Kawasaki disease (KD) is a systemic vasculitis and the most common cause of acquired heart disease among preschool-aged children. Asthma is one of the most common chronic illness of childhood. There is increasing interest in the potential link between inflammatory diseases and allergic diseases, and there is increasing epidemiologic evidence for an association of KD and allergic disease. In regards to asthma, 9 studies have been reported about its association with KD; 5 of them showed positive associations between these 2 diseases, while 4 of them showed no association. There are some possible underlying mechanisms for this association. The serum IgE levels are found to be increased and there is a Th2-predominant immune response in KD. These are common findings of asthma. Human leukocyte antigen-G/regT cells and SMAD3/transforming growth factor-beta might also be involved in the pathogenesis of both diseases. Asthma may increase susceptibility to KD and tends to lead to immune dysregulation. Clinician's recognition of the increased risks of KD and other asthma-related comorbidities among patients with asthma may enable early identification and intervention. The early identification and management of comorbidities may ultimately reduce the economic and social burden of these chronic conditions. (Allergy Asthma Respir Dis 2019;7:173-178)

The prevalence of asthma in children is increasing worldwide, yet risk factors for the development of asthma is unclear. Evidence to date indicates that environmental factors are the main reason of the recent increase in the prevalence of asthma. For example, exposure to air pollution and diet as well as microbial alterations are reported as environmental factors. In addition, we should focus on the critical period of the exposure, especially pregnancy period as an important period for human development. Therefore, environmental exposure during pregnancy to tobacco smoke or air pollutants, maternal stress, obesity, and vitamin D may contribute to the development of childhood asthma. Herein, modifiable prenatal exposure, its mechanisms associated with childhood asthma and multiple intervention controlling risk factors needed during pregnancy in order to achieve primary prevention of asthma has been described. (Allergy Asthma Respir Dis 2019;7:179-185)

Purpose: Allergic diseases have been increasing worldwide over the past few decades. Allergic sensitization is a pivotal risk factor for the development of allergic diseases. The purpose of this study was to examine changes in allergic sensitization patterns of aeroallergens over the last 10 years in children with respiratory allergic diseases.
Methods: We retrospectively reviewed the medical records of 12,848 children under the age of 18 years who received skin prick tests (n=3,852) or serum specific IgE tests (n=8,996) to evaluate sensitization from 2007 to 2016 in a single center, Seoul, Korea.
Results: Sensitization rate to house dust mite (Dermatophagoides farinae and Dermatophagoides pteronyssinus) reached a plateau in preschool (28.3%-32.8%) and schoolchildren (45.8%-47.2%). Sensitization rate to animal dander (cat and dog) was increasing from 8.4% to 12.5% in preschool children and from 10.3% to 18.6% in schoolchildren (trend P<0.001 each). In preschool children, tree (birch, oak, and alder; from 3.5% to 6.4%), grass (timothy; from 0.8% to 6.5%), weed (ragweed and mugwort; from 2.8% to 6.9%) pollens and mold (Alternaria; from 2.5% to 6.0%) were also in similar increasing pattern (trend P=0.001, P<0.001, P=0.003, and P<0.001, respectively). Additionally, tree (from 9.0% to 15.2%), grass (from 2.6% to 5.2%) pollens were also in increasing pattern in schoolchildren (trend P<0.001 and P=0.024, respectively).
Conclusion: Over the past 10 years, sensitization patterns of aeroallergen have been changing in Korean children with allergic diseases. We should pay attention to the changing patterns of allergic sensitization to educate and prevent the allergic disease. (Allergy Asthma Respir Dis 2019;7:186-191)

Purpose: Various studies have investigated factors related to the prevalence of allergic rhinitis (AR). We studied the correlation between the outbreaks of AR and airborne pollen in September.
Methods: According to data from the National Health Insurance Service, the number of AR cases was increased from 2012 to 2016. During the same period, the number of patients with upper respiratory tract infection, respiratory virus detection rate, air pollutants, and concentration of airborne pollen were correlated with the occurrence of AR in correlation analysis.
Results: The number of patients with AR showed increasing biphasic patters in the spring and fall with the peak reached in September (278,487±12,894), while April marked the fifth-highest figure with 241,570±132,677. The concentration of airborne pollen was highest at 4,450 grains/m3 in May, followed by 3,597 grains/m3 in April, marking its peak in the spring. September marked the third-highest level at 1,619 grains/m3. According to the monthly correlation between the number of patients with AR and pollen, Seoul and Daejeon showed correlations of ρ=0.929 (P=0.022) and ρ=0.955 (P=0.011), respectively, in September. There were no significant correlations among AR, air pollutants, and respiratory virus detection rate.
Conclusion: Based on this study, the monthly number of patients with AR was the highest in September. In September, we found the correlation between allergic rhinitis and pollen, although there are regional limitations, regarding outbreaks in the number of patients with AR. Further research and attention are needed to prepare measures against airborne weed pollen during the fall. (Allergy Asthma Respir Dis 2019;7:192-198)

Purpose: Anaphylaxis and asthma exacerbation could be life-threatening medical emergencies. The 119 (911 in the United States) rescue teams are at the forefront of such emergency conditions. Early recognition and proper prehospital management by 119 rescuers are important. We evaluated the awareness of 119 rescuers of anaphylaxis and asthma exacerbation in Korea.
Methods: Between May 17 and June 28 of 2018, a total of 180 rescuers were recruited from Gyeonggi-do province, Korea. The 90-minute educational sessions on anaphylaxis and asthma exacerbation were provided by an allergy specialist, which included some lectures and a hands-on workshop on self-injectable epinephrine autoinjector. A questionnaire survey with the same content was performed before and after education to assess the improvement in awareness. It had 2 domains: anaphylaxis awareness and asthma awareness.
Results: After education, awareness score for anaphylaxis increased from an average of 3.1 (51.7%) to 5.5 (91.7%). Particularly, the effect of education on the use of epinephrine, the most crucial treatment for anaphylaxis, was greatest. The awareness score for asthma after education increased from an average of 21.3 (78.9%) to 25.1 (93%). The effect of education on treatment and management of asthma was greatest.
Conclusion: The 119 rescuers could be the first medical personnel at the forefront of anaphylaxis and asthma exacerbation. Hence, it is important to increase their awareness of anaphylaxis and asthma exacerbation. A simple educational activity can dramatically change the level of awareness. (Allergy Asthma Respir Dis 2019;7:199-205)

Purpose: To evaluate clinical characteristics of pediatric nontraumaitc chylothorax and to suggest appropriate therapeutic managements.
Methods: We retrospectively reviewed medical records of 22 patients with nontraumatic chylothorax from January 2005 to December 2018 in the Children's Hospital of Seoul National University. We analyze their etiology, treatment, complications and outcome.
Results: Of the 22 patients, 16 were diagnosed before 1 year old and 6 after 1 year old. The causes of chylothorax under 1-year-old children were related to congenital factors (n=9), unknown causes (n=5), and high central venous pressure (n=2). The causes of chylothorax over 1-year-old children were related to congenital factors (n=3), unknown causes (n=1), high venous pressure (n=1), and lymphoma (n=1). All patients had dietary modification. Eight of them were cured by dietary modification, but there was no improvement in over 1-year-old children. Medication was added to patients refractory to dietary modification. Four patients with medication were improved and 5 were improved by surgical management. Nutritional, immunological and other complications occurred in many patients. Five death cases were reported. Four patients were under 1 year old and 1 was over 1 year old. The causes of nontraumatic chylothorax in dead patients were high central venous pressure (n=3), congenital (n=1), and unknown (n=1).
Conclusion: Nontraumatic chylothorax more frequently occurs in under 1-year-old children. The most common cause is congenital factors. Stepwise management is effective in many patients, but specific treatment is needed in some cases. The prognosis is related to the onset of age and underlying diseases. (Allergy Asthma Respir Dis 2019;7:206-211)

Eosinophilic granulomatosis with polyangiitis (EGPA, also known as the Churg-Strauss syndrome) is a disorder characterized by asthma, peripheral eosinophilia and systemic vasculitis. It rarely occurs in children, so that physicians may frequently mistake it for a simple uncontrolled asthma. Since a subsequent cardiac involvement is critical for the prognosis, it is important to suspect EGPA in children with severe, uncontrolled asthma. The cardiac manifestations in EGPA are variable from asymptomatic electrocardiogram abnormalities to pericarditis with pericardial effusion, myocarditis with cardiomyopathy, heart failure, and sudden cardiac death. Although delayed treatment may lead to fatal cardiac complications in EGPA, adequate immune suppression can reverse cardiac impairment. We report a 14-year-old girl with persistent asthma refractory to steroids who was eventually diagnosed with an anti-neutrophil cytoplasmic antibody-negative EGPA. (Allergy Asthma Respir Dis 2019;7:212-217)

Anaphylaxis is a sudden-onset life-threatening systemic hypersensitivity reaction. Allergens, such as foods, stinging insect venoms, and drugs, are the globally important causative factors for anaphylaxis. Para-phenylenediamine (PPD), an aromatic amine, is a well-known hair dye component that can act as a skin irritant and/or a skin sensitizer. As an allergen, PPD can induce various reactions; the most common being contact dermatitis, a delayed-type hypersensitivity reaction. Anaphylaxis or other immediate hypersensitivity reactions by hair dye contact is extremely rare, with only a few cases reported worldwide. Here, we report a case of a 63-year-old female who presented to the Emergency Department with dyspnea, rash, vomiting, and diarrhea within minutes after using a hair dye product containing PPD. Her past medical history includes urticaria of unknown cause. Her total IgE antibody level was increased to 630 kU/L. Skin prick and patch tests with the hair dye she applied at the time of anaphylaxis demonstrated an immediate reaction. An additional patch test with 25 common contact allergens showed positive reaction to PPD. This is the first case report of hair dye-induced contact anaphylaxis presenting sensitization to PPD in Korea. (Allergy Asthma Respir Dis 2019;7:218-221)