Background : Many drugs and the combinations of drugs are recommended for each treatment step in bronchial asthma. However, there are few issues examined about the optimal drug and combination of drugs in a long term prognosis. In this study, we investigated the optimal drugs and combinations of drugs from a point of view of prognosis. Methods : One hundred and ninty four patients who visited our hospital for treatment from November, 2003 to October, 2004 and were managed according to GINA guideline were surveyed retrospectively. We compared the rate of step up and the frequency of urgent visit and urgent hospitalization in one year between drug groups in each treatment step. Results : The rate of step up was significantly higher in leukotriene receptor antagonist (LTRA) group than in inhalation corticosteroid (ICS) group and theophylline group in Step 2. The frequency of urgent visit and urgent hospitalization was significantly higher in ICS + LTRA group than in ICS + theophylline group and ICS + long-acting beta 2-agonist (LABA) group in Step 3. Conclusion : There is a possibility that the prognosis becomes bad when we use LTRA in the practical treatment according to GINA guideline.

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Objectives: To discover features of patients with theophylline toxicosis among patients who developed convulsions during theophylline administration. Methods: Fifteen patients, whose measured or estimated blood theophylline concentration at the time of convulsion development was ≥40μg/mL, were extracted out of 334 patients who were reported between October 1987 and April 2004 and who developed convulsions during theophylline administration (oral theophylline: 255 patients; intravenous theophylline: 79 patients). Patient background, state of drug administration, blood theophylline concentration, presence or absence of status epilepticus, and outcome were examined. Results: Young children and children with fever were predominant, and eight of 15 patients had both features. Furthermore, the dose exceeded the currently recommended target dose in most of patients whose given dose is known. Patients with misdispensing and patients having problems with administration and ingestion methods were included in them. Outcomes included one case of death, two cases of sequelae, 11 cases of recovery or alleviation, and 1 case of unknown. The patient who died took large doses of theophylline, and both of two patients who had sequelae had fever associated with an infection. Conclusions: Our study revealed 1) heed should be given to the age of the affected child and to theophylline administration when fever is present in order to avoid theophylline toxicosis and 2) many patients with the toxicosis (11/15) present a relatively favorable prognosis.

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The patient was a 23-year-old female with a history of atopic dermatitis, allergic rhinitis, and allergic conjunctivitis. In her fourth year of primary school, she ate macadamia nuts and developed oral discomfort and generalized uticaria. In her second year of junior high school, she ate macadamia nuts and developed oral and pharyngeal discomfort, followed by generalized uticaria and dyspnea. At the age of 20 years, she also developed oral discomfort after eating vegetables in a Chinese dish containing macadamia nuts and visited our department for close examination. A scratch test of extract oil (concentration, as is) was positive, and a diagnosis of immediate allergy due to macadamia nuts was made. Thereafter, she avoided macadamia nuts completely and had no further recurrence. This patient developed oral allergy syndrome (OAS) after eating macadamia nuts. However, she was negative for Bet vl and Bet v2 as allergens in white birch pollinosis, in which OAS has been most frequently reported. She had Japanese cedar pollinosis, but its onset was when she was in her second year of high school. Therefore, it is unlikely that Japanese cedar pollen is a sensitization antigen for macadamia nut allergy.

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A seven month-old boy had been suffering from recalcitrant pompholyx of both soles in spite of the treatment with corticosteroid ointment for three months. Because patch test of chromium was positive at 48 and 96 hr reading, we advised to his mother that the infant must avoid to touch and to take the chromium-containing goods. His lactating mother had been taking high amounts of chocolate and cocoa every day, both of which contain considerable amounts of chromium. The pompholyx disappeared within 2 weeks, after his mother stopped eating chocolate and cocoa. Oral provocation test with chocolate and cocoa to the patient's lactating mother resulted in the development of pompholyx in the baby within two days. We diagnosed the infant as systemic metal allergy to chromium which was possibly transferred from his mother's milk. This is the first report of systemic metal allergy which is provoked by mother's milk which is from the person who takes a lot of metal-containing foods.

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Here we report a case of eperisone hydrochloride-induced drug eruption. A twenty-three-year-old female suffering from the common cold, headache and arthralgia was administered eperisone hydrochloride with several drugs including loxoprofen sodium. Two hours after receiving the medications, she noticed erythema and edema in the hands, and then the eruption spread across the whole body. The patient was hospitalized and treated with a corticosteroid intravenously. An oral challenge test showed that eperisone hydrochloride was responsible for this drug eruption. There have been eighteen cases of drug eruption caused by eperisone hydrochloride in the literature and eight cases have shown urticaria/anaphylaxis types. Some cases took several hours to exhibit symptoms even for urticaria/anaphylaxis types that were confirmed to induce an immediate allergic reaction.

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In general, steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation steroid, a report is given below regarding buccal capsule/esophageal candidiasis. The patient came to the hospital with the chief complaint regarding passage dysphagia in the time of deglutition; pharyngitis and esophageal candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using endoscope in one month and a half. Pharyngitis was improved, and in the didital endoscopic assessment of esophageal candidiasis complincating inhaled steroid therapy the esophageal candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as nasal obstruction and dysphagia. In addition, the inflammation caused by candidiasis and found in the early examination was improved. The patient in this case was under treatment for thrombosis in the vein of lower extremity, but no complications such as diabetes mellitus or immune deficiency syndrome were observed. Discussion: Esophageal candidiasis by chronic administration of inhalation of steroid before sleep for asthmatic patients has been reported. However, there has not been a report of esophageal candidiasis by chronic administration of rhinenchysis steroid before sleep for patients with allergic rhinitis. Similarly, in the case of the use of steroid in the form of collunarium before sleep, steroid stayed in the esophagus via the transendothelial nasal cavity, and that seemed to cause, in the long run, to develop esophageal candidiasis. Conclusions: One of the implications of the above case is that collunarium can go down, even when it is nebulized in the nasal cavity, to the esophagus via the nasal cavity to buccal capsule. This suggests the necessity for preventative measures in the case of chronic administration of steroid as follows. A. Blowing of the nose just after the use of collunarium B. Daily rinsing (gargling and nasal douche)

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