Seung Youp Shin

The Clinical Characteristics of Anisakis Allergy in Korea

Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.

Changes in histological features of nasal polyps in a Korean population over a 17-year period.

Objective Nasal polyps can be categorized as eosinophilic or non-eosinophilic, depending on inflammatory cell infiltration. There are geographical differences in the prevalence of types of pathologic polyps. The aim of this study was to evaluate the change in the prevalence of histological subtypes of polyps over time in a Korean population. Study Design A retrospective cross-sectional study with histologic analysis. Setting A single academic medical center. Subjects and Methods A total of 230 patients with nasal polyps were enrolled between 1993-1994 (group A) and 2010-2011 (group B). Specimens were fixed in formalin and embedded into paraffin blocks. Slides were stained with hematoxylin-eosin (H&E) and were subsequently reviewed by 2 of the authors. The numbers of eosinophils per high power field (HPF), as well as other cellular, epithelial, and stromal markers, were recorded. Results We compared nasal polyp eosinophil counts according to time period. The average eosinophil count/HPF increased from 6.8 in group A to 19.3 in group B (P = .006). The prevalence of eosinophilic polyps also increased from 24.0% in group A to 50.9% in group B (P < .001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hyperplasia showed significant differences between groups. Conclusion After comparison of histopathologic findings of nasal polyps from 1993 and 2011 at 1 academic medical center in Korea, the prevalence of eosinophilic nasal polyps, which are known to be rare among Asians, has significantly increased.

Intralesional Injection versus Mouth Rinse of Triamcinolone Acetonide in Oral Lichen Planus A Randomized Controlled Study

Objective To compare the efficacy, relapse, and adverse effects between intralesional injection and mouth rinse of triamcinolone acetonide (TA) in patients with oral lichen planus (OLP). Study Design A randomized controlled study. Setting College medical center. Subjects and Methods Forty consecutive patients, who had been diagnosed with OLP, were recruited. Participants were randomly divided into 2 groups using intralesional injection or mouth rinse of TA. The severity of pain and burning sensation on a 10-cm visual analog scale (VAS) and the Oral Health Impact Profile–14 (OHIP-14) were assessed at weeks 0, 1, 2, 3, 4, and 6. The signs of OLP were quantified using a special scoring system for OLP. The rate of relapse and the adverse effects were compared between both groups. Results The VAS scores for pain and burning mouth sensation and objective scoring for OLP were significantly improved at 1, 2, 3, 4, and 6 weeks in both groups. The changes in the VAS for burning mouth sensation, OHIP-14, and objective scoring for OLP were similar between both groups. The change in the VAS for pain from baseline to week 1 in the intralesional injection group was significantly higher than in the mouth rinse group. The rate of adverse effects was significantly higher in the mouth rinse group than in the intralesional injection group (44.4% vs 5.0%). Conclusion The efficacies of both treatments were similar. The rate of adverse effects was significantly lower for intralesional injection of TA than mouth rinse of TA.

Neutrophil Activation in Patients with ASA-Induced Urticaria

The pathogenic mechanism of acetyl salicylic acid (ASA)-induced urticaria (AIU) is not fully understood. We compared the levels of neutrophil activation and related cytokines in patients with ASA-intolerant acute urticaria (AIAU) and ASA-intolerant chronic urticaria (AICU). A total of 51 patients with AIAU, 88 patients with AICU, and 102 normal controls (NC) were enrolled in this study. The serum levels of myeloperoxidase (MPO), interleukin-8 (IL-8), and IL-18 were compared among the three groups. The serum levels of MPO were highest in the AIAU group, followed by the AICU and NC groups, and the serum levels of IL-18 were significantly higher in the AIAU and AICU groups than in NC group. Within the AIU groups, significant correlations were noted between the levels of MPO and IL-8, and IL-8 and IL-18. In conclusion, neutrophil activation, which was associated with the levels of IL-8 and IL-18 in the AIAU group, may be involved in the pathogenic mechanism of AIU. A role for IL-18 in the pathogenesis of AIU is also suggested.

Prevalence of Snoring and High Risk of Obstructive Sleep Apnea Syndrome in Young Male Soldiers in Korea

There are little information on prevalence of obstructive sleep apnea syndrome (OSAS) and clinical features in the young military population. The purpose of this study was to estimate the prevalence of snoring and high risk of OSAS in young male soldiers in Korea and to identify the risk factors of OSAS. A total of 665 participants (aged 20-23 yr) who visited the Armed Forces Ildong Hospital for regular physical examination were enrolled. All participants completed the Berlin Questionnaire and underwent a physical examination. The participants with high risk for OSAS completed portable sleep monitoring. The prevalence of snoring and high risk of OSAS in young male soldiers in Korea was 13.5% and 8.1%, respectively. The prevalence of high arched palate, tongue indentation, long uvula, large tonsil and retrognathia was significantly higher in the high risk OSAS group. High arched palate, long uvula or low lying soft palate, tonsil size III or IV, Epworth Sleepiness Scale score > 10 and obesity (BMI > 27 kg/m2) were found to independently predict OSAS. For early identification and treatment of young soldiers with OSAS in a military environment, a precise screening by questionnaire and physical examination is needed.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

Purpose Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens. Methods Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy. Results There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups. Conclusions We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

A case of occupational rhinitis caused by porcine pancreatic extract developing into occupational asthma.

Porcine pancreatic extracts (PPE), which are widely used as a digestive drug in Korea, are composed of α-amylase and lipase. Such enzymes are commonly described as occupational allergens. This is the first report of occupational rhinitis caused by PPE developing into occupational asthma in a hospital nurse. She showed strong positive response in the skin prick test (SPT) (5+, wheal ratio of allergen to histamine) and had a high serum-specific IgE level to PPE, but showed a negative response in the methacholine bronchial challenge test (MBT). She had been exposed to PPE intermittently with intermittent medications for rhinitis. Two years later, she presented with rhinitis and additional asthmatic symptoms. In contrast to her first visit, she showed a positive response in the MBT, and developed bronchoconstriction in the PPE-bronchial provocation test (BPT). These findings suggest that inhalation of PPE powder can induce IgE-mediated occupational rhinitis in a hospital setting, which will develop into occupational asthma if avoidance is not complete.

Short-term effect of multilevel surgery on adipokines and pro-inflammatory cytokines in patients with obstructive sleep apnea.

Abstract Conclusion: This study shows the possibility that multilevel surgery for obstructive sleep apnea (OSA) is helpful to improve the levels of pro-inflammatory cytokines and adipokines, which are related to complications of OSA. Objectives: The effects of multilevel surgery on adipokines and pro-inflammatory cytokines in patients with OSA were assessed. Methods: Fifty-one patients with OSA underwent uvulopalatopharyngoplasty and radiofrequency tongue base reduction. Body mass index (BMI), Epworth sleepiness scale (ESS) and subjective symptoms using visual analog scales were assessed at baseline and 4 weeks after treatment. Adiponectin, leptin, interleukin (IL)-6, and tumor necrosis factor (TNF)-α were measured with a LINCOplex Human Immunoassay at baseline and 4 weeks after surgical treatment. Results: Significant improvements in subjective symptoms and ESS were found at 4 weeks after multilevel surgery. No significant change in BMI was observed. Adiponectin level was significantly increased after surgical treatment. Postoperative leptin, IL-6, and TNF-α levels were significantly decreased. The percent changes of adiponectin, leptin, IL-6, and TNF-α after multilevel surgery were not significantly different among patients with mild, moderate, and severe OSA.

Effects of uvulopalatopharyngoplasty with or without radiofrequency tongue base reduction on voice in patients with obstructive sleep apnea

To investigate voice change as a complication after uvulopalatopharyngoplasty (UPPP) with or without radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea.

Changes of histamine receptors and CC chemokines in nasal epithelial cells and fibroblasts after respiratory syncytial virus infection.

Background Respiratory syncytial virus (RSV) is reported as the most influential factor that triggers hyperreactivity of the airway and causes asthma in infants and children. However, the mechanisms remain to be elucidated. The study evaluated the changes in the levels of four types of histamine receptor (HR) and CC chemokines, such as eotaxin and regulated on activation, normal T cell expressed and presumably secreted (RANTES), in nasal epithelial cells and fibroblasts after RSV infection. Methods Nasal cavity mucosa attained from 20 patients who had undergone inferior turbinoplasty were cleaned by normal saline mixed with gentamicin. Each sample was divided in half. One-half was used for incubation of epithelial cells, and the other half was used for culturing fibroblasts. The levels of HR 1 (H1R), 2 (H2R), 3 (H3R), 4 (H4R), eotaxin, and RANTES were measured by real-time polymerase chain reaction 0, 12, and 36 hours after infection with RSV. Results H1R was significantly increased at 12 and 36 hours compared with 0 hours in both cell types. The level of H2R was significantly increased in epithelial cells from 0 to 36 and 12 to 36 hours and in fibroblasts from 0 to 12 and 0 to 36 hours. There were significant increases of H3R level in fibroblasts from 0 to 12 and 0 to 36 hours, and of H4R in epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Eotaxin and RANTES were also significantly increased in both epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Conclusion RSV infection increases the levels of all four HRs, especially H1R and H2R, as well as the levels of eotaxin and RANTES in nasal epithelial cells and fibroblasts. These findings suggest that RSV infection might cause respiratory tract hyperreactivity by increasing the content of HRs and CC chemokines.