Search

M O N D A Y 574 Age-Dependent Cut Points for Airway Hyperresponsiveness to Distinguish Asthma from Healthy Children in Methacholine Challenge Test Ji-Won Kwon, MD, Eun Lee, Song-I. Yang, MD, Young-Ho Ho Jung, MD, Ju-Hee Seo, MD, Byoung-Ju Kim, MD, PhD, Hyo-Bin Kim, MD, PhD, So Yeon Lee, MD, PhD, Woo Kyung Kim, MD, PhD, Jung Yeon Shim, MD, PhD, Soo-Jong Hong, MD, PhD; Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea, Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, South Korea, Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea, Department of Pediatrics, Hae-undae Paik Hospital, Inje University College of Medicine, Busan, South Korea, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea, Department of Pediatrics, Hallym University College of Medicine, Seoul, South Korea, Research Center for Standardization of Allergic Diseases, Seoul, South Korea, South Korea, Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea, Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, South Korea. RATIONALE: Cut-off points of bronchial provocation tests to distinguish asthma in children have not been fully investigated. We evaluated agedependent cut-off values of bronchial provocation test to determine asthma in children. METHODS: A total of 3,045 subjects aged from 6 to 19 years old were undertaken a methacholine challenge test. All subjects were classified into 3 groups. The group 1 included patients with clinical asthma diagnosed by pediatric allergist. The group 2 included 280 subjects with a history of recent wheeze, physician diagnosed asthma, or recent asthma treatment by a Korean version of ISAAC questionnaire from population-based researches. The group 3 included healthy subjects (n52,399) except group 2 from population studies. Receiver operating characteristics curves to determine the cut-off values for clinical asthma were analyzed between group 1 and 3, and also analyzed between group 2 and 3. RESULTS: From ROC analysis between group 1 and 3, cut-off values for determining asthma were increased with age. Cut-off of PC20 were 5.95 mg/ml at age 6, 9.13 mg/ml at age 7, 11.77 mg/ml at age 8, 12.62 mg/ml at age 9, 14.94 mg/ml at age 10, 16.61 mg/ml at age 11, and 24.60 mg/ ml at age more than 15 years. All cut-off points were statistically significant. In ROC analysis between group 2 and 3, a significant cut-off value was only found in subjects aged more than 15 years. CONCLUSIONS: The reference values of PC20 for determining asthma distinguished from healthy children were increased with age. Age-dependent interpretation is needed in evaluating AHR in children with asthma.

S U N D A Y 277 Asthma Severity in Korean Children Assessed By the 12 Pediatric Allergists Working at Different Hospitals Dong In Suh, MD, DaeHyun Lim, Hyeon Jong Yang, MD, BongSeong Kim, MD, Youn Ho Shin, So-Yeon Lee, Geunhwa Park, Woo Kyung Kim, MD, PhD, Hyo-Bin Kim, MD, PhD, Heysung Baek, MD, PhD, Jin-Tack Kim, MD, PhD, Ja-Kyoung Kim; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Seoul, South Korea, Inha University, Incheon, South Korea, Soonchunhyang University Hospital, Seoul, Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangnam CHA hospitatl, Seoul, South Korea, Department of Pediatrics, Hallym University College of Medicine, Gwanghye general hospital, Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea, Department of Pediatrics, Hallym University College of Medicine, Seoul, South Korea, Department of Pediatrics, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Gyeonggi-Do, South Korea, Kangwon National University Hospital. RATIONALE: Information on the exact distribution of severity is critical. However no data is available on the Korean asthmatic children. METHODS: We have requested 12 pediatric allergists to review the medical records on asthmatic children who visited their own clinic during themost recent 3 months. Based on the subjects’ symptoms, signs and their medications to maintain control, their asthma severities were assessed according to both the Global Initiative for Asthma (GINA) criteria and the Japanese Pediatric Guidelines for the Treatment and Management of Bronchial Asthma (JPGL) criteria. Thereafter, the disparity between severities assessed by the two criteria were evaluated. RESULTS: A total of 906 cases (less than 3 years, 22.3%; 3 to 6 years, 21.3%, more than 6 years, 56.4%) were reviewed. When we assess the severities of asthma via GINA criteria, 328/906 cases (36.2%) were mild intermittent, 327 (36.1%) cases weremild persistent and 227 (25.1%) cases were moderate persistent. Whereas only 24 (2.6%) cases were severe persistent. On the other hand, when we classify the severity of asthma by the JPGL criteria, 244/906 cases (26.9%) were intermittent, 300 (33.1%) cases were mild persistent and 342 (37.7%) cases were moderate persistent. Whereas only 20 (2.2%) cases were severe persistent. CONCLUSIONS: In Korea, about 1/3 of asthmatic children had intermittent asthma whereas only less than 3% of subjects had severe persistent asthma. Considering the disparity between both guidelines, specific asthma guideline for Korean children based on our own data should be needed.

Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Seoul, Korea Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

S U N D A Y 339 Dust Mite Allergen In Bed Dust Predicts Rhinitis Symptom Persistence In Urban Pre-Adolescent Children With Higher Elemental Carbon Particulate Matter Exposure Dr. Young Yoo, MD, PhD, Dr. Luis M. Acosta, MD, Prof. Inge Goldstein, DrPH, Prof. Andrew Rundle, DrPH, Omar Olmedo, Adnan Divjan, Dr. Beihzhan Yan, Prof. Judith Jacobson, DrPH, Dr. Rachel L. Miller, MD, FAAAAI, Dr. Steven Chillrud, Prof. Matthew S. Perzanowski, PhD; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, Department of Pediatrics, College of Medicine, Korea University, Seoul, South Korea, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, NY. RATIONALE: Few studies have examined environmental risks for persistent rhinitis symptoms in urban populations during pre-adolescence. Combustion byproduct particulate matter has been shown to promote the Thelper cell-2 response to allergens. We hypothesized that preadolescents exposed to both combustion byproducts and domestic allergens would have more persistent rhinitis symptoms than those exposed to one or neither. METHODS: The New York City (NYC) Neighborhood Asthma and Allergy Study recruited 7-8 year-old children with (cases) and without (controls) asthma through a health insurance plan. Bed dust was collected for measurement of indoor allergens. Neighborhood-level annual outdoor elemental carbon (EC) was estimated for each child at baseline based on NYC Community Air Survey data. Questionnaires were administered at age 7-8 and age 9-10. Children reported to have had rhinitis symptoms in the past 12 months were categorized as having ‘‘current rhinitis.’’ RESULTS: Of 102 children who had current rhinitis at age 7-8 and were followed for 2 years, 54 (53%) had current rhinitis symptoms at age 9-10. In multivariable regression analyses, neither dust-borne allergen concentrations nor EC concentration were associated with persistence of rhinitis. However, Der f 1 concentration was associated with rhinitis persistence (relative risk (RR)51.33, P50.03) among the children with higher EC (greater than median)[Pinteraction50.096]. CONCLUSIONS: Children with rhinitis may be more likely to have persistent symptoms if they are also exposed to combustion byproduct particulate matter than if they are not. Exposure to EC may thus contribute to the persistence of rhinitis symptoms in urban communities.

Background The prevalence of allergic rhinitis (AR) is increasing worldwide. Allergic diseases develop in susceptible subjects when they are exposed to specific environmental factors. Objective We analyzed changes in the prevalence of AR and identified genetic and environmental factors in early childhood that affect risk. Methods We used the International Study of Asthma and Allergies in Childhood questionnaire to collect data on AR, allergies, and environmental exposures from 4554 elementary school students from 5 areas of Seoul, Korea, in 2008. We also obtained DNA from 1050 subjects from 1 area of Seoul for genotype analysis of IL13 . Results We identified genetic and environmental factors during infancy and early childhood that increased the risk for current AR (resulting in a diagnosis of AR and AR symptoms in the past 12 months) in elementary school–aged children. These included allergic disease in parents and antibiotic use in infants, allergic disease in parents and exposure of infants to mold, and allergic disease in parents and moving an infant to a newly built house. The risk of current AR also increased in subjects with GA or AA at nucleotide 2044 in IL13 who had been exposed to mold in the home during infancy (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11) compared with subjects who had GG at this position and had not been exposed to mold (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11). Conclusion The prevalence of AR is increasing in Korean children. Children with a family history of allergic disease and exposure to specific environmental risk factors during infancy are more likely to have AR. Children with GA or AA at IL13( + 2044) are at increased risk for AR when exposed to mold in the home during the first year of life.

Rationale Inhalational therapy is mow one of the major method in managing asthma. Nebulizer is widely used at home nowadays, but there has been not many survey on the usage methods of home nebulizer in Korea yet. This study was performed using questionnaires to evaluate that how the patients use the personal nebulizer properly as a treatment tool for asthma and culture of nebulizer accessory instruments (chamber, mouthpiece, mask, line, et al). Methods The questionnaire survey was performed to sixty asthmatic children who used nebulizer at home. Personal history, purpose of personal nebulizer, understanding of the instruction to use were analyzed using questionnaires. At the same time we collected nebulizer and there accessory instruments. The mouthpiece, mask, chamber, and line were cultured with a sterile swab. All samples were plated on agar plates. The plates were incubated at 35°C for 24 hours. Results A questionnaire survey showed that where the patients gets information about using and cleaning nebulizer was form nurse (55%), there doctors (35%), neighborhood (5%) and sellers(5%). The survey showed that 62.5% were not cleaning the nebulizer and accessory instruments. The most common cleaning methods were using boiling water and other way was put in vinegar. From the mouthpiece α-hemolytic streptococcus had been cultured. And from the line gram negative bacilli, coagulase negative staphylococcus were cultured. Conclusions Many problems on the use and cleaning of personal home nebulizer in asthmatic children were revealed by this study. Education of patient parents on how to use and clear nebulizers is necessary when prescribe or sell the nebulizers.

Rationale Breast milk contains several components that provide specific immunity and affect the maturation of the infant's immune system. Allergic disease (AD), including atopic eczema, asthma, allergic rhinitis, and food allergy is characterized by an imbalance between cytokines produced by distinct T-helper cell subtypes. The objective was to investigate the concentrations and interactions of nutritional and inflammatory factors in breast milk. Methods The questionnaire survey about mother and their infant. And then breast milk samples were collected from mothers with AD (n=40) and without AD (n=40). Breast milk was collected at the second day and two or four weeks later. At the same time blood samples were collected. The level of cytokines (IL-4, IL-8, IL-10, IL-16, et al) and fatty acid (ω-3, ω-6) in breast milk were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer's instructions. From the blood samples we measured eosinophil counts, total IgE, specific IgE (milk, egg, et al). Results Mothers with AD had a higher concentration of Interlukine (IL)-4 in breast milk compared with those without AD ( p >0.001), and also IL-8, IL-16 was higher concentration in AD mother ( p >0.001). Whereas other cytokines concentrations or fatty acid composition were not significantly different between the groups. The high level of IL-16 had higher eosinophil level ( p >0.03). Conclusions Mother with AD had a higher concentration of IL-4 in breast milk. The IL-4 is the most important factor for induction of Th2-cell development and thereby production of Th2-cell cytokines. Further studies are necessary to evaluate longer follow up of breast milk components.