Background: Montelukast is a cysteinyl-leukotriene receptor antagonist used as an anti-inflammatory drug in asthma. In asthma pathophysiology, allergen sensitization is important in the development of asthma. Especially, allergen sensitization is essential to induction of the adaptive immune response. However, the effect of Montelukast in allergen sensitization period is not well known. Objective: The aim of this study is to investigate effect of montelukast treatment by intranasal route in allergen sensitization period. Methods: BALB/c mice were repeatedly administered with Dermatophagoides pteronyssinus (Der p) intra-nasally to develop Der p-allergic sensitization and asthma. Montelukast was given by intranasal route during the Der p sensitization period or the Der p challenge period, and its effects were examined such as AHR, airway inflammation and serum Immunoglobulin levels. Results: Montelukast treatment by intranasal route during Der p sensitization significantly diminished AHR, eosinophilic airway inflammation. In addition, Serum Der p specific IgG1 levels were also decreased by montelukast treatment during Der p sensitization period. However, montelukast treatement during Der p challenge period had not changed these features. Conclusion: This study showed that montelukast may play a more effective role by intranasal treatment during sensitization period in Der p mouse model. Therefore, further experiments are needed to clarify this mechanism, in addition to comparison with another route of administration. Keyword: Allergen sensitization, Montelukast
Introduction Patients with chronic obstructive pulmonary disease (COPD) are vulnerable to particulate matter (PM) exposure which can increase acute exacerbations and hospitalisation. Interventions to avoid PM exposure are important but evidence-based guidance is lacking. This study aims to assess the impact of PM on lung function, quality of life and exacerbations in patients with COPD using a panel design study; it will also provide evidence for interventional measures to reduce harm from PM exposure. Methods and analysis A prospective panel study of patients with COPD aged ≥40 years will be conducted. Patients will be required to have a forced expiratory volume in one second <80% of the predicted value at enrolment. A total of 120 patients from three different regions will be enrolled, 60 from the metropolitan area, 30 from an industrialised area and 30 from a clean rural area. Clinical outcomes will be assessed through COPD assessment test scores, the St. George’s Respiratory Questionnaire for patients with COPD and pulmonary function testing. Indoor and outdoor PM in the patients’ environments will be measured using gravimetric and light scattering platforms. To estimate the individual dose of PM exposure, a time–activity diary, Geographic Information System and land use regression model will be combined in every season for 1 year. The correlation between PM exposure and the health status of patients with COPD will be evaluated. In addition, 40 patients with the lowest score of life behaviour score to reduce environmental PM exposure will be randomised to a control or intervention group, who will receive in-depth education on risk-reducing behaviours. Ethics and dissemination This study was approved by the Institutional Review Board of each site. The participants received comprehensive information and provided informed consent. The result of this study will be discussed in the form of conference presentations and peer-reviewed publications. Trial registration number NCT04020237 .
Eperisone is a widely used muscle relaxant and believed to be relatively free of adverse drug reactions. However, a rare case of fatal anaphylaxis has been reported in the literature. Poor awareness due to its rarity and combined administration with other drugs are the major hurdles in diagnosing eperisone-induced anaphylaxis. We experienced 3 cases of immediate hypersensitivity reaction oc curring after eperisone administration. Case 1, a 63-year-old female, was admitted via the Emergency Department with urticaria, generalized erythroderma, sore throat, chest discomfort, and dyspnea within 1 hour after administration of common cold remedy. Case 2, a 58-year-old male, visited our allergy clinic to detect culprit drugs. He experienced itching, urticaria, hypotension for several hours after administration of the pills for back pain in the last 3 years. Case 3, a 58-year-old male developed urticaria and dyspnea af ter administration of medication for a headache. He also experienced urticaria and facial edema after administration of the common cold remedy. Among the medications, eperisone hydrochloride was proven as the culprit drug and others were excluded through oral provocation tests. We advised them to avoid eperisone and issued drug safety card. Clinicians should be aware that eperisone hydrochloride is a potential culprit agent of fatal anaphylaxis. (Allergy Asthma Respir Dis 2017;5:228-231)
Purpose: Since drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is very rare and difficult to diagnose, its exact epidemiology is still unknown. If screening tools based on laboratory results or electronic medical records are available, the occurrence of DRESS syndrome can be monitored in real time.
Methods: To screen cases with DRESS syndrome, all the results of both eosinophil and alanine transaminase (ALT) level from July 2014 to June 2015 were analyzed by 36 searching conditions for the signal detection of 7 definite DRESS cases among 199,924 pa tients during the study period. Those searching conditions were diverse combinations of different cutoff levels of eosinophil and ALT with or without nursing records presenting skin symptoms. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated for individual searching conditions.
Results: As cutoff levels of eosinophil and ALT for screening DRESS increased from 3% to 5% and 40 U/L to 300 U/L, respectively, the sensitivity decreased from 100% to 42.9% and the PPV increased from 0.06% to 13.0%. A combination of eosinophil >10% and ALT >300 U/L which had the highest PPV among 36 search conditions could detect DRESS syndrome by sensitivity 42.9% and PPV 13.0%. When nursing records for skin symptoms were added, PPV was augmented to 21.4%.
Conclusion: A combination of eosinophil and ALT levels is a useful search condition for the screening of DRESS syndrome. Nursing records can provide an additional increment in PPV. (Allergy Asthma Respir Dis 2018;6:149-154)
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hy persensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involve ment. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitu bercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diag nosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line anti tubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome. (Allergy Asthma Respir Dis 2017:5:111-116)
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