Soo Ick Cho

Food Hypersensitivity in Patients with Childhood Atopic Dermatitis in Korea

Background It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method. Objective To examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea. Methods A total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity. Results Forty-two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05±9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions. Conclusion The overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork.

Improvement of atopic dermatitis severity after reducing indoor air pollutants.

Background Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). Objective The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. Methods The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigators global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. Results The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 µg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. Conclusion Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

Lack of Association of Plasma Histamine with Diamine Oxidase in Chronic Idiopathic Urticaria

Background Chronic idiopathic urticaria (CIU) is considered a complex and multifactorial disease. Excessive histamine intake may induce an attack of urticaria. The main enzyme for histamine metabolism is diamine oxidase (DAO). Objective Plasma histamine concentrations and DAO activities were evaluated to determine whether there are abnormalities in the histamine metabolism of CIU patients. Methods Seventy-five CIU patients and twenty-five healthy control subjects were included in the study. Blood was taken from all subjects to measure plasma levels of the histamine and DAO. Results Mean plasma histamine levels were significantly higher in CIU patients (11.59±10.98 nM) than in the control subjects (8.75±2.55 nM) (p=0.04). Mean DAO activities were lower in patients of CIU (80.86±26.81 histamine degrading unit [HDU]/ml) than in the controls (81.60±9.67 HDU/ml), but without significant difference. In 15 CIU patients with gastrointestinal symptoms, the mean histamine concentration was higher (12.43±7.97 nM) and DAO activity was lower (77.93±27.53 HDU/ml) than in the remaining 60 CIU patients without gastrointestinal symptoms (11.38±11.67 nM and 81.58±26.82 HDU/ml), without significant difference. The relationship between DAO activity and plasma histamine concentrations showed a significant negative linear value (p=0.001). There were no significant relationships between plasma histamine concentrations and symptom severity score. Conclusion In CIU patients, a high plasma histamine concentration may not be explained by DAO activity. CIU patients with gastrointestinal (GI) symptoms showed no significantly lower DAO activity. Larger group studies are required to elucidate the relationship between plasma histamine concentrations and DAO activity, especially of CIU patients with GI symptomsto understand the difference in CIU patients with and without GI symptoms.

Treatment of Atopic Dermatitis with a Low-histamine Diet

Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative.

Dose-Dependent Effects of Evening Primrose Oil in Children and Adolescents with Atopic Dermatitis

Background Previous clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined. Objective The aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids. Methods Forty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography. Results The serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups. Conclusion The results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

The proactive treatment of atopic dermatitis with tacrolimus ointment in Korean patients: a comparative study between once-weekly and thrice-weekly applications

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Epidermal cysts in a tacrolimus treated renal transplant recipient.

Tacrolimus, a calcineurin inhibitor, formerly also known as FK506, is a macrolactam drug isolated from Streptomyces tsukubaensis. Its mode of action closely parallels the action of cyclosprorin A (CsA) and can be used for the treatment of inflammatory and autoimmune skin diseases in which systemic CsA has proved effective against psoriasis, pyoderma gangrenosum, atopic dermatitis, lupus erythematosus and graft versus host disease (GVHD). Although several cases of epidermal cysts have been reported in patients using cyclosporine and other immunosuppressants after organ transplantation; such types of cases have yet not been reported after administration of tacrolimus. However, we report herein a case of presence of multiple, various sized epidermal cysts in a renal transplant recipient receiving tacrolimus.

Induction of a Hardening Phenomenon and Quantitative Changes of Ceramides in Stratum Corneum

Background Hardening phenomenon of human skin after repeated exposure to the irritants is well-known, but the precise mechanism remains elusive. Objective To modify the previous experimental model of hardening phenomenon by repeated applications of two different concentrations of sodium lauryl sulfate (SLS) solutions to Korean healthy volunteers and to investigate the quantitative changes of ceramides in stratum corneum before and after chronic repeated irritation. Methods Eight hundred microliters of distilled water containing 0.1% and 2% SLS was applied for 10 minutes on the forearm of 41 healthy volunteers for 3 weeks. After an intervening 3-week rest, 24-hour patch tests with 1% SLS were conducted on previously irritated sites. Transepidermal water loss (TEWL), erythema index and quantity of ceramide were measured in the stratum corneum before and after irritation. Results TEWL values on the sites preirritated with 2% SLS were lower than those with 0.1% SLS. Hardening phenomenon occurred in 24 volunteers at day 44. The changes in ceramide levels were not significantly higher in the hardened skin than in the non-hardened skin. Conclusion Repetitive stimulation with a higher concentration of SLS can more easily trigger skin hardening.

Response to Searle's Letter to the Editor

To the Editor: We appreciate the interesting letter from Dr Searle. As he correctly pointed out, Bouhassira et al mentioned the Douleur Neuropathique 4 (DN4) questionnaire in relation to risk factors for the development of postherpetic neuralgia. Our studywas different from that of Bouhassira et al in many ways. First, the DN4 questionnaire was only one of many assessment tools in that study. In contrast, we focused on screening tools to identify neuropathic pain. Second, the 10 questions of the DN4 and the cutoff point of 4were not validated for postherpetic neuralgia, as in our study. In our study, we concluded that some of the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questions were not useful for predicting postherpetic neuralgia; thus, we modified the cut-off point. The items in DN4 and S-LANSS overlap considerably. Third, the predictability of the S-LANSS score and the application of the model to patient groups were suggested in our paper, but were not mentioned in the work of Bouhassira et al. We feel that our study dealt in depth, for the first time, with screening tools useful to identify neuropathic pain that might be helpful for predicting postherpetic neuralgia. We thank Dr Searle for his insightful letter and hope that tools for assessing neuropathic pain, including S-LANSS and DN4, may be helpful for establishing a predictive model for prevention of postherpetic neuralgia.