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Vol.8 No.4 December, 2007
100 6 5 5081 9 0 8 1 6 6 1
T e l (02) 2311-4670Fax (02) 2311-4732ht tp: / /www.ai r .org. tw
19391392T e l (02) 2311-4670Fax (02) 2311-4732ht tp: / /www.asthma.org. tw
( ----1000-1500 )
Vol.8 No.4 December 2007 1
A
1. 97 1 20 3 23
14 00 16 00 9
2. 97 1 26 27
B
1. 8th International Conference on New Trends in Im-8th International Conference on New Trends in Im-8th International Conference on New Trends in Im-8th International Conference on New Trends in Im-8th International Conference on New Trends in Im-
munosuppression and Immunotherapymunosuppression and Immunotherapymunosuppression and Immunotherapymunosuppression and Immunotherapymunosuppression and Immunotherapy Berlin, Ger-
many on February 14-17, 2008 Secretariat: 17 rue du
Cendrier, P.O. Box 1726 CH-1211 Geneva 1, Switzerland
www.kenes.com/immuno
2007-2008 ........................ 2
......................................... 6
......... 10
Hyper-IgM .. 16
....................................... 18
(Netherton's )................................................................... 21
flavonoids....................................................................... 22
................................................................... 24
.......................................................... 29
........................................... 30
Vol.8 No.4 December 200722222
( )
5-20% 200,000
36,000
(tracheal epithelium)
(1,2)
30
24
(shedding)1-2
4-5
10-14 (1)
(3)
( g e n o m e ) 8
(segment)
(1,4)
( 1) Orthomyxoviridae fam-
ily RNA (a large,
single-stranded helically shaped RNA virus of
Orthomyxoviridae family) A B C
A B A
(glycoprotein)
(enveolp) 1) - (hemagglutinin
HA) H1-H16 16 2)
(neuraminidase NA) N1-N9 9
B HA
NA (2,5)
(World Health Organization WHO)(1) (type)
(geographical source) (isolate number)
(year of isolation) (HA subtype &
NA subtype) A/StLouis/101/2007/H1N1
Influenza A type1 St. Louise
101 2007
1918-1919
(A/H1N1) 9,000
190 1958-1959
(Asian flu A/H2N2) 9,000
20 1968-1969
(Hong Kong flu A/H3N2)
9,000 20 (1) 2002/
2007-20081 1 2
3 3
1 2 3
Vol.8 No.4 December 2007 33333
2002 2005/2006 A/H1N1 2002/
2003 2003/2004 A/H3N2 (4)
65 10
98.3 50-64 10
7.5 6
10 0.88
( )
59% (5)
CDC (the Centers for Disease Control and
Prevention) 2007-2008
[Morbidity Mortality Weekly Report MMWR 2007;56
(RR-6):1-54] (5)
1) 6
2) 6-59
3) 5
4)
2007-2008
(surveillance)
A/Solomon Islands/3/2006 (H1N1)-
like A/Wisconsin/67/2005 (H3N2)-like
B/Malaysu/2506/2004-like
CDC (American Acad-
emy of Pediatrics) 6 9
(Trivalent inactivated influenza
vaccine TIV-T) (live attenuated
influenza vaccine LAIV-T, Flumist, MedImmune)
TIV LAIV (5,6)
CDC 9
(5,6,7,8)
(TIV) 6 3
0.25ml 3 0.5ml
1 2 1
2 1(9)
( 2) TIV
60-70% LAIV
73-93%
( p r e - e x i s t i n g
immunity)
(robust immune response) (3,10)
LAIV 2(9,10)
(outbreak)
(11)
TIV
6.
25% 18.9% 16%
(placebo) (6.15%,19.4% &17.5%)
TIV Guillain-Barre syndrome(GBS)
1-1.6/100,000 6-10(7) LAIV
(13.9%) (44.5%) (27.
8%) (40.4%) (8.6%) (16.7%)
(25.7%)(13)
2,000
(exacerbation)(12)
(13)
Ig E
(13).
Vol.8 No.4 December 200744444
TIV LAIV
IgG -
(hemagglutinin HA)
LAIV IgA
(10)
1 )
adamantanes (amantadine and rimantadine), 2)
n e u r a m i n i d a s e i n h i b i t o r s ( o s e l t a m i v i r &
zanamivir) A
(influenza A) amantadine
(sensitivity)
A amantadine rimantadine(2) 1/3
amantadine
3
M2 protein
neuraminidase inhibitors (oseltamivir[Tamiflu] &
zanamivir [Relenza]) (2,3,11,14)
12
48
(14)
(thimerosal)
TIV Fluzone(Sanofi Pasteur, Swiftwater, PA)
Fluvirin(Novartis Vaccine, Emeryvill, CA)(14)
6-59 (thimerosl free)
7-8 (0.25 ml dose) 2006-
2007 6-6.5 MedImmune
7 FluMist 5-
49 2
CDC (Advisory Commit-
tee on Immunization Practices ACIP)
1.32
2004,2006,2007(3,11,14))
(14)
TIV
1. 6-59
2. 6
(cystic fibrosis )
(hemodynamic significance)
HIV (sickle cell
anemia) (hemoglobiopathy)
salicylate ( Kawasaki
)
(risk of aspiration)
3.
TIV LAIV
1. 6 5
2.
3.
4.
TIV
Vol.8 No.4 December 2007 55555
1.
2. 6
3.
4. 6 Guillain-Barre syn-
drome
LAIV
1. 2
2.
3. 4 (live antigen vaccine)
4.
5. (salicylate)
6.
7. Guillain-Barre syndrome
8. (reactive airways
disease)
9.
(immunosuppresants)
(hemoglobiopathy)
1.
amantadine [Symmetrel] rimantadine
[Flumadine]
neuraminidase inhibitor (oseltamivir [Tamiflu]
zanamivir [Relenza])
2.
1.
2. 6
3.
Reference
1. Belshe RB: Structure and strains of the influenza
virus, Pediatric Influenza Vaccine: New Strategies
and Clinical Advice. Vincico Medical Education
3-4, 2007
2. Fleing D, Crovari P, Wahn U, et al.: Comparison
of the efficacy and safety, transmissibility and
phenotypic and genotypic stability of cold-adapted
influenza virus vaccine. Pediatr Infect Dis J 25
590-5, 2006
3. Committee on Infectious Disease of American
Academy of Pediatrics: Antiviral Therapy and Pro-
phylaxis for Influenza in Children. Pediatrics
113 1441-7, 2004
4.
22 813-27,
2006
5. Bernstein Henry H: CDC issues guidance for
2007-'08 flu season. AAP News 28 1-14, 2006
6. Dennehy PH: Pediatric Immunizations: What's
New in 2007. Pediatric Annals 36 317-20, 2007
7. Atmar RL & Weitel WA: Preventing Pandemic
Influenza: An Update on Vaccine Development.
Infections in Medicine 24 292-7, 2007
8. Vanfraafeiland B: The Impact of Influenza: A
Worldwide Concern. Consultant for Pediatricians
6 53-7, 2007
9. 96
2007 13
10. Berstein D: Efficacy of influenza vaccines, Pedi-
atric Influenza Vaccine: New Strategies and
Clinical Advice. Vincico Medical Education 10-
2, 2007
11. Committee on Infectious Disease of American
Academy of Pediatrics: Antiviral Therapy and
Prophylaxis for Influenza in Children. Pediatrics
119 852-60, 2007
12. Antiviral Therapy and Prophylaxis for Influenza
Vol.8 No.4 December 200766666
in Children. Pediatrics 119 852-60, 2007
13. Naguwa SM, Gershwin MR. Food Allergies. Al-
lergy & Immunology Secrets by Hanley & Belfus
INC/ Medical Publisher/ Philadelphia 159-174,
2001
14. Committee on Infectious Disease of American
Academy of Pediatrics: Prevention of Influenza:
Recommendations for Influenza Immunization
of Children, 2006-2007. Pediatrics 119 846-
851, 2006
1. Structure of the Influenza Virus
Adapted from Hayden FG, Palese P. Clin Viro.
1997; 911-942
1 1 2 3 3
1 2 3
44
(03) 824-1555
(
-> -> )
(500 ) (80
)
38
2. TIV & LAIV
TIVTIVTIVTIVTIV LAIVLAIVLAIVLAIVLAIV
3
(A 2 B 1 )
6
2-59
Vol.8 No.4 December 2007 77777
130 36 97/50
(
)
Hb 9.9 mg/d L
RBC 539 X 106/u L, HT31.7%, WBC 10.4 X 103/u
L, WBC/DC(%)5-41-0-0-4-45, AST108 IU/L, ALT43
IU/L 7.8 ug/mL
NSAIDs (Ibuprufen)
(RSV
Ag)
ACT
AST169 IU/L, ALT224 IU/L 0.1
g/m L
Silymarin
0.5 BID
AST62 IU/L ALT155 IU/
L 0.1 ug/mL
( )
1. 150mg/kg 24
4gm
2. 250mg/kg 24
12gm
3. 12 200mg/kg;
7.5gm;
(60mg/kg/day)
4
ACT 2
4 ACT 90%
(1) g lucuron ide
(40~67%) (2) sulfate (20~46%) (3)
cytochrome P450 (CYP2E1,CYP1A2,
CYP3A4) Glutathione
(NAPQI conjugate)
Glutathione ACT Glutathione
ACT Free NAPQI)
(N-acetyl-p benzoquinoneimine) hepatocyte
hepato-
cyte zone III necrosis zone I
zone II
Enzyme inducers ethanol , i soniaz id ,
anticonvulsants
ACT
(0.5-24 )
Vol.8 No.4 December 200788888
24
(24-48 )
24
12 36
8
(72-96 )
ARDS
2% 25%
(4 -2 )
1. ACT
A.
a. 4 ACT (
4~ 10 15
)
b. AST
=>
=> ACT Rumack-Matthew no-
mogram ( )
=>
c. AST PT, Glucose, BUN,
CPK
B. Activated Charchol 1g/kg(
1~2 )
N-acetylcysteine (NAC)
a. ACT Rumack-Matthew nomogram
( )
b. AST
c. ACT 10 g/mL
2. ACT
A.
a.
b.
=> 24 75mg/kg
CYP450 system inducers
( )
=> 24 150mg/kg
c.
=> 24 4
CYP450 system inducers
( )
=> 24 7.5
B. ACT AST
C.
a.
. ACT 10 g/mL
=> AST 2
=> AST
. ACT 10 g/mL AST
. ACT
=> NAC
b.
=> ACT 10 g/mL AST
=> ACT
Vol.8 No.4 December 2007 99999
AST
=>
24
NAC
c. ACT 10 g/mL
AST
=>
Rumack-Matthew nomogram
ACT
16
loading dose 140mg/kg
4 70mg/kg 17
ondansetron
2004 FDA
NAC
Loading dose 4% 14%
0.05%
diphenhydramine
3% ( 30 NAC 1
Dis. water)
1 140~150mg/kg
ACT 8
15mg/kg/hr 4
7.5mg/kg/hr 16 8
15mg/kg/hr
44 NAC
1.
2. NAC
3.
1500mg/day(
150mg/kg/day) ACT
4 24
150mg/kg
ACT AST
NAC
1. Nelson textbook of Pediatrics 18th edition
2. Marx: Rosen's Emergency Medicine: Concepts
and Clinical Practice, 6th ed.
3. Ford: Clinical Toxicology, 1st ed.
4. Pediatrics 55 871-6, 1975
5. The Journal of Emergency Medicine 23 253-6,
2002
6. J Emerg Nurs 30:281-3, 2004
Rumack-Matthew nomogram( ACT)
1. ACT
2.
3.
NAC 8
Vol.8 No.4 December 20071010101010
(papulomacular skin rashes)
:
13.30 10^3/uL 541
10^3/uL 55 mm/hr
IgA 352 mg/dl (25~154) C3 C4
ANA C-ANCA P-ANCA
Henoch-Schonlein
Purpura(HSP)
Henoch-Schonlein Purpura(HSP)
(dependent area)
25 50
A
A C3
50 5
(HSP)
--
NSAIDs sensitive
Vol.8 No.4 December 2007 1111111111
Staphylococcal Scaled Skin Syndrome
1.
( )
(Acetaminophen)
2. ~
Langerhans
Hydrocortisone
Cyclooxygenase
3. (NSAIDs)
(NSAIDs)
( )
( )
. (NSAIDs)
aspirin
FEV1 70%(
) lysine aspirin
aspirin aspirin
4.
C1-INH
C1-INH
C1-INH
2000 Lancet 10 36
hereditary angioedema C1-
INH
variant type
hereditary angioedema
1 15
C1 esterase inhibitor Kallikrein
Bradykinin
C1 esterase inhibitor C4a,
C3a, C5a
C1 esterase inhibitor
danazol
5.
Vol.8 No.4 December 20071212121212
90%
24
10% E
1% E
(50~100)
prednisone
6. Staphylococ-
cal Scaled Skin Syndrome
7.
2
6
(
) (>
200 mg/dL) (<2.5 g/dL)
(
) (
)
95 99%
1 8
(steroid-responsive)
(steroid-
dependent) (steroid-resistant)
(frequent relapse)
( steroid-resis-
tant nephrotic syndrome ) FSGS
Vol.8 No.4 December 20071616161616
1~1.5
pneumocystis carinii
amp ic i l l i n ce fo t ax ime er y th romyc in
trimethoprim-sulfamethoxazole
IgG 18 mg/
dl (172~1069), IgA 4 mg/dl (4.4~84), IgM 128 mg/
dl (33~126), IgE 1 IU/ml (0~230), IgD < 48 IU/ml
( <100), CH50 16.6 U/ml ( 75~160).
(cell marker) CD3 24.6%, CD4 10.3%,
CD8 2.2%, CD19 30.2%, CD57 1.0%, active T cell
1.1% Hyper-IgM natural-killer
cell flow cytometry
CD4+ T CD40 ligand
CD4+ T CD40
ligand 1.95 % control
13.18%, 9.42%, 11.08%
Hyper-IgM natural-killer
Hyper-
IgM G-
CSF
Hyper-IgM
IgM IgG,
IgA,IgE
Hyper-IgM T
CD40 ligand T CD40
ligand B CD40
( immunoglobulin isotype switching)
IgM
Hyper-IgM
B AID (activation-induced cytidine
deaminase)
( immunog l obu l in i s o t ype
switching)
pneumocystis carinii
Hyper-IgM
Cryptosporidium
Cryptosporidium
Hyper-IgM
Hyper-IgM
Vol.8 No.4 December 2007 1717171717
IgM IgG, IgA,IgE B
T T
( blood group isohemagglu-
tinin titers )
flow cytometry
CD4+ T CD40 ligand
Hyper-IgM CD4+ T
CD40 ligand
DNA CD40 ligand
Hyper-IgM
X-linked hyper-IgM
( karyotypic analysis )
CD40 ligand DNA
Hyper-IgM
IVIG Hyper-IgM
IgM G-CSF
Hyper-IgM
Hyper-IgM
HLA
(Aphthous ulcer)
(Behcet`s Disease)
1. (Aphthous ulcer)
20%
2.
3.
A
4.
(systemic
lupus erythematosus SLE)
(malar rash) (discoid rash)
Vol.8 No.4 December 20071818181818
(photosensitivity) (arthritis)
(serositis)
(ANA anti-
nuclear antibody)
(
)
5. (Behcet`s Disease)
(Behcet`s Disease)
6.
(Malar rash) (Gowers' sign)
(muscle power)
(Deep Tendon Reflex DTR)
ANA : 1:80 (homogeneous)
(CPK 428.0 IU/L GOT: 24 IU/L
LDH 89.0 IU/L)
HE Stain NADH
Stain Modified Gomori-Trichome Stain
Perifascicular atrophy
Prednisolon Cyclosporine
Azathioprine
Prednisolon
Prednisolon methotrexate
(MTX)
Prednisolon
(superficial
lumps)
Vol.8 No.4 December 2007 1919191919
5 14 (
6.7 ) 1 2.3
HLA antigen DQA1*0501 HLA-DMA*0103
HLA-DMB*0102 alleles
DQA1*0501 allele
Microchimerism
CD40 CD56 natural
k i l l e r ( N K ) c e l l s
(keratinocytes) Ki-67 p53
neopterin monocytes/macrophage
(CD14) neopterin
CD54
(ICAM-1)
Fas T Fas ligand
(myositis-specific
antibodies(MSA) myositis-associated antibodies
(MAA) Anti- Mi-2 Ab
Anti-Jo-1(histidyl-tRNA synthetase) anti-
PL-12 (alanyl-tRNA synthetase) signal recognition
particle (SRP)
Anti-Jo-1 Anti-PL-12
Antibodies to Pm/Scl
Anti-Jo-1 SRP pulmo-
nary interstitial fibrosis Anti-
Jo-1 SRP
1975 Bohan A, Peter JB
1.
2. CPK GOT LDH
aldolase
3. (denervation)
4.
Perifascicular atrophy ( )
5. :
( Heliotrope sign )
(Gottron )
Monocyclic course,
Polycyclic course, Prolonged chronic continuous
nonulcerative course Ulcerative course
Monocyclic course Ulcerative course
(calicnosis)
Prolonged chronic continuous nonulcerative course
methylpredniso-
lone
azathioprine hydroxycloroquine cyclosporine
methotrexate
(IVIG)
Inhibitors of TNF-
Etanercept and infliximab Monoclonal CD20 + B
cell-depleting antibody - Rituximab
20-40%
2002 Lisa G. Rider, M.D. 66 An-
nual American College of Rheumatology Meeting
1. Superficial plaques or nodules (calcinosis
circumscripta) :
33%
2. Tumoral deposits (calcinosis universalis) :
Vol.8 No.4 December 20072020202020
20%
3. Fascial planar deposits :
16%
4. Exoskeleton is an extensive :
X 10%
Macrophages Giant Cells Proinflammatory
cytokines (TNF TGFs) chemokines (MCP-1)
pro-
teins-Osteocalcin Bone sialoprotein
Macrophages pro-inflammatory
cytokinesin (IL-6 IL-1 TNF- )
2006 Pachman et al
osteonectin mineral content col-
lagen maturity
osteopontin crystalline hydroxyapatite protein
(amide I) band in the deposit
PM-Scl autoantibody
creatine kinase
TNF- -308A allele
Diltiazem Probenecid
Aluminum Hydroxide
( )
:
1. Lauren M. achman :Behrman: Nelson Textbook of
Pediatrics, 17th ed Chapter 149-Juvenile Der-
matomyositis
2. Harris: Kelly-s Textbook of rheumatology, 7th edi-
tion 1061-4, 2005
3. S. Zampieri et al. Polymyositis-dermatomyositis
and infections Autoimmunity 39(3) 191-6, 2006
May
4. Geetha Chari, MD; Teresita A. Laude, MD, FAAP,
FAAD Juvenile Dermatomyositis: A Review Int
Pediatr 15(1) 21-5, 2000
5. Pachman L. Juvenilr dermatomyositis. Pathophysi-
ology and expression. Pediatr Clin NorthAm 42
1071-98, 1995a
6. Pachman L. An update on juvenilr dermatomyositis.
Curr Opin Rheumatol 7 437-41, 1995b
7. TAKASHI MATSUSHITA, MINORU HASEGAWA,
MANABU FUJIMOTO, et al Clinical Evaluation of
Anti-Aminoacyl tRNA Synthetase Antibodies in
Japanese Patients with Dermatomyositis The Jour-
nal of Rheumatology 34 5, 2007
8. Hengstman, ter Laak, Vree Egberts, et al Anti-sig-
nal recognition particle autoantibodies: marker of
a necrotising myopathy Ann Rheum Dis 65
1635-8, 2006
9. Levine TD. Rituximab in the treatment of
dermatomyositis: an open-label pilot study. Arthri-
tis Rheum 52(2) 601-7, 2005
10. Huber AM, Lang B, LeBlanc CMA, et al. Me-
dium- and long-term functional outcomes in a
multicenter cohort of children with juvenile
dermatomyositis. Arthritis Rheum 43(3), 2000
11. Pachman et al. Calcific Deposits in Juvenile
DM.ARTHRITIS & RHEUMATISM 54(10)
3345-50, 2006 October
12. Lisa G. Rider, M.D.Calcinosis in Juvenile
Dermatomyositis: Pathogenesis and Current
Vol.8 No.4 December 2007 2121212121
Therapies Modified from Presentation, Treatment
of Refractory Juvenile Dermatomyositis , 66th
Annual American College of Rheumatology
Meeting, October 2002, New Orleans
13. Eddy MC, Lee awattana R, McAlister WH, et al.
Calcinosis universalis complicating juvenile
dermatomyositis: resolution during Probenecid
therapy. J Clin Endocrinol Metab 82(11) 3536-
42, 1997
14. Mukamel M, Horev G, Mimouni M. New insight
into calcinosis of juvenile dermatomyositis: A
study of composition and treatment. J Pediatr
138 763-6, 2001
15. HIDEKI NAKAMURA, ATSUSHI KAWAKAMI,
H I R O A K I I D A , E R I E J I M A , T O M O K I
ORIGUCHI,and KATSUMI EGUCHI Case Re-
port Efficacy of Probenecid for a Patient with
Juvenile Dermatomyositis Complicated with Cal-
cinosis The Journal of Rheumatology 33(8)
1691-93, 2006
16. Chiu, Shih Kai. Yang, Yao Hsu. Wang, Li Chieh.
Chiang, Bor Luen.Ten-year experience of juve-
nile dermatomyositis: a retrospective study. Jour-
nal of Microbiology, Immunology & Infection. 40
(1) 68-73, 2007 Feb
17. Singh S Twelve years experience of juvenile der-
matomyositis in North India. Rheumatol Int- 01-
APR 26(6) 510-5, 2006
18. Fisler RE, Liang MG, Fuhlbrigge RC, Yalcindag
A, Sundel RP. Aggressive management of juve-
nile dermatomyositis results in improved out-
come and decreased incidence of calcinosis. J
Am Acad Dermatol 47 505-11, 2002
eosinophilia 1998/
cmm, lymphopenia 1036/cmm
m e t h i c i l l i n
(MRCoNS)
(Staphy lococca l Sca lded Sk in
Syndrome)
(CD3 8.5, CD4 7.6,
CD8 0.4, active T cell 5.6) IgE
(IgE > 10000/cmm)
(GVHD) (Omenn's Syndrome)
(Scanning Electronic Microscopy)
(Netherton's )
Vol.8 No.4 December 20072222222222
Netherton's
Pneumocystis Carinii (PCP)
Netherton's
(
) ( )
( )
IgG IgE
SPINK5 (Chromesome 5q32)
Netherton's
SPINK5 (Chromesome 5q32)
SPINK5
(
)
(GVHD)
(Omenn's Syndrome)
ammonium lactate lotion
Netherton's
(
)
flavonoids
1 2
1
2
Vol.8 No.4 December 2007 2323232323
Figure 1. Structures of basic flavonoid skelectons.
. (Albert Szent-Cyorgyi)
C C
C
100% C
basophil IL-4, IL13, CD40 ligand
8000
( ) Fewtress
Gomperts flavone
quercetin
basophil PLA2
5-lipooxygenase
IgE TNF- IL-6
IgE IgE CD40 CD40
ligand B IL-4
IL-13 B Luteolin, apige-
nin fisetin anti-IgE
basophil IL-4 IL-13 CD3
T
Luteolin, apigenin fisetin
basophil KU812 CD40 ligand
luteolin, apigenin
fisetin IgE
basophil IL-4, IL13,CD40 ligand
(signaling pathway)
Fc RI (tyrosine kinase)
Lyn Syk PI3 kinase MAPK
PLC DNA IL-4, IL13
mRNA
3
(alternative medicine)
Vol.8 No.4 December 20072424242424
IL-4,
IL13, CD40 ligand
luteolin, apigenin,
quercetin kaempferol
Reference
1. Mari Kawai et.al. Flavonoids and related com-pounds as anti-allergic substances. Allergol. Int.56 113-23, 2007
2. Holgate ST. The epidemic of allergy and asthma.Nature 402 B2-4, 1999
3. Von Mutius E. The environmental predictors ofallergic diseases. J. Allergy Clin. Immunol 1059-19, 2000
4. Middleton EJ, Kandaswami C, Theoharides TC.The effects of plant flavonoids on mammaliancells: implications for inflammation, heart disease,and cancer. Pharmacol. Rev. 52 673-751, 2000
5. Yoshimoto T et,al. Flavonoids: potent inhibitors ofarachidonate 5-lopooxygenase. Biochem. Biophys.Res. Commun 116 612-18, 1983
6. Hirono T, Higa S, Arimitsu J, et.al. Flavonoidssuch as luteolin, fisetin and apigeninare inhibitorsof interlukin-4 and interlukin-13 production byactivated human basophils. J. Allergy Clin.Immunol 134 135-40, 2004
7. Tanaka T, Higa S, Hirano T et.al. Is an appropri-ate intake of flavonoids a prophylactic means orcomplementary and alternative medicine for aller-gic diseases? Recent Res. Devel. Allergy&Clin.Immunol 5 1-14, 2004
8. US Department of Agriculture. USDA databasefor the flavonoid content of selective foods. Avail-able from http://www.srs.usda.gov/Services/docs.htm?docid=6231.
Table 1. Summary of anti-allergic properties of fla-vonoids
1. Biological activities
Inhibition of histamine, Th2 cytokines(IL4, IL13),
and CD40 ligand expression in basophils and
mast cells.
2. Presumable mechanisms
Inhibition of activation of transcriptional factors
such as AP-1 and NFAT.
3. Hierarchy of inhibitory activity of representative
flavonoids
Luteolin, apigenin, fisectin > Kaempferol, querce-
tin > myricetin and others.
4. Clinical effect
Preventative and ameliorative effect on dermatitis
in NC/Nga mice.
5. Epidemiological report
The higher the intake of flavonoids, the lower the
incidence of asthma (relative risk=0.65).
1 2
1
2
(cystic fibrosis) (primary
ciliary dyskinesia)
( t r a c h e o m a l a c i a )
Vol.8 No.4 December 2007 2525252525
(bronchomalacia)
(habit-cough syndrome)
(exercise-induced laryngomalacia)
(hyperventilation syndrome)
(exercise-induced vocal cord dysfunction)
( e x e r c i s e - i n d u c e d
laryngomalac ia)
(exercise-induced hyperventilation)
(exercise-induced supraventricular
tachycardia)
(inflammation)
2mg/kg/day 5-7
10
(1)
1.
2
(2)
(PCR)
2.
(3)
1500 7
(cystic fi-
brosis transmembrane regulatory protein)
(meconium ileus)
< 40 mEq/L 40-60
mEq/L > 60 mEq/L
3.
(air sacs) (alveoli)
Kartagener Kartagener 3
(bronchiectasis) (4)
4.
(bronchoalveolar lavage
fluid)
Hemophilus species, M.
Vol.8 No.4 December 20072626262626
catarrhalis, S. pneumoniae
5.
(5)
(6)
(prolonged expiratory
phase) X-
(hyperinflation)
happy
wheezer
18-24 (4)
6.
3 3
40
Cochrane Library, PubMed, EMBASE (7)
1966 2005
vocal tic or habit cough , or
psychogenic cough or chronic cough
cough-tic syndrome, Tourette syndrome
cough-tic syndrome, Tourette syndrome
50-75% (attention deficit
disorder) 30-60% (obsessive-
compulsive behavior) (8)
1966 Berman(9)
(suggestion therapy)
6
(10)
(self-hypnosis) (11)
irritation-cough cycle
15
45
7.
(stridor)
(wheezing)
1. (vocal cord dysfunction):
(abduct)
(motor neurons)
Arnold-Chiari malformation, cerebral
aqueductal stenosis(12)
(high-
pitched inspiratory stridor)
(spirometry)
- (flow-volume loop)
Vol.8 No.4 December 2007 2727272727
(spontaneous) (exercise-induced)
(acute management) (chronic
management)
(Atrovent)
(13)
2. (Partial Airway Obstruction)
(intrathoracic)
(Dyspnea)
1.
(pulse oximetry)
(Pco2) pH
2. Simon
2006 (Anxiety-Sensitivity
Index)
3. (Exertional Dyspnea)
(PEF, Peak Expiratory Flow)
(insufficient tissue oxygenation)
lactic acid acidosis
6-
Beta-2
6-
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morbidity natural history
Haland
Illi
mite
Perkin
Chen mor-
bidity Zeidler
Adler
5
Juhn
Profita
Marco IgE
Stoloff Boushey
methacoline
Covar 8000 methacoline
7%
eosinophilic
Aerocrine
Vol.8 No.4 December 20073030303030
(LTRA)
(
)
LTE4 Montuschi
LTE4
LTE4
2006 FDA (black box
warning) LABAs (long-acting 2-adrenergic
agonists) LABAs
(ICS)
Kumar 8 15
bronchodilator response (BDR) bronchodilator
hyperresponsive BDR
BMI
Robert 39 3 16
grass pollen (specific
immunotherapy)
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Fluticasone
100ug/day 1000ug/
day
61.
5%
pMDI
(Pressurized metered-dose inhaler)
DPI (Dry power inhaler)
60~90
1
1.
2.
3.
2-agonist
1.
Vol.8 No.4 December 20073232323232
2.
3.
2-agonist
4. (1000~1500 mg/d)
D(400 IU/d)
1000mcg Estrogen
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