Although allergen-specific immunotherapy (AIT) is a standard treatment for allergic diseases, only 5% or less of patients in whom AIT is indicated have been receiving immunotherapy because AIT needs a long-term therapeutic duration of up to 5 years. To overcome this limitation of conventional AIT, Kündig and his colleagues first introduced intralymphatic immunotherapy (ILIT) in patients with allergic rhinitis, publishing their results in 2008. Since then, 10 clinical trials that evaluated therapeutic efficacies and adverse effects of ILIT have been conducted. This article reviews the clinical trials of ILIT and suggests unmet needs in research fields of ILIT. (Allergy Asthma Respir Dis 2020;8:53-65)

Purpose: Macrolide-refractory Mycoplasma pneumoniae pneumonia (MP) has markedly increased since 2003 and corticosteroids or second-line antibiotics, such as fluoroquinolones or tetracyclines, was considered an alternative treatment modality in macrolide-refractory MP. We aimed to show the real-world treatment pattern of MP in hospitalized children and compared clinical and laboratory findings between children with and without steroid treatment.
Methods: We reviewed the medical records of 384 children diagnosed with MP from 6 hospitals in Korea from August 2015 to March 2016. We investigated the clinical, laboratory and radiologic findings, and medications used for the treatment of the subjects.
Results: The corticosteroids and second-line antibiotics were administered in 55.5% and 7.0%, respectively. The percentages of steroid administration varied from 17% to 69% in each hospital. The mean start date of corticosteroid administration was 3.4 hospital days. Patients with corticosteroid treatment had a longer length of hospital stay than those without corticosteroid. They exhibited higher rates of lobar pneumonia and pleural effusion, and required longer days until improvement in chest X-ray findings. They also had higher rates of allergic diseases and showed higher C-reactive protein levels at admission.
Conclusion: In the real-world practice studied in the 6 hospitals, corticosteroids were more frequently administered than second-line antibiotics to hospitalized children with MP. Children with corticosteroid adjuvant therapy had more severe pneumonia than those without. Randomized controlled trials are needed to make appropriate guidelines for macrolide-refractory MP. (Allergy Asthma Respir Dis 2020;8:66-72)

Purpose: This study evaluated the clinical effects of heated humidified high flow nasal cannula (HHHFNC) treatment in pediatric patients with respiratory disease and respiratory insufficiency.
Methods: We reviewed the medical records for clinical features and tests performed in patients admitted to Chungnam University Hospital pediatric ward and treated with HHHFNC between July 2014 and December 2018. We evaluated the effects of HHHFNC treatment in patients with bronchiolitis treated with oxygen using a nasal prong.
Results: The 136 children were treated with HHHFNC during the study period, and their median age was 8 months. Among the 136 patients, 39 (28.7%) were diagnosed with bronchiolitis and pneumonia, 42 (30.9%) with pneumonia, 28 (20.6%) with bronchiolitis, and 3 (2.2%) with epilepsy. Thirty-five patients (25.7%) had underlying neurological disorders. Fifty-one (37.5%) received invasive ventilator treatment. After HHHFNC treatment, venous blood gas analysis showed a pH increase from 7.32 to 7.37 (P<0.05) and a decrease in partial pressure of carbon dioxide (pCO2) from 53.1 to 46.2 mmHg (P<0.05). The respiratory rate had decreased from 46.3 to 43.3/min (P<0.05). There were no statistically significant differences in hospital stay duration or intensive care unit admission rates between bronchiolitis patients receiving HHHFNC treatment and those not receiving.
Conclusion: In this study, in various diseases leading to pediatric respiratory insufficiency, HHHFNC treatment may improve physiologic parameters at the pediatric ward. HHHFNC may also be effective in patients with underlying neurological disorders and those with respiratory insufficiency from nonrespiratory infectious disease. (Allergy Asthma Respir Dis 2020;8:73-79)

Purpose: Recent studies of food allergy (FA) at all ages are scanty in Korea. We performed this study to better understand severity-related and age-stratified causes of FA from infants to older adults in a single tertiary hospital in Korea.
Methods: A retrospective medical record review was performed on patients of all ages diagnosed with immediate-type FA between March 2008 and February 2018 in Ajou University Hospital.
Results: A total of 4,680 cases of FA among 2,733 patients were reported. The distribution of onset ages of the first FA symptom was as follows: 45.3% below 2 years, 16.2% at 2-6 years, 5.5% at 7-12 years, 4.0% at 13-18 years, 16.9% at 19-40 years, 10.4% at 41-65 years, and 1.8% above 65 years of age. The major 10 causative foods were hen's eggs (17.2%), cow's milk (16.7%), wheat (8.6%), crustaceans (8.5%), fish (4.6%), walnuts (4.4%), pork (3.2%), peanuts (3.2%), shellfish (3.0%), and peach (2.2%). The culprits ranked from the 11th to the 20th were as follows: soybean, apple, chicken, buckwheat, beef, kiwi, almonds, perilla seeds, tomato, and squid. The top 3 causative foods in children were hen's eggs, cow's milk, and wheat, while those in adults were crustaceans, wheat, and fish. Food-induced anaphylaxis was reported in 29.2% of all cases, with cow's milk, hen's eggs, wheat, crustaceans, fish, walnuts, pork, shellfish, buckwheat, and peanuts being the major 10 causes.
Conclusion: This study could provide a better understanding of the detailed ranks of the causes of FA according to severity and age in Korea. (Allergy Asthma Respir Dis 2020;8:80-88)

Baek-ok injection (glutathione) has been widely used antioxidant therapy to whiten and has antiaging effects in Korea. Glutathione is an enzyme which synthesizes leukotriene, then it can induce asthma attack theoretically; however, there have been few case reports concerning this therapy. In this report, we described a 41-year-old woman who developed glutathione-induced life-threatening asthma attack. She has asthma history controlled by an intermittent salbutamol inhaler. She developed general weakness and dyspnea right after glutathione injection, and injection was discontinued. Dyspnea was progressively aggravated, and she lost consciousness with shock. Cardiopulmonary resuscitation was started, and she arrived at the Emergency Department with wheezing, hypoxia, severe respiratory acidosis, and nonmeasurable blood pressure. Intubation and mechanical ventilation were started with intramuscular epinephrine/intravenous methylprednisolone injection and repeated salbutamol/ipratropium/budesonide inhalation. After 5 hours, extubation and spontaneous breathing were successful without wheezing. Next day, pulmonary function test showed moderate an obstructive airway disease pattern, and she was discharged with inhaled fluticasone/salmeterol, oral methylprednisolone, and montelukast. We can exclude anaphylaxis, because serum tryptase obtained at the Emergency Department was 0.0 mg/dL and the absence of skin lesions and angioedema at arrival. Baek-ok injection (glutathione) should be carefully performed in asthma patients. (Allergy Asthma Respir Dis 2020;8:89-91)

Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case reports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with status asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with mechanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas exchange with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had successful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy. (Allergy Asthma Respir Dis 2020;8:92-95)

Eosinophilic fasciitis (EF) is a scleroderma-like immune-allergic disorder of unknown etiology and pathogenesis. This rare disease is characterized by the progressive induration of the skin and soft tissue, and peripheral eosinophilia. Here, we report a case of EF. A 21-year-old female was referred due to edema in the upper and lower extremities for 1 month. Laboratory results were unremarkable except for severe eosinophilia. Parasite infestation, venous thrombosis, and cardiac and renal problems were excluded. Magnetic resonance imaging of both the lower extremities revealed symmetrical thickening and contrast enhancement of crural fascia with adjacent subcutaneous fat infiltration. A full-thickness biopsy at the lower extremity showed infiltration of the fascia by eosinophils, plasma cells, and lymphocytes with marked edema. Thus, this patient was confirmed to have EF and she was treated with systemic corticosteroids, resulting in a remarkable improvement in both edema and eosinophilia. (Allergy Asthma Respir Dis 2020;8:96-101)

Topiramate is an antiepileptic drug effective for multiple types of seizure and is also used to prevent migraine attack. Several side effects have been reported, such as metabolic acidosis, nephrolithiasis, anorexia, weight reduction, drowsiness, glaucoma, hyperthermia, and cognitive dysfunction, whereas skin manifestationis were rarely reported. We report a case of a 12-year-old girl on medication of topiramate for 8 months due to focal epilepsy. She had fever, sore throat, burning sense in the vaginal area, and then flaccid bullae and erythematous patches proceeded to the whole bodyskin and mucosa including the conjunctiva, oral cavity, and genital areas. She was diagnosed with toxic epidermal necrolysis (TEN) and improved after the discontinuation of topiramate and with administration of high-dose intravenous steroid and immunoglobulin. We, herein, report a girl who developed severe side effects on the skin, TEN, due to topiramate. (Allergy Asthma Respir Dis 2020;8:102-104)