Comparison of Exhaled Nitric Oxide Analyzers in Childhood Asthma

Purpose The measurement of exhaled nitric oxide (eNO) is a noticeable tool that reflects asthmatic airway inflammation. However, the eNO values might be variable according to the patient's condition and the method of measurement. The aim of this study was to compare the values of eNO measured by two different eNO analyzers in asthmatic children (Niox mino® [Aerocrine; Solna, Sweden] and CLD88® [Eco Medics; Durten, Switzerland]. Methods One hundred four asthmatic children and 59 healthy controls were enrolled. The study participants underwent pulmonary function testing before and after inhaled bronchodilator treatment, a methacholine provocation test, and sputum induction; the eNO concentration was then measured. Results The value of eNO measured by Niox mino® was significantly lower than the value of eNO measured by CLD88® (30.7±25.0 vs. 38.6±29.2 ppb, P<0.001). The intraclass correlation coefficient was 0.786 (P<0.001). The eNO concentration was significantly increased in asthmatic children than controls (38.4±27.9 vs. 17.2±9.0 ppb, P <0.001 by Niox mino®; 47.8±31.8 vs. 22.2±12.7 ppb, P<0.001 by CLD88®). The eNO concentration was significantly correlated with the FEV1/FVC (r=-0.382, P<0.001 [Niox mino®]; r=-0.273, P=0.001 [CLD88®], percent sputum eosinophils (r=0.257, P=0.032 [Niox mino®]; r=0.297, P=0.017 [CLD88®]), and PC20 (r=-0.333, P<0.001 [by Niox mino®] r=-0.240, P=0.003 [CLD88®]). Conclusion The measurement of eNO might be a supportive tool for the diagnosis of asthma in children; however, the eNO values differ according to analyzers.ope

Utility of Infant Pulmonary Function Test in Bronchopulmonary Dysplasia

Purpose: Pulmonary function is decreased in varying degrees in healthy premature infants as well as those with bronchopulmonary dysplasia. The evaluation of pulmonary function in infants is finally standardized after strenuous efforts, but it has not yet been in Korea. In this study, we aimed at the evaluation of the utility of pulmonary function tests in premature infants with chronic lung disease by objectively measuring pulmonary function and by analyzing the risk factors that may decrease lung function. Methods: Fifty-four premature infants born in Severance Hospital were selected. Among the 54 infants, 31 were male and 23 were female, and their mean age was 5.6±3.7 years. Exhalyser was used to measure tidal volume and functional residual capacity, and then their change after the inhalation of bronchodilators was evaluated. There was no test related complication in all subjects. Results: Among the 54 subjects, 22 were at the gestational age of ＜28 weeks, 25 were at the gestational age between 28 and 33 weeks, and 7 were at the gestational age between 33 and 37 weeks. As for birth weight, 23 had extreme low birth weight, 23 had very low birth weight, and 8 had low birth weight. The delta functional residual capacities (FRCs) before and after the inhalation of bronchodilator were significantly increased in infants with younger gestational age (P＜0.05) and lower birth weight (P＜0.05). There was a significant negative correlation between gestational age and birth weight, and a significant positive correlation with the duration of ventilator care and that of oxygen therapy. The delta FRC before the inhalation of bronchodilator was significantly lower in infants with lower birth weight, and the tidal volume before the inhalation of bronchodilator correlated negatively with the duration of ventilator care. Conclusion: The reversibility of FRC is increased in premature infants with lower birth weight, younger gestational age, and longer duration of ventilator care and oxygen therapy. The reversibility of FRC may be a useful parameter of pulmonary function that can be safely measured in premature infants with chronic lung disease.ope

A Case of Gluten Allergy in a 4-Year-Old Boy With Recurrent Urticaria

Wheat is the most widely cultivated grain and an important source of food and dietary protein. Wheat proteins are classified based on extraction in different solvents, which are albumin, globulin, prolamin (gliadin) and glutenin. The term `gluten` contains approximately equal amounts of gliadin and glutenin and is the major determinant of the properties of wheat flour conferring cohesiveness and viscoelasticity that allows its dough to be processed into many kinds of food. Gluten is known to be responsible for triggering celiac disease and wheat allergy. Wheat allergy is primarily an IgE-mediated response. Clinical manifestations of wheat allergy are similar to those of other food allergies, with symptoms on the skin, gut and respiratory tract. Recent studies have shown that IgE to gliadin can be an indicator for risk of severe immediate reaction-like anaphylaxis and wheat- dependent, exercise-induced anaphylaxis (WDEIA). However, current in vitro test reagents for the diagnosis of wheat allergy mainly contain water-soluble wheat protein and a small amount of gluten, so there are some limitations to diagnose gluten allergy. Furthermore, there is no acceptable method to measure gluten in food products for preparing effective gluten-free diet. To overcome these limitations and to improve quality of life of wheat allergy sufferers, more work is needed. We report a case of a 4-year-old boy with gluten allergy who presented with urticaria after ingestion kneaded wheat flour with a brief review of the literatureope