Hye Mi Jee

Increased serum thymic stromal lymphopoietin in children with atopic dermatitis

Lee EB, Kim KW, Hong JY, Jee HM, Sohn MH, Kim K‐E. Increased serum thymic stromal lymphopoietin in children with atopic dermatitis.
Pediatr Allergy Immunol 2010: 21: e457–e460.
© 2010 John Wiley & Sons A/S

Reference values for respiratory system impedance using impulse oscillometry in healthy preschool children

Purpose The normal values for lung resistance and lung capacity of children, as determined by impulse oscillometry (IOS), are different for children of different ethnicities. However, reference values there is no available reference value for Korean preschool children have yet to be determined. The aim of the present study was to determine the normal ranges of IOS parameters in Korean preschool children. Methods A total of 133 healthy Korean preschool children were selected from 639 children (aged 3 to 6 years) who attended kindergarten in Seongnam, Gyeonggi province, Korea. Healthy children were defined according to the European Respiratory Society (ERS) criteria. All subjects underwent lung function tests using IOS. The relationships between IOS value (respiratory resistance (Rrs) and reactance (Xrs) at 5 and 10 Hz and resonance frequency (RF)) and age, height, and weight were analyzed by simple linear and multiple linear regression analyses. Results The IOS success rate was 89.5%, yielding data on 119 children. Linear regression identified height as the best predictor of Rrs and Xrs. Using stepwise multiple linear regressions based on age, height, and weight, we determined regression equations and coefficients of determination (R2) for boys (Rrs5=1.934-0.009×Height, R2=12.1%; Xrs5=0.774+0.006×Height-0.002×Age, R2=20.2% and for girls (Rrs5=2.201-0.012×Height, R2=18.2%; Xrs5=-0.674+0.004×Height, R2=10.5%). Conclusion This study provides reference values for IOS measurements of normal Korean preschool children. These provide a basis for the diagnosis and monitoring of preschool children with a variety of respiratory diseases.

Resistance and reactance in oscillation lung function reflect basal lung function and bronchial hyperresponsiveness respectively

Background and objective:  Currently there are few data available regarding the use of impulse oscillometry parameters to assess airflow obstruction during standardized methacholine challenge testing.

Relationship between mode of delivery in childbirth and prevalence of allergic diseases in Korean children.

Purpose We tested the hypothesis that cesarean section might increase the risk for allergic diseases compared to vaginal delivery, by depriving the newborn of exposure to maternal microflora. Methods We evaluated the prevalence of allergic diseases, allergic inflammation, and allergic sensitization according to mode of delivery for 279 Korean children aged ≤16 years. Data were extracted from medical records and a questionnaire filled out by parents. Logistic regression was used to determine the association between cesarean section and the outcomes of interest. Results Of the 279 children, 179 (62.6%) were delivered vaginally and 100 (37.4%) by cesarean section. There were no differences in the prevalence of allergic diseases, allergic inflammation, or allergic sensitization according to mode of delivery. Children born by cesarean section had no higher risk of allergic disease than those delivered vaginally, regardless of a parental history for allergic disease. Adjusted odds ratios (95% confidence intervals) for cesarean section compared to vaginal delivery were not statistically significant for any outcome considered: asthma, 0.76 (0.37-1.57), allergic rhinitis, 1.14 (0.61-2.10), atopic dermatitis, 1.01 (0.59-1.71). Conclusions Delivery by cesarean section may not be associated with the subsequent development of asthma, allergic rhinitis, or atopic dermatitis in Korean children.

Relationship Between Amphiregulin and Airway Inflammation in Children With Asthma and Eosinophilic Bronchitis

BACKGROUND Amphiregulin, a member of the epidermal growth factor family, has been shown to promote the growth of fibroblasts, to be associated with the T-helper type 2 cell adaptive immune response, and to up-regulate mucin gene expression. We aimed to determine whether sputum amphiregulin is expressed at elevated levels in patients with asthma or eosinophilic bronchitis (EB), and whether it is associated with eosinophilic inflammation, pulmonary function, and bronchial hyperresponsiveness in children. METHODS A total of 117 children with asthma, 77 with EB, and 84 control subjects were enrolled in this study. Amphiregulin and eosinophil cationic protein (ECP) levels were measured in sputum supernatants. We performed pulmonary function and methacholine challenge tests while measuring total eosinophil count, and serum levels of total IgE and ECP in all children. RESULTS The children with asthma had significantly higher levels of sputum amphiregulin (mean, 10.80 pg/mL; range, 4.07 to 38.75 pg/mL) than both the children with EB (mean, 5.76 pg/mL; range, 0.61 to 21.65 pg/mL; p = 0.013) and the control subjects (mean, 6.56 pg/mL; range, 0.51 to 17.98 pg/mL; p = 0.003). Sputum amphiregulin levels positively correlated with levels of sputum eosinophils (gamma = 0.221; p = 0.007) and sputum ECP (gamma = 0.601; p < 0.0001). Negative significant correlations were found between sputum amphiregulin and FEV(1) (gamma = -0.181; p = 0.006) or post-bronchodilator therapy FEV(1) (gamma = -0.233; p = 0.002). In children with asthma who were not receiving any controller medications, sputum amphiregulin level was negatively correlated with the provocative concentration of methacholine causing a 20% fall in FEV(1) (r = -0.398; p = 0.008). CONCLUSIONS Our findings suggest that childhood asthma is associated with sputum amphiregulin, whereas EB is not, and that sputum amphiregulin would be a supportive marker of airway inflammation in asthma.

Useful Parameters of Bronchial Hyperresponsiveness Measured with an Impulse Oscillation Technique in Preschool Children

Background. There are few studies focused on bronchial challenge testing using the oscillation technique, and results from the test in preschool children have been inconsistent. Objectives. The aim of this study was to explore which level of provocative concentration (PC) is appropriate for bronchial challenge testing using the impulse oscillometry system (IOS) for assessing asthma. The authors also compared variable diagnostic cutoff values of PC expressed in different ways. Methods. A methacholine challenge test was performed using an IOS and the mean baseline value, resistance (Rrs), reactance (Xrs), resonance frequency (Rf), and area of reactance (AX) of the respiratory system were recorded simultaneously over a frequency spectrum of 5 to 35 Hz in 50 preschool children with asthma and 41 children with chronic cough, serving as controls. Results. The results of the methacholine challenge test by IOS, expressed as percent changes of the predicted value (Δ%Pred), were significantly different between the two groups, whereas results expressed as actual data or Z-score were not. PC80_Xrs5 was a valuable diagnostic cutoff level for asthma with acceptable sensitivity (80.0%) and specificity (82.9%). The areas under the ROC curves of Xrs5 for both actual (0.867; p < .001) and predicted values (0.877; p < .001) were larger than those for Rrs5 (0.746 and 0.730, respectively). Conclusions. The authors suggest PC80_Xrs5 might be a useful parameter for IOS-assessed bronchial challenge testing in preschool children with asthma.

Oscillometric and spirometric bronchodilator response in preschool children with and without asthma

BACKGROUND Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children. OBJECTIVES To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children. METHODS Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed. RESULTS Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1 %initial versus ΔRrs5 % initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1 >=9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1 >=9% or ΔRrs5 >=29% was considered as an additional criterion for the diagnosis of asthma. CONCLUSION The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.

Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children

Purpose Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children. Methods This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done. Results The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022). Conclusions A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

RANTES Gene Promoter Polymorphisms Are Associated with Bronchial Hyperresponsiveness in Korean Children with Asthma

Regulated upon activation in normal T cells, expressed, and secreted (RANTES) protein is abundantly expressed during atopic asthma, suggesting that it is an important mediator of this disease. The aim of this study was to evaluate the possible role of RANTES promoter polymorphisms in children with asthma. We genotyped 271 children with atopic asthma, 55 children with nonatopic asthma, and 253 control children for allelic determinants at two polymorphic sites in the promoter region at positions −403G>A and −28C>G by restriction fragment length polymorphism methods. There was no significant difference in genotype and allele frequencies of the RANTES −403G>A and −28C>G polymorphisms when the atopic asthma, nonatopic asthma, and control groups were compared. However, atopic asthmatic patients who were homozygous GG for the RANTES −28C>G tended to have lower PC20 methacholine than those carrying the wild genotype. In addition, a significantly lower PC20 was demonstrated for the homozygous haplotype −403A/−28G in asthmatic children. The polymorphisms within the RANTES promoter may have a disease-modifying effect in Korean children with asthma.

Patterns of sensitisation to common food and inhalant allergens and allergic symptoms in pre‐school children

Sensitisation to allergens and allergy symptoms depends on age, but this relationship is poorly understood. We therefore investigated the effect of age on allergen sensitisation and allergy symptoms in pre‐school children.