracts in Korean school aged children. Ragweed pollen counts have gradually increased since 2000. In the same period, sensitization rates for airborne pollen, especially weeds, in Korean children have increased annually(1999:4.4 percent, 2000:7.1 percent, 2001:7.4 percent, 2002:8.5 percent, 2003:7.7 percent). CONCLUSION: Sensitization rates for outdoor airborne pollens have increased in Korean children. These findings might result from the changes of life styles and living environments in Korea.

Murine Model of Buckwheat Allergy by Intragastric Sensitization with Fresh Buckwheat Flour Extract

Food allergies affect about 4% of the Korean population, and buckwheat allergy is one of the most severe food allergies in Korea. The purpose of the present study was to develop a murine model of IgE-mediated buckwheat hypersensitivity induced by intragastric sensitization. Young female C3H/HeJ mice were sensitized and challenged intragastricly with fresh buckwheat flour (1, 5, 25 mg/dose of proteins) mixed in cholera toxin, followed by intragastric challenge. Anaphylactic reactions, antigen-specific antibodies, splenocytes proliferation assays and cytokine productions were evaluated. Oral buckwheat challenges of sensitized mice provoked anaphylactic reactions such as severe scratch, perioral/periorbital swellings, or decreased activity. Reactions were associated with elevated levels of buckwheatspecific IgE antibodies. Splenocytes from buckwheat allergic mice exhibited significantly greater proliferative responses to buckwheat than non-allergic mice. Buckwheat-stimulated IL-4, IL-5, and INF-gamma productions were associated with elevated levels of buckwheat-specific IgE in sensitized mice. In this model, 1 mg and 5 mg dose of sensitization produced almost the same degree of Th2-directed immune response, however, a 25 mg dose showed blunted antibody responses. In conclusion, we developed IgE-mediated buckwheat allergy by intragastric sensitization and challenge, and this model could provide a good tool for future studies.

Allergen and chow-protein stimulated splenocyte cytokine productions in buckwheat allergic mice / 천식및알레르기

BACKGROUND AND OBJECTIVE: Normal gut immune response to ingestive food proteins is induction of immune tolerance rather than sensitization, even in atopic individuals. Very restricted kinds of food antigens have been known to cause allergic sensitization in humans. To evaluate the differences of systemic T-cell immune responses to sensitized antigen and regular chow-protein, we performed this study. SUBJECTS AND METHODS: Eight naive female, 5-week-old C3H/HeJ mice were grown under the regular mouse chow feeding condition for 4 weeks. During that period, Group I mice were sensitized with buckwheat extract(1mg/dose) mixed with cholera toxin(10 microgram/dose) by intragastric administration at day1, 2, 3, 7, and 21. The sera were obtained at weekly intervals to measure buckwheat-specific and chow-protein-specific IgE, IgG1 and IgG2a antibodies. Splenocyte proliferation assays and cytokine productions were evaluated with buckwheat. chow-protein. and Con A stimulation. Levels of antibodies (IgE, IgG1, IgG2a) and cytokines (IL-4, IL-10, IL-12, INF-gamma were measured by ELISA. RESULTS: The levels of buckwheat specific IgE, IgG1 and IgG2a were markedly increased in Group I mice, but not in Group II mice. Chow-protein specific IgE and IgG1 antibodies were not increased in both groups of mice. The degrees of buckwheat-specific and chow-protein-specific splenocyte proliferations showed low-grade(SI: 6.68 and 4.48. respectively) compared to those by Con A stimulation(SI : 58). Buckwheat stimulated IL-4 productions were markedly increased in Group I mice, which were higher than Con A stimulated production. INF-gamma production was increased in Group I mice by buckwheat stimulation, and in both groups of mice by Con A stimulation. IL-12 production was shown in Con A stimulated culture supernatants in both groups of mice, but in Group I mice with buckwheat stimulation. IL-10 productions were increased in Group I mice with buckwheat, Con A, and chow-protein stimulations, furthermore, markedly increased IL-10 levels were also shown in chow-protein stimulated splenocyte cultures in both groups of mice. CONCLUSION: While Th1 and Th2 immune responses were induced by intragastricly sensitized buckwheat extract, only regulatory immune responses were dominated by regular chow proteins in this system. The minimum ability of chow-protein specific splenocyte proliferation was preserved and IL-10 was the unique cytokine produced by chow-protein simulation.

Distribution of Fungus Spores in Indoor and Outdoor Air / 대한의진균학회지

The number of fungus spores in the air is greater compared to that of pollen and also is less influenced by season. Recently there is increasing interest in the role of fungus as an allergen and causative factor of sick building syndrome. There are several kinds of samplers for the collection of fungus spore in outdoor and/or indoor air such as Durham sampler, rotorod sampler, personal volumetric air sampler, seven-day recording volumetric spore trap, and portable air sampler for agar plates. Because personal volumetric air sampler is small, rechargeable and volumetric equipment, it is suitable for air sampling indoors. Portable air sampler for agar plates is useful for fungus culture from indoor and outdoor air. According to the results of our study on distribution of fungus spores in indoor and outdoor air by using personal volumetric air sampler, Cladosporium and Leptosphaeria were common spores in indoor and outdoor air. The number of spores in indoor air was closely correlated with that in outdoor air. Therefore it would be necessary to establish a standard method for collecting the fungus spores. We need to perform the nationwide study on distribution of fungus spores using this method, and to evaluate the allergenicity of fungus spores.

Five Cases of Severe Allergic Keratoconjunctivits Not Respond to Treatment / 소아알레르기및호흡기학회지

Conjunctivitis of allergic origin is associated with a diversity of clinical presentation. The common features include pronounced itching, a milky conjunctival appearance, a stringy or ropy discharge & papillary hypertrophy of the tarsal conjunctiva in severe cases, and a family history of allergy. The pathogenesis of ocular allergy involves multiple mechanisms, which lead to mast cell degranulation & the release of chemical mediators. The current therapy of ocular allergy involves elimination of the offending allergen, modulation of the immune system, & pharmacologic inhibition of chemical mediators. We are reporting 5 cases of severe allergic keratoconjunctivitis.

Immunoblot Analysis of Hypoallergenic Buckwheat with Monoclonal Antibodies to Raw Buckwheat / 소아알레르기및호흡기학회지

BACKGROUND AND OBJECTIVE: It is generally accepted that one third of children with food allergy lose their clinical activity if the responsible food allergen can be identified and completely eliminated from their diet. But buckwheat allergy rarely lose clinical activity. So, we have produced hypoallergenic buckwheat(HBW) according to Ikezawa's method, and characterized the allergenicity by immunoblot method using monoclonal antibodies to raw buckwheat. MATERIAL AND METHODS: HBW was prepared from raw buckwheat by salting with 0.5 M NaCl. 18 monoclonal antibodies to raw buckwheat were made according to standard polyehtylene glycol method. We performed SDS-PAGE of HBW and transferrd to nitrocellulose membranes, which were immunoblotted by selected 3 monoclonal antibodies to raw buckwheat. RESULTS: The protein concentration of HBW was 47.3 microgram/microliter. As the result of SDS-PAGE of HBW the protein bands of 50, 36, 13 kD of raw buckwheat disappeared. 3 monoclonal antibodies were selected due to their higher specificities in ELISA. Immunoblot study showed that 2 among 3 monoclonal antibodies bind to HBW. CONCLUSION: The SDS-PAGE of HBW showed less protein bands in comparison to raw buckwheat. But the allergic component of HBW still remained. So further studies are required to eliminate the residual allergenicity of hypoallergenic food.

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.

Identification and characterization of buckwheat allergen / 천식및알레르기

BACKGROUND AND OBJECTIVE: Buckwheat is considered one of the most important food allergens in Korea. Although a very small amount is ingested or inhaled, it can cause serious allergic reactions. However, the major allergens of buckwheat still remain to be elucidated. The aim of our study was to identify and characterize the major allergen of buckwheat seed. MATERIAL AND METHOD: Dialysis membrane with a cut-off MW 1kD was used for the preparation of crude buckwheat seed allergen extract. SDS-PAGE under reducing conditions and IgE immunoblotting were performed using sera from 15 buckwheat sensitive subjects. Isoelectric focusing and lectin blotting assay were done. RESULT: Western blot analysis showed more than 15 IgE-reactive buckwheat proteins. Among them, a 24kD protein was shown to be the most frequently bound to sera from allergic subjects (54%). Isoelectric point of 24kD protein was around 5.9. In lectin blotting assay, 24kD protein did not bind to Con A nor five other lectins. CONCLUSION: A 24kD protein was the most frequently recognized allergenic component in buckwheat seed. Isoelectric point was around 5.9. Glycosylation was not detected in 24kD of buckwheat protein.

Production of Recombinant Buckwheat Allergen / 소아알레르기및호흡기학회지

PURPOSE: Buckwheat is one of the most common food allegen in Korea and frequently elicit severe allergic reactions. However, up to now, only few reports on buckwheat allergens have been reproted. The purpose of this study was to isolate mRNA for the production of recombinant buckwheat allergens. METHODS: After the isolation of mRNA from ripening buckwheat seeds, in vitro translation was performed. The proteim patters of in vitro traslate products were identified using SDS-PAGE. RESULTS: A260/A260 ratio total RNA was 1.9 and mRNA was 2.0. In vitro translate products showed towered molecular buckwheat proteins such as 1, 3, and 14kD, while other high molecular weight protein of buckwheat seed were not shown in SDS-PAGE. CONCLUSION: mRNA of buckwheat was purified only from ripening seeds. The composition of mRNA was different according to the ripening periods. It is believed that this finding can give a clue to the basic research of buckwheat allergen.

A Clinical Study on Oral Buckwheat Provocation Test / 소아알레르기및호흡기학회지

PURPOSE: Buckwheat is one of the most common allergen in food allergy, the pathomechanism is IgE-mediated, type I immune reaction. Antigenicity of Buckwheat is extremely strong, and hypersensitivity symptoms included asthmatic attacks, urticaria eruption, gastrointestinal disorders even anaphylactic shock. The purpose of this study is to evaluate diagnostic significance of allergy skin test and allergy history and analyze clinical features of buckwheat allergy confirmed by oral provocation test. METHODS: We carried out the retrospective study on 55 patients who had been performed oral buckwheat provocation test at Yonsei university children's allergic clinic. RESULTS: 1) 40 out of 55 cases(72.7%) showed positive buckwheat oral provocation test. 2) The most common clinical finding after oral provocation test was urticaria. 60% showed severe allergic reactions such as asthma attack or anaphylactic shock. 3) The rate which past history and positive skin test corresponded to oral provocation test was very high(86.1%). CONCLUSIONS: The most valuable diagnosis of food allergy is oral provocation test. However, predictive value of allergy skin test and past history was very high in buckwheat allergy. Our study suggest that the troblesome oral provocation test may be not needed in all cases of suspicious buckwheat allergy patients.

Immediate Type Reaction of Food Allergy Confirmed by Open Food Challenge Test: Diagnostic Value of History and Skin Test in Food Allergy / 소아알레르기및호흡기학회지

PURPOSE: Food allergy is one of the common allergic diseases and elicits various clinical manifestations in children. Although the offending food could be suspected by history of food allergy and skin test with food allergen, it should be confirmed by food challenge test. We investigated the result of open food challenge test(OFCT) with offending food as suspected by history and/or skin test. Thereafter we analyzed the relationship between positive history of food allergy and positive skin test to food allergen, and positive food challenge test. METHODS: The subjects consisted of 208 children (age range, 3-15 years) with history of food allergy and/or positive skin test to food allergen. Open food challenge test was performed in 276 cases with 33 kinds of suspected foods. Increasing doses of natural food were given every 20 minutes, and the clinical manifestations elicited by challenge test were observed for 1 hour. RESULTS: 1) One-hundred twenty eight of 276 cases were positive for OFCT, and the provocation rate was 46.4%. 2) The provocation rate of individual food was highest in buckwheat flour(72.3%), followed by crab(60.0%), shrimp(45.8%), milk(41.6%), and egg(41.4%). 3) OFCT elicited allergic manifestations in 44.8% of positive history alone and 31.1% of positive skin test alone. Allergic manifestations were elicited in 91.2% when both the positive history and skin test were positive for the same food. 4) Positive and negative predictive values for OFCT were 67.8% and 68.9% in history, 46.8% and 55.2% in skin test, and 91.2% and 65.3% in history and skin test respectively. 5) Urticaria was the most common symptom(84.4%) elicited by OFCT. There were various allergic manifestations such as asthma, rhinitis, conjunctivitis and burning sensation in throat. Anaphylactic shock was observed in 3 cases with buckwheat flour allergy. 6) For the most cases(51.5%) symptoms occurred by the ingestion of small amount(1-100gm) of offending food. But symptoms in 27 cases were elicited just by scrubbing the food on lips or licking it by tongue. CONCLUSIONS: Open food challenge test showed the highest positive provocation rate with buckwheat. The most common symptom was urticaria, which was elicited with only a small amount of offending food. In predicting the result of OFCT, food allergy history was more reliable than the positive skin test, and if both the history and the skin test were positive for the same food, almost all the cases showed positive results with OFCT.