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author:("Ahn, kango")
1.  World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics 
Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.
The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.
We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations.
Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.
WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.
Electronic supplementary material
The online version of this article (doi:10.1186/s40413-015-0055-2) contains supplementary material, which is available to authorized users.
PMCID: PMC4307749  PMID: 25628773
Allergy; Prevention; Probiotics; Practice guidelines; GRADE
2.  Significance of 40-, 45-, and 48-kDa Proteins in the Moderate-to-Severe Clinical Symptoms of Buckwheat Allergy 
This study was aimed to investigate the relationship between the allergen components and moderate-to-severe allergic reactions in patients with buckwheat allergy.
Fifteen patients with a history of buckwheat ingestion and a buckwheat specific IgE level≥0.35 kU/L were enrolled. They were divided into 2 groups according to clinical severity scores, with 0-1 being asymptomatic-to-mild and 2-4 being moderate-to-severe symptoms. Immunoblotting was performed to investigate IgE reactivity toward buckwheat allergens and to measure intensity of each component by using a reflective densitometer.
The proportions of positive band to the 16 kDa (62.5% vs 0%, P=0.026) and 40-50 kDa (87.5% vs 28.6%, P=0.041) buckwheat allergens in the grade 2-4 group were higher than those in grade 0-1 group. The level of buckwheat specific IgE of grade 2-4 group was higher than that of grade 0-1 group (41.3 kU/L vs 5.5 kU/L, P=0.037). The median optical densities (ODs) of IgE antibody binding to 40-50 kDa protein were higher in the grade 2-4 group, compared with those in the grade 0-1 group (130% OD vs 60.8% OD, P=0.037).
The 40-50 kDa protein is implicated as an important allergen to predict moderate-to-severe clinical symptoms in Korean children with buckwheat allergy.
PMCID: PMC4274468  PMID: 25553261
Food allergy; buckwheat; allergen; severity; component; immunoblotting
4.  Relationship Between Indoor Air Pollutant Levels and Residential Environment in Children With Atopic Dermatitis 
This study was aimed to investigate the relationship between indoor air pollutant levels and residential environment in children with atopic dermatitis (AD) living in Seoul.
A total of 150 children with AD were included. Residential environment was assessed by questionnaires which were completed by their parents. To evaluate the level of exposure to the indoor air pollutants, concentrations of the indoor air pollutants including particulate matter with diameter less than 10 µm (PM10), formaldehyde, carbon dioxide (CO2), carbon monoxide (CO), nitrogen dioxide (NO2), Total Volatile Organic Compound (TVOC), benzene, toluene, ethyl-benzene, xylene, styrene, bacterial aerosols, and airborne fungi were measured.
A significant difference was exhibited in the levels of PM10 in case of visible fungus on the walls (P=0.047). There was relationship between the construction year of the house, moving to a newly constructed building within 1 year and formaldehyde level. With the use of artificial air freshener, the differences were found in the concentrations of TVOC (P=0.003), benzene (P=0.015), toluene (P=0.012) and ethyl-benzene (P=0.027). The concentration of xylene was significantly high when oil was used as heating fuel (P=0.015). Styrene exhibited differences depending on building type and its concentrations were significantly high in a residential and commercial complex building (P=0.005). The indoor concentration of bacterial aerosols was significantly low with the use of air cleaner (P=0.045). High NO2, benzene concentrations were present in case of almost no ventilation (P=0.028 and P=0.028, respectively).
Individual residential environments are closely related with the levels of the indoor air pollutants. To alleviate AD symptoms, simple questions about residential environments such as visible fungus on the walls and the use of artificial air freshener are helpful to assess the possibility of increased indoor air pollutant levels when direct measurement is not available.
PMCID: PMC4214972  PMID: 25374751
Atopic dermatitis; environment; childhood; air pollution; pollutant
5.  The Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) study: design, rationale and methods 
BMC Pulmonary Medicine  2014;14:109.
This paper describes the background, aim, and design of a prospective birth-cohort study in Korea called the COhort for Childhood Origin of Asthma and allergic diseases (COCOA). COCOA objectives are to investigate the individual and interactive effects of genetics, perinatal environment, maternal lifestyle, and psychosocial stress of mother and child on pediatric susceptibility to allergic diseases.
The participants in COCOA represents a Korean inner-city population. Recruitment started on 19 November, 2007 and will continue until 31 December, 2015. Recruitment is performed at five medical centers and eight public-health centers for antenatal care located in Seoul. Participating mother-baby pairs are followed from before birth to adolescents. COCOA investigates whether the following five environmental variables contribute causally to the development and natural course of allergic diseases: (1) perinatal indoor factors (i.e. house-dust mite, bacterial endotoxin, tobacco smoking, and particulate matters 2.5 and 10), (2) perinatal outdoor pollutants, (3) maternal prenatal psychosocial stress and the child’s neurodevelopment, (4) perinatal nutrition, and (5) perinatal microbiome. Cord blood and blood samples from the child are used to assess whether the child’s genes and epigenetic changes influence allergic-disease susceptibility. Thus, COCOA aims to investigate the contributions of genetics, epigenetics, and various environmental factors in early life to allergic-disease susceptibility in later life. How these variables interact to shape allergic-disease susceptibility is also a key aim.
The COCOA data collection schedule includes 11 routine standardized follow-up assessments of all children at 6 months and every year until 10 years of age, regardless of allergic-disease development. The mothers will complete multiple questionnaires to assess the baseline characteristics, the child’s exposure to environmental factors, maternal pre- and post-natal psychological stress, and the child’s neurodevelopment, nutritional status, and development of allergic and respiratory illnesses. The child’s microbiome, genes, epigenetics, plasma cytokine levels, and neuropsychological status, the microbiome of the residence, and the levels of indoor and outdoor pollutants are measured by standard procedures.
The COCOA study will improve our understanding of how individual genetic or environmental risk factors influence susceptibility to allergic disease and how these variables interact to shape the phenotype of allergic diseases.
PMCID: PMC4099383  PMID: 24990471
Cohort study; Gene-environment interaction; Allergy; Microbiota; Nutritional Status; Psychologic stress
6.  Identification of a Novel Mutation in the CYBB Gene, p.Asp378Gly, in a Patient With X-linked Chronic Granulomatous Disease 
Chronic granulomatous disease (CGD) is a rare immunodeficiency disease, which is characterized by the lack of a functional nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in phagocytes. The disease presents leukocytosis, anemia, hypergammaglobulinemia, and granuloma formation of the skin, lung, or lymph nodes. The mutation of the CYBB gene encoding gp91phox, located on chromosome Xp21.1 is one of the causes of CGD. We report a patient with X-linked CGD who carried a novel mutation, a c.1133A>G (paAsp378Gly) missense mutation, in the CYBB gene.
PMCID: PMC4077965  PMID: 24991462
Chronic granulomatous disease; immunodeficiency; CYBB gene; mutation
7.  Effects of enzymatic hydrolysis of buckwheat protein on antigenicity and allergenicity 
Nutrition Research and Practice  2014;8(3):278-283.
Due to its beneficial health effects, use of buckwheat has shown a continuous increase, and concerns regarding the allergic property of buckwheat have also increased. This study was conducted for evaluation of the hydrolytic effects of seven commercial proteases on buckwheat allergens and its allergenicity.
Extracted buckwheat protein was hydrolyzed by seven proteolytic enzymes at individual optimum temperature and pH for four hours. Analysis was then performed using SDS-PAGE, immunoblotting, and competitive inhibition ELISA (ciELISA) with rabbit antiserum to buckwheat protein, and direct ELISA with pooled serum of 21 buckwheat-sensitive patients.
Alkaline protease, classified as serine peptidase, was most effective in reducing allergenicity of buckwheat protein. It caused decomposition of the whole buckwheat protein, as shown on SDS-PAGE, and results of immunoblotting showed that the rabbit antiserum to buckwheat protein no longer recognized it as an antigen. Allergenicity showed a decrease of more than 50% when pooled serum of patients was used in ELISA. Two proteolytic enzymes from Aspergillus sp. could not hydrolyze buckwheat allergens effectively, and the allergenicity even appeared to increase.
Serine-type peptidases appeared to show a relatively effective reduction of buckwheat allergenicity. However, the antigenicity measured using rabbit antiserum did not correspond to the allergenicity measured using sera from human patients. Production of less allergenic buckwheat protein may be possible using enzymatic hydrolysis.
PMCID: PMC4058561  PMID: 24944772
Buckwheat; allergy; enzymatic hydrolysis
8.  The Usefulness of Component-Resolved Diagnostics in Food Allergy 
PMCID: PMC3936036  PMID: 24587944
9.  Prevalence of Immediate-Type Food Allergy in Early Childhood in Seoul 
There are scanty epidemiologic data on the prevalence of food allergy (FA) among preschool children in Asia. We performed this study to determine the prevalence and causative foods of immediate-type FA in early childhood in Korea.
A questionnaire-based, cross-sectional study was performed between September and October 2011. Children aged 0-6 years were recruited from 301 public child care centers in Seoul. Parents were asked to complete a questionnaire on FA. Children with FA were classified into "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" according to the algorithm.
A total of 16,749 children were included in this study. The prevalence of "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" was 15.1%, 7.0%, and 3.7%, respectively. "Immediate-type FA, current" was reported by 182 (4.9%) out of 3,738 children aged ≤2 years, 262 (3.4%) of 7,648 children aged 3-4 years, and 177 (3.3%) of 5,363 children aged 5-6 years. Hen's egg (126/621) was the most frequent cause as the individual food item, followed by cow's milk (82/621) and peanut (58/621). Among the food groups, fruits (114/621), tree nuts (90/621) and crustaceans (85/621) were the most common offending foods. The three leading causes of food-induced anaphylaxis were hen's egg (22/47), cow's milk (15/47), and peanut (14/47).
The prevalence of immediate-type FA in early childhood is 3.7%, and is higher in younger children. The most common offending foods differed with age.
PMCID: PMC3936041  PMID: 24587949
Immediate hypersensitivity; child; food allergy; prevalence
10.  Identification of a novel mutation in the CHD7 gene in a patient with CHARGE syndrome 
Korean Journal of Pediatrics  2014;57(1):46-49.
CHARGE syndrome has been estimated to occur in 1:10,000 births worldwide and shows various clinical manifestations. It is a genetic disorder characterized by a specific and a recognizable pattern of anomalies. The major clinical features are ocular coloboma, heart malformations, atresia of the choanae, growth retardation, genital hypoplasia, and ear abnormalities. The chromodomain helicase DNA-binding protein 7 (CHD7) gene, located on chromosome 8q12.1, causes CHARGE syndrome. The CHD7 protein is an adenosine triphosphate (ATP)-dependent chromatin remodeling protein. A total of 67% of patients clinically diagnosed with CHARGE syndrome have CHD7 mutations. Five hundred twenty-eight pathogenic and unique CHD7 alterations have been identified so far. We describe a patient with a CHARGE syndrome diagnosis who carried a novel de novo mutation, a c.3896T>C (p. leu1299Pro) missense mutation, in the CHD7 gene. This finding will provide more information for genetic counseling and expand our understanding of the pathogenesis and development of CHARGE syndrome.
PMCID: PMC3935113  PMID: 24578717
CHARGE syndrome; CHD7; Mutation
11.  Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA) 
Korean Journal of Pediatrics  2013;56(10):439-445.
Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort.
The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia.
The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ≥75.0 nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004).
The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.
PMCID: PMC3827492  PMID: 24244212
Cohort studies; Infant; Respiratory tract infections; Umbilical cord blood; Vitamin D
12.  Inhalation Toxicity of Humidifier Disinfectants as a Risk Factor of Children’s Interstitial Lung Disease in Korea: A Case-Control Study 
PLoS ONE  2013;8(6):e64430.
The occurrence of numerous cases of interstitial lung disease in children (chILD) every spring in Korea starting in 2006 raised suspicion about a causal relationship with the use of humidifier disinfectants (HDs). The aim of this study was to evaluate the association between HD use and the risk of chILD.
This retrospective, 1∶3 matched case-control study consisted of 16 cases of chILD that had developed between 2010 and 2011. The three groups of parallel controls (patients with acute lobar pneumonia, asthma, and healthy children) were matched by age, gender, and index date. Indoor/outdoor environmental risk factors, including HD use, were investigated by asking the guardians to complete a questionnaire.
The median age of the affected children (43.8% male) was 26 months (18.25–36.25). The chILD group did not differ significantly from the control groups with respect to socio-demographic and clinical variables. Indoor and outdoor environmental factors were not associated with a risk of chILD. However, the previous use of HDs (OR; 2.73. 95% CI; 1.41–5.90, P = 0.00) were independently associated with an increased risk.
This study showed that HDs, which are widely used in South Korea in the winter season, independently increased the risk of chILD in spring. Therefore, continuous monitoring and, if needed, changes in policy are essential to prevent and control pediatric diseases caused by toxic chemicals.
PMCID: PMC3673956  PMID: 23755124
13.  Anaphylaxis to Topically Applied Sodium Fusidate 
Fusidic acid is a bacteriostatic antibiotic that is effective primarily on gram-positive bacteria, such as Staphylococcus and Corynebacterium species. It is often topically applied to the skin, but is also given systemically as a tablet or injection. Allergic contact dermatitis, or urticaria, has been reported as a side effect of fusidic acid treatment, whereas anaphylaxis to topically administered fusidic acid has not been reported previously. A 16-year-old boy visited an outpatient clinic for further evaluation of anaphylaxis. He suffered abrasions on his arms during exercise, which were treated with a topical ointment containing sodium fusidate. Within 30 minutes, he developed urticaria and eyelid swelling, followed by a cough and respiratory difficulty. His symptoms were relieved by emergency treatment in a nearby hospital. To investigate the etiology, oral provocation with fusidate was performed. After 125 mg (1/2 tablet) of sodium fusidate was administered, he developed a cough and itching of the throat within 30 minutes, which was followed by chest discomfort and urticaria. Forced expiratory volume in 1 second (FEV1) dropped from 4.09 L at baseline to 3.50 L after challenge, although wheezing was not heard in his chest. After management with an inhaled bronchodilator using a nebulizer, chest discomfort was relieved and FEV1 rose to 3.86 L. The patient was directed not to use fusidate, especially on abrasions. Here we report the first case of anaphylaxis resulting from topical fusidic acid application to abrasions.
PMCID: PMC3579090  PMID: 23450038
Anaphylaxis; fusidic acid; ointment
14.  The Influence of the Time and Temperature of Heat Treatment on the Allergenicity of Egg White Proteins 
The present study was performed to determine the factor, either duration or the temperature of heat treatment, exerting maximal and significant influence on the composition and allergenicity of egg white (EW) proteins.
Raw EW and 4 kinds of heated EW (fried EW, boiled EW for 10 minutes, boiled EW for 30 minutes, and baked EW for 20 minutes at 170℃) were prepared, and subsequently protein extraction was carried out. The proteins were separated by SDS-PAGE, and then immunoglobulin E (IgE) immunoblots were performed with the sera of 7 egg-allergic patients. Furthermore, the antigenic activities of ovalbumin (OVA), ovomucoid (OM), and ovotransferrin (OT) in different EW samples were measured by inhibition enzyme-linked Immuno-sorbent assay (ELISA).
In SDS-PAGE analysis, the intensity of the protein band at 45 kD (corresponding to OVA) decreased significantly in boiled EW (30 minutes) and baked EW, but no change was observed in the case of boiled EW for 10 minutes. In IgE immunoblots, the IgE response to 34-50 kD (OM and OVA) in boiled EW for 30 minutes decreased significantly, when compared with raw EW and other heated EWs. In inhibition ELISA, a significant decrease in the OVA antigenic activity was observed in boiled EW for 30 minutes amongst other heated EW samples. However, OM antigenic activity in all kinds of heated EW including boiled EW for 30 minutes did not reduce after heat treatment. The OT antigenic activity nearly disappeared in heated EWs except in the case of boiled EW for 10 minutes.
Amongst 4 kinds of heated EWs, the boiled EW for 30 minutes showed the most significant changes both in composition and reduction in allergenicity. Our results revealed that the duration of heat treatment had more influence on the composition and allergenicity of EW proteins than the temperature.
PMCID: PMC3579098  PMID: 23450247
Egg allergy; egg white; heat treatment; ovomucoid
15.  The Influence of the Presence of Wheat Flour on the Antigenic Activities of Egg White Proteins 
It is known that ovomucoid, an egg allergen, is heat resistant and remains soluble after heating. However, a recent study showed that the antigenic activity of ovomucoid could be reduced by heating when egg white (EW) was mixed with wheat flour. This study was performed to determine the influence of wheat flour on the antigenic activities of EW proteins when EW is heated, and the influence of the duration of heat treatment.
A mixture of EW and wheat flour was kneaded for 10 minutes and then baked at 180℃ for 10 minutes and 30 minutes. The EW without wheat flour was also heated at 180℃ for 10 minutes and 30 minutes. The proteins were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE immunoblotting was performed with the pooled sera of 5 egg-allergic patients. The antigenic activities of ovomucoid in different EW samples were measured by inhibition enzyme-linked immunosorbent assay (ELISA).
1) SDS-PAGE: the intensity of the 37-50 kD bands (overlapped bands of ovomucoid and ovalbumin) decreased significantly in the mixture of EW and wheat flour baked for 30 minutes, compared with the mixture baked for 10 minutes, heated EW and raw EW. 2) IgE immunoblot: in the mixture of EW and wheat, a remarkable decrease of IgE reactivity to 37-50 kD was observed when baked for 30 minutes. 3) Inhibition ELISA: the antigenic activity of ovomucoid decreased significantly in the mixture of EW and wheat baked for 30 minutes, but not in the heated pure EW.
This study showed that the antigenic activity of ovomucoid can be reduced by baking EW with wheat flour. The decrease in ovomucoid antigenicity in the baked mixture of EW and wheat flour was dependent on the time of heat treatment, indicating that heating should be prolonged to achieve a reduction in ovomucoid antigenic activity.
PMCID: PMC3529228  PMID: 23277877
Egg white; wheat flour; hot temperature; ovomucoid
16.  A Case of Hereditary Angioedema in a 7-Year-Old Korean Girl 
Hereditary angioedema (HAE) is a rare autosomal dominant disease that usually occurs in adolescence and early adulthood. It is characterized by recurrent non-pitting edema involving the skin and intestinal tract, especially the extremities and face. It is not associated with urticaria and pruritus. The cause is known to be the deficiency of C1 inhibitor. We herein report a 7-year-old girl with HAE who had recurrent episodes of swelling of the extremities and face without urticaria and pruritus. Her great grandmother had suffered from the same symptoms. The level of serum C4 was 8.01 mg/dL (normal: 10-40 mg/dL). The level of C1 inhibitor was 5.0 mg/dL (normal: 18-40 mg/dL). To our knowledge, this is the first pediatric case with typical clinical symptoms of HAE and C1 esterase inhibitor deficiency in Korea.
PMCID: PMC3529231  PMID: 23277880
Hereditary angioedema; angioedema; young children; Korea
17.  The Indoor Level of House Dust Mite Allergen Is Associated with Severity of Atopic Dermatitis in Children 
We attempted to investigate the correlation between the severity of atopic dermatitis (AD) in children and the indoor level of house dust mite (HDM) allergens. Ninety-five patients (31.1 ± 19.5 months of age) with AD were enrolled in this study, and serum specific IgE against Dermatophagoides pteronyssinus and D. farinae was measured. The severity of AD was assessed using the visual analogue scale on the same day of house dust collection. Living rooms and mattresses where the child usually slept were vacuumed for 2 minutes and concentrations of Der f 1 were measured by enzyme-linked immunosorbent assay. The skin symptoms were more severe in patients with Der f 1 concentrations in living room > 2 µg/g dust than ≤ 2 µg/g dust (P = 0.018). This difference was noted in AD patients without sensitization to HDM (P = 0.004), but not in patients with sensitization. There was no difference in symptom severity according to Der f 1 concentrations in mattresses (P = 0.062). The severity of skin symptoms is associated with indoor concentrations of HDM in children with AD, and it is likely to act as nonspecific irritants as well as allergens in AD skin lesions.
PMCID: PMC3546108  PMID: 23341715
Atopic Dermatitis; Allergens; House Dust Mite
18.  Nutrient Intake and Food Restriction in Children with Atopic Dermatitis 
Clinical Nutrition Research  2013;2(1):52-58.
This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD.
PMCID: PMC3572819  PMID: 23429834
Nutrient intake; Food restriction; Atopic dermatitis; Children
20.  Effect of bathing on atopic dermatitis during the summer season 
Asia Pacific Allergy  2012;2(4):269-274.
There are little objective data regarding the optimal practice methods of bathing, although bathing and the use of moisturizers are the most important facets to atopic dermatitis (AD) management.
We performed this study to evaluate the effect of bathing on AD.
Ninety-six children with AD were enrolled during the summer season. Parents were educated to bathe them once daily with mildly acidic cleansers, and to apply emollients for 14 days. Parents recorded the frequency of bathing and skin symptoms in a diary. Scoring AD (SCORAD) scores were measured at the initial and follow-up visits. Patients were divided into two groups, based on the compliance of bathing; poor compliance was defined as ≥ 2 bathless days.
There was an improvement of SCORAD score, itching, and insomnia in the good compliance group (all p < 0.001). The mean change in SCORAD score from the baseline at the follow-up visit was greater in the good compliance group than the poor compliance group (p = 0.038).
Daily bathing using weakly acidic syndets can reduce skin symptoms of pediatric AD during the summer season.
PMCID: PMC3486972  PMID: 23130333
Atopic dermatitis; Child; Education; Skin care
21.  Serum immunoglobulin E (IgE) levels and dietary intake of Korean infants and young children with atopic dermatitis 
Nutrition Research and Practice  2012;6(5):429-435.
Atopic dermatitis (AD) has become a serious epidemic in Korean children. We aimed to investigate the association between vitamin C, E and other nutrients, and serum total IgE/specific IgE levels in children with AD. A total of 119 children (0-24 mo) diagnosed with AD were recruited for this cross-sectional study from a medical center in Seoul. A 24 h recall was used to assess dietary intakes. Serum total and six food-allergen specific IgE levels were measured by CAP-FEIA. Serum vitamin E was also measured but only in 25 out of the total 119 participants. Multiple linear regression analysis was performed to estimate the coefficients between serum IgE levels and dietary intake as well as serum vitamin E. Serum vitamin E levels showed a significantly inverse association with serum total IgE and all specific IgE levels (P < 0.05). Fat intake was inversely related with specific-IgEs for egg whites, milk, buck wheat, soy, and peanuts (P < 0.05). Positive associations were found between carbohydrate (CHO) intake and total IgE and specific IgEs to egg whites, milk, soy, and peanuts (P < 0.05). Vitamin C, E and n-3/n-6 fatty acids were not related with serum total IgE and specific IgE levels except for the association between buck wheat and vitamin E. In addition, there were no significant differences between males and females in dietary intake and serum IgE levels by student's t-test. Although dietary vitamin E showed no association with serum IgE levels, serum vitamin E drew a significant inverse relationship with serum IgE levels. The evidence seems to suggest that vitamin E may possibly lower total and specific-IgEs in children with AD, and that it is important to maintain a relatively high serum vitamin E level in children with AD.
PMCID: PMC3506874  PMID: 23198022
Atopic dermatitis (AD); serum immunoglobulin E (IgE); serum vitamin E; dietary intake; children
22.  Retrospective Analysis of the Natural History of Atopic Dermatitis Occurring in the First Year of Life in Korean Children 
Journal of Korean Medical Science  2012;27(7):723-728.
The aim of this study was to analyze the natural history of atopic dermatitis (AD) and the risk factors associated with the remission of AD in Korean children. We enrolled 597 children with AD that occurred in the first year of life. A variety of factors influencing the prognosis were assessed by medical records and telephone interviews. Their outcome was classified into complete remission, intermittent, and persistent AD. AD had completely disappeared in 422 cases (70.6%), while 149 (25%) and 26 cases (4.4%) showed intermittent and persistent skin symptoms, respectively. The average healing time was 29.6 months in complete remission group and expected healing time of the AD was 60 months. None of risk factors were significant by multivariate analysis. But, in moderate-to-severe AD group, maternal diet restriction during lactation (P = 0.046) and no sensitization to cow's milk (P = 0.017) were significantly associated with remission of AD in the multivariate analysis. In conclusion, AD occurring in the first year of life disappears in a significant proportion of patients. In addition, in Korean children with moderate-to-severe AD, maternal diet restriction of allergenic food during lactation and sensitization to cow's milk seem to predict the prognosis of AD.
PMCID: PMC3390718  PMID: 22787365
Dermatitis, Atopic; Natural History; Risk Factors
23.  Prevalence of Atopic Dermatitis in Korea: Analysis by Using National Statistics 
Journal of Korean Medical Science  2012;27(6):681-685.
We attempted to investigate the prevalence of atopic dermatitis (AD) in Korea by using national statistics. Data on AD patients who received medical service at least once a year from 2003 through 2008 were collected from health insurance research team of National Health Insurance Corporation. Data of estimated populations during the same period were obtained from the Statistics Korea. In 2008, the prevalence of AD was 26.5% in aged 12-23 months and decreased substantially to 7.6% at age 6 yr, 3.4% at age 12 yr and to 2.4% at age 18 yr. In males, the prevalence was higher than females until 2 yr of age, while the opposite was shown in children aged 2 yr or older. In children aged less than 24 months, the prevalence of AD has increased from 19.8% to 23.8% between the years 2003 and 2008, while the prevalence showed no increase in the older age group. In conclusion, the prevalence of AD in 2008 peaked during infancy up to 26.5% and decreased thereafter. Our findings also suggest that increasing prevalence of AD in children less than 24 months might be responsible for the recent increase in the prevalence of AD in Korean children.
PMCID: PMC3369456  PMID: 22690101
Prevalence; Dermatitis, Atopic; Korea
24.  The HLA-DRB1 Polymorphism is Associated With Atopic Dermatitis, but not Egg Allergy in Korean Children 
We investigated whether particular HLA-DRB1 polymorphisms contribute to egg allergy development in Korean children with atopic dermatitis (AD).
HLA-DRB1 alleles were determined by PCR-sequence-specific oligonucleotide (SSO) and PCR-single-strand conformation polymorphism (SSCP) methods in 185 patients with AD and 109 normal control (NC) subjects. AD patients were divided into two groups: 1) AD with egg allergy, consisting of 96 patients with egg allergies as determined by egg-specific immunoglobulin E (IgE) reactivity; and 2) AD without egg allergy, consisting of 89 patients without egg allergies. HLA-DRB1 alleles were classified into functional groups (A, De, Dr, E, Q, R, a). HLA-DRB1 phenotype and functional group frequencies in the AD, AD with egg allergy, and AD without egg allergy groups were compared with those in the NC group.
The frequency of DRB1*08:02 was decreased in the AD with egg allergy group compared with the AD without egg allergy group (2.1% vs. 10.1%, P=0.021), and DRB1*15:01 was increased in the AD with egg allergy group compared with the AD without egg allergy group (22.9% vs. 11.2%, P=0.036). However, significance was lost after Bonferroni correction. HLA-DRB1*11:01 had a significantly higher frequency in AD patients compared with NCs (12.4% vs. 1.8%, corrected P=0.048) and was regarded as a susceptibility factor associated with AD. DRB1*08:03 was decreased in AD patients compared with NCs (10.8% vs. 19.3%, P=0.043). HLA-DRB1 functional group 'a', which includes DRB1*15:01, seemed to be associated with the development of egg allergy in AD (P=0.033), but this result was not significant after Bonferroni correction.
HLA-DRB1 polymorphism is not associated with egg allergy, but HLA-DRB1*11:01 is associated with AD in Korean children.
PMCID: PMC3328731  PMID: 22548207
Egg; atopic dermatitis; HLA-DRB1; children; Korean
25.  Changes in Major Peanut Allergens Under Different pH Conditions 
Regional dietary habits and cooking methods affect the prevalence of specific food allergies; therefore, we determined the effects of various pH conditions on major peanut allergens. Peanut kernels were soaked overnight in commercial vinegar (pH 2.3) or acetic acid solutions at pH 1.0, 3.0, or 5.0. Protein extracts from the sera of seven patients with peanut-specific IgE levels >15 kUA/L were analyzed by SDS-PAGE and immunolabeling. A densitometer was used to quantify and compare the allergenicity of each protein. The density of Ara h 1 was reduced by treatment with pH 1.0, 3.0, or 5.0 acetic acid, or commercial vinegar. Ara h 2 remained largely unchanged after treatment with pH 5.0 acetic acid, and was decreased following treatment with pH 1.0, 2.3, or 3.0 acetic acid. Ara h 3 and Ara h 6 appeared as a thick band after treatment with pH 1.0 acetic acid and commercial vinegar. IgE-binding intensities to Ara h 1, Ara h 2, and Ara h 3 were significantly reduced after treatment with pH 1.0 acetic acid or commercial vinegar. These data suggest that treatment with acetic acid at various pH values affects peanut allergenicity and may explain the low prevalence of peanut allergy in Korea.
PMCID: PMC3328733  PMID: 22548209
Acetic acid; allergens; Ara h 1 allergen; Ara h 2 allergen; Ara h 3 allergen; peanuts

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