IMSEAR Repository :: Browsing by Author "Vichyanond, Pakit"

Browsing by Author "Vichyanond, Pakit"

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The accumulation of dust mite allergens on mattresses made of different kinds of materials.
(2010-06) Visitsunthorn, Nualanong; Chirdjirapong, Varakorn; Pootong, Visanu; Jirapongsananuruk, Orathai; Pacharn, Punchama; Weeravejsukit, Sirirat; Mahakittikun, Vanna; Vichyanond, Pakit
Background: Different mattress materials may affect the accumulation of allergens. Objective: To compare the amount of group 1 dust mite allergens (Der p1 + Der f1) on mattresses made of different kinds of materials before and after use. Methods: Sixty new mattresses made of kapok, synthetic fiber, coconut fiber and sponge-like polyurethane, were placed in the house officers’ dormitory at Siriraj hospital, Thailand. The dust samples were collected before (0), 1, 2, 3, 6, 9 and 12 months after the mattresses were used. Group 1 dust mite allergens were analyzed using two-site monoclonal antibody ELISA. Results: Der f1 made up 86.7 % of group 1 allergens found in the matress dust. After the 2nd month, only the mean level in sponge-like polyurethane mattress was under 2 µg/g dust (sensitized level). At the 6th month, the mean levels were 13.1 in coconut, 21.7 in kapok and 17.3 µg/g dust in synthetic fiber, all of which were more than 10 µg/g dust (symptomatic level). At the 9th month, the level in sponge-like polyurethane mattress was increased to 11.2 µg/g. At 12th month the level in coconut fiber, sponge-like polyurethane synthetic fiber and kapok mattresses were 20.2, 22.4, 28.9 and 32.2 µg/g dust respectively. Conclusions: The accumulation rate in kapok and synthetic mattresses was significantly higher than coconut and sponge-like polyurethane mattresses. The mean level of group 1 mite allergens exceeded 10 µg/g dust after the 6th month of use in coconut fiber, kapok and synthetic fiber and at the 9th month in sponge-like polyurethane mattress.
Allergen sensitization to aeroallergens including Blomia tropicalis among adult and childhood asthmatics in Thailand.
(2003-12-17) Daengsuwan, Tassalapa; Lee, Bee-Wah; Visitsuntorn, Nualanong; Charoenratanakul, Suchai; Ruangrak, Sirirat; Jirapongsananuruk, Orathai; Vichyanond, Pakit
To study prevalence of allergen sensitization among asthmatics in Thailand, skin prick tests (SPT) were performed in 84 pediatric, 71 adult asthmatics and 71 adult volunteers. Allergen extracts used for testing included common allergens in Thailand and in Singapore. The incidence of positive SPT to any allergen among the three groups (childhood, adult patients and adult controls) were 64.3%, 43.7% and 35.2%, respectively. Dermatophagoides were the most common allergens sensitized by both pediatric (58.3%) and adult asthmatics (40.8%). Twenty-four children (28.6%) and 8 adult patients (11.3%) were sensitized to storage mites (Blomia tropicalis and/or Austroglyciphagus malaysiensis). All patients sensitized to Blomia tropicalis were sensitized to Dermatophagoides. Twenty-seven percent and 15.5% of childhood and adult asthmatics were sensitized to cockroach allergens. The rates of sensitization to oil palm pollen in childhood and adult asthmatics were 8.3% and 5.6%, respectively. Sensitization to other pollens and spores were less than 5%. This study confirms the importance of Dermatophagoides among Thai asthmatics.
Allergic rhinitis and its impact on asthma update (ARIA 2008) - western and asian-pacific perspective.
(2009-12) Pawankar, Ruby; Bunnag, Chaweewan; Chen, Yuzhi; Fukuda, Takeshi; Kim, You-Young; Le, Lan Thi Tuyet; Huong, Le Thi Thu; O’Hehir, Robyn E; Ohta, Ken; Vichyanond, Pakit; Wang, De-Yun; Zhong, Nanshan; Khaltaev, Nikolai; Bousquet, Jean
The prevalence of allergic diseases such as allergic rhinitis (AR) and asthma is markedly increasing worldwide as societies adopt western life styles. Allergic sensitization is an important risk factor for asthma and AR, and asthma often co-exists with AR. An estimated 300 million people worldwide have asthma, about 50% of whom live in developing countries and about 400 million people suffer from AR. Yet, AR is often under-diagnosed and under-treated due to a lack of appreciation of the disease burden and its impact on quality of life, as well as its social impact at school and at the workplace. However, AR with or without asthma is a huge economic burden. Thus, there was clearly a need for a global evidence-based document which would highlight the interactions between the upper and lower airways including diagnosis, epidemiology, common risk factors, management and prevention. The Allergic Rhinitis and its Impact on Asthma (ARIA) document was first published in 2001 as a state-of-the-art guide-line for the specialist, the general practitioner and other health care professionals. Subsequent new evidence re-garding the pathomechanisms, new drugs and increased knowledge have resulted in the publication of the ARIA 2008 update. The present review summarizes the ARIA update with particular emphasis on the current status of AR and asthma in the Asia-Pacific region and discusses the Western and Asian perspective
Chronic granulomatous disease with disseminated trichosporonosis: A case report.
(2001-08) Kanngurn, Samonmars; Parichatikanond, Paisal; Pootong, Visanu; Vichyanond, Pakit
A case of a two year and three month old Thai boy with a history of recurrent bacterial infections since aged 2 months. A definite absence of superoxide activity in the patient' s granulocytes detected by nitroblue tetrazolium test indicated the diagnosis of chronic granulomatous disease. He suffered from septicemia and systemic fungal infection, resulting in death despite rigorous medical care. The postmortem findings showed extensive granulomatous inflammation in several internal organs. Tissue culture led to diagnosis of disseminated Trichosporonosis, an uncommon infection in immunocompromised patients. This is the first case report of disseminated trichosporonosis in a chronic granulomatous disease patient.
Chronic rhinosinusitis and recurrent nasal polyps in two children with IgG subclass deficiency and review of the literature.
(2005-11-22) Chinratanapisit, Sasawan; Tunsuriyawong, Prayuth; Vichyanond, Pakit; Visitsunthorn, Nualanong; Luangwedchakarn, Voravich; Jirapongsananuruk, Orathai
Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of mucosa of the nose and the paranasal sinuses. Two major forms of CRS can be differentiated; CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The pathophysiology and etiology of nasal polyps (NPs) are partly understood. IgG subclass deficiency was shown to be associated with an increased susceptibility to infections. However the association between NPs and IgG subclass deficiency has never been reported. OBJECTIVES: To report two cases of recalcitrant CRS and recurrent NPs with IgG subclass deficiency. CASE REPORT: Two children (6 and 8 year-old boys) were referred to the Pediatric Allergy/Immunology Clinic, Siriraj Hospital due to a prolonged history of CRS and recurrent NPs. Both of them were treated with aggressive medical (topical and systemic corticosteroids, antibiotics, leukotriene antagonist, nasal irrigation) as well as surgical therapy, without significant improvement. Immunologic investigation in both patients showed that IgG, IgA, and IgM level were normal. IgG subclasses level in patient No. 1 were IgG1 1,235 (280-1120) mg/dl (79%), IgG2 235 (30-630) mg/dl (23.5%), IgG3 27.3 (40-250) mg/dl (1.74%), and IgG4 92.4 (11-620) mg/dl (5.9%). IgG subclasses level in patient No. 2 were IgG1 1,139 (280-1120) mg/dl (82.5%), IgG2 170 (30-630) mg/dl (12.3%), IgG3 5.6 (40-250) mg/dl (0.4%), IgG4 65.7 (11-620) mg/dl (4.8%). The diagnosis of CRS and recurrent NPs with IgG3 subclass deficiency in the first patient and IgG2/IgG3 subclass deficiency in the second patient were made. Patient No. 1 was given monthly IVIG therapy for the total of 7 courses and medications were gradually tapered. Currently, the patient is doing well after the cessation of IVIG therapy for 3 months. Patient No. 2 denied the IVIG treatment and was lost to follow up. CONCLUSION: We reported two cases of recalcitrant CRS and recurrent NPs in children. Immunologic work up revealed IgG subclass deficiency. The treatment with monthly IVIG improved CRS and NPs in treated patient which brought up the possibility of association between NPs and IgG subclass deficiency. Further study on the direct role of IVIG in NPs will be needed in the future.
Clinical characteristics of children with non-allergic rhinitis vs with allergic rhinitis.
(2010-12) Vichyanond, Pakit; Suratannon, Chanthana; Lertbunnaphong, Piyarat; Jirapongsananuruk, Orathai; Visitsunthorn, Nualanong
Background: Allergic rhinitis (AR) and nonallergic rhinitis (NAR) are major causes of chronic rhinitis. Knowledge about children with non-allergic rhinitis is limited. Objective: To study clinical characteristics differentiating NAR and AR among children with chronic rhinitis. Methods: This is a retrospective, descriptive study of 302 children (with ages of 14 years or less) with chronic rhinitis evaluated at the pediatric allergy clinic, Siriraj Hospital between January and December 2006. Based on the results of skin prick test (SPT), they were classified into 2 groups, i.e., AR and NAR. Their medical records were reviewed with respect to clinical data on rhinitis and related symptoms. Results: There were 222 patients with AR and 80 with NAR (73.5% and 26.5%). Median age of onset of the disease among patients with NAR was younger than AR (p = 0.04) while the duration of disease among AR cases was longer than in NAR (p < 0.01). Severity of rhinitis, based on Allergic Rhinitis and its Impact on Asthma (ARIA), was not different between the two groups. Nasal pruritus, sneezing and eye symptoms were more commonly observed in AR than in NAR (p <0.01), whereas snoring and sinusitis were more common in NAR than in AR (p < 0.01). The presence of nasal pruritus, sneezing and eye symptoms strongly suggested AR (adjusted OR 2.73, 2.96, 1.49) while snoring was a risk factor for NAR
Cockroach allergen detection and cockroach allergens of allergic Thai patients.
(2003-03-23) Sookrung, Nitat; Diraphat, Pornphan; Chaicumpa, Wanpen; Tongtawe, Pongsri; Sakolvaree, Yuwaporn; Tapchaisri, Pramuan; Mahakittikun, Vanna; Tungtrongchitr, Anchalee; Vichyanond, Pakit; Bunnag, Chaweewan
Hybridomas secreting monoclonal antibodies (MAb) specific to American cockroach (Periplaneta americana) were produced through a fusion of immune splenocytes of a BALB/c mouse immunized with crude cockroach (CR) extract and mouse myeloma cells. Two hybridomas namely 38G6 and 3C2 were established. These specific hybridomas secreted IgG1 monoclonal immunoglobulins with antigenic specificities to CR protein components of over 207 to 72 kDa and 45 to 40 kDa, respectively. The monoclonal antibodies were applied to select their specific epitopes out of the crude CR extract using affinity chromatography. A Prausnitz-Kustner test revealed that these epitopes were allergens which caused wheals and flares of the skin of a guinea-pig previously sensitized with a pool of serum samples from CR allergic patients. The monoclonal antibodies were also used in a capture ELISA to detect specific IgE in serum samples of allergic Thai patients. It was found that 72% and 76% of the patients had IgE antibodies to the epitopes of MAb 38G6 and MAb 3C2, respectively, indicating that the two epitopes are major CR allergens among the CR allergic Thai patients. An antibody-sandwich ELISA was developed for quantitative detection of CR allergens using the two monoclonal antibodies as a capture reagent and rabbit polyclonal antibodies to crude CR extract as a detection reagent. The assay could detect allergenic epitopes contained in as little as 122 pg of crude cockroach extract, and has high potential for direct measurement of the marker allergens in extracts of environmental samples.
A combination of intravenous immunoglobulin and pulse methylprednisolone extended survival in pulmonary alveolar proteinosis with chronic interstitial pneumonitis: a case report.
(2010-06) Jirarattanasopa, Nongnapa; Tantikul, Chutsumarn; Vichyanond, Pakit; Pacharn, Punchama; Visitsunthorn, Nualanong; Suttinont, Panthep; Jirapongsananuruk, Orathai
Pulmonary alveolar proteinosis (PAP) is characterized by intra-alveolar accumulation of lipoproteinaceous material. The severe chronic pulmonary disease and susceptibility to pulmonary infection is a prominent feature of the disease. We reported a case of postnatal-onset PAP and chronic interstitial pneumonitis in a girl with chronic respiratory distress since she was 5 months of age. A lung biopsy confirmed the diagnosis. The therapeutic bronchoalveolar lavages, a short trial of granulocyte colony-stimulation factor (G-CSF) and a combination of low dose methylprednisolone and hydroxychloroquine were used at different times without noting satisfactory improvement. Intravenous immunoglobulin (IVIG) and pulse methylprednisolone were given monthly with gradual recovery. She did not require oxygen supplement after 21 months of this combination. Our report suggested that IVIG and pulse methylprednisolone might have a potential role in the treatment of PAP with chronic interstitial pneumonitis.
A comparative study of the major allergenic components in house dust extracts between siriraj and commercially prepared extracts.
(2003-06) Mahakittikun, Vanna; Bunnag, Chaweewan; Vichyanond, Pakit; Komoltri, Chulaluk; Wongkamchai, Sirichit; Tunsuriyawong, Prayuth; Jareoncharsri, Perapun; Wimolwattanapun, Suwat; Manochun, Chaiyaporn
The quantity and concentration of major allergens in mite allergenic extracts are crucial for skin testing, which is the recommended standard method for the diagnosis of house dust mite allergic disease. The purposes of this study were 1) To compare the constituents of major mite allergens in 3 types of mite extracts, i.e., extracts from mite reared in-house (Dermatophagoides pteronyssinus and Dermatophagoides farinae), extracts from commercial mite products and commercial ready-made mite extracts. These in-house extracts were prepared either with or without the preservative, glycerine. The concentrations of the major constituents of group 1 and 2 allergens of the extracts were determined by a two-site monoclonal based ELISA. 2 ) Biological assays were also carried out to determine the relative potency of the extracts in 120 allergic patients by skin prick test. It was found that the mean concentrations of Der p1, Der f1 and group 2 mite allergens in extracts from mites reared in-house were 102, 195 and 94 ตg/ml, respectively, compared to 169, 238 and 91 ตg/ml, respectively in commercial mite extracts. The commercial with product had the lowest concentrations of mite allergens (1 ตg/ml). Comparison of mite extracts with and without glycerine preservative showed no significant difference in concentrations of major allergens. Reduction of allergens concentration from 10,000 to 1,000 PNU/ml also reduced the concentration of mite allergen proportionately. Siriraj mite extracts were stable for at least 1 year at 4 oC without any significant change in composition or concentration. In conclusion, mite reared in-house can be used as raw material for preparation of mite allergenic vaccine.
Editorial Column.
(2010-06) Bunnag, Chaweewan; Vichyanond, Pakit; Jirapongsananuruk, Orathai; Kasinrerk, Watchara; Klaewsongkram, Jettanong; Wongratanacheewin, Surasakdi
The effect of montelukast on bronchial hyperreactivity and lung function in asthmatic children aged 6-13 years.
(2011-06) Visitsunthorn, Nualanong; Chirdjirapong, Varakorn; Santadilog, Satit; Pajarn, Panjama; Jirapongsananuruk, Orathai; Komoltri, Chulaluk; Vichyanond, Pakit
Background: Cysteinyl leukotrienes have been shown to play an important role in the pathogenesis of asthma. The effect of the leukotriene receptor antagonist, montelukast, on bronchial hyperreactivity (BHR) as measured by the methacholine challenge test in school children has not been reported. Objective: To determine the effect of montelukast (Singulairâ) on BHR measured by methacholine challenge and lung function tests in Thai asthmatic children aged 6-13 years. Materials and methods: This was a randomized, double-blind, placebo-controlled, crossover study performed in 29 mild to moderate persistent asthmatic children aged 6-13 years. Each child received crossover treatment with 6 weeks of montelukast (5 mg/day) and 6 weeks of placebo separated by a two-week washout period. Results: The improvement of FEV1 and FEV1/FVC after 6 weeks of treatment was significantly higher in montelukast group compared to those of placebo group (p<0.05). After 6 weeks of treatment, mean (+ SEM) PC was 20 in the placebo group (5.7 + 1.41 mg/ml) which was lower than in montelukast group (6.8 + 1.74 mg/ml) but there was no significant difference (p=0.79). Conclusion: Montelukast significantly improved FEV1 and FEV1/FVC but not BHR in mild to moderate persistent asthmatic children aged 6-13 years after the 6 weeks of treatment.
Efficacy of montelukast and loratadine as treatment for allergic rhinitis in children.
(2008-12-06) Watanasomsiri, Apassorn; Poachanukoon, Orapan; Vichyanond, Pakit
The objective of this study was to compare the effectiveness of montelukast combined with loratadine once daily to loratadine alone for a 2-week treatment course of allergic rhinitis in a randomized, double-blind placebo controlled trial which enrolled 115 children, 6- 15-years-old. The patients were randomly assigned to receive montelukast and loratadine (treatment group) or placebo and loratadine (control group). The primary outcome was the mean percent change of the total daytime nasal symptom scores (PDTS) and secondary outcomes were the mean percent changes of the nighttime nasal, daytime eye and composite symptom scores (PNTS, PES, PCS), as well as the nasal secretion, turbinate swelling and nasal congestion scores (PNSS, PTSS, PNCS). There were no significant differences in the PDTS of the 2 groups. The change in the night time nasal congestion score (PNTS-congestion) was higher in the treatment group, but not statistically significant (p = 0.077). Only the mean percent change in decreased turbinate swelling was significantly greater in the montelukast and loratadine group than the loratadine alone group (-22 +/- 7 vs. -1 +/- 5, p < 0.05).
Epidemiology of latex allergy among healthcare personnel at Siriraj Hospital.
(1997-09) Teeraratkul, Achara; Dangsuwan, Tassalapa; Wittitsuwannakul, Rapeepun; Kerdsomnuk, Sirikul; Sawaengsakdi, Lawan; Roengrak, Sirirat; Wititsuwannakul, Dhirayos; Vichyanond, Pakit
AIIergic reactions to latex allergens, ranging from contact dermatitis, urticaria, angioedema, rhinoconjunctivitis, asthma and life-threatening anaphylaxis, have been increasingly recognized among healthcare workers. However, this problem has neither been studied nor reported in Thailand. The objectives of this study are : to (a) delineate the prevalence of latex allergy among healthcare workers in Thailand ; (b) determine the risk factors for the development of latex allergy among hospital personnel in Thailand ;(c) study clinical presentation of latex allergy among those with and without positive latex skin testing ; and (d) undertake a preliminary electrophoretic pattern study of latex proteins contained in latex extracts made from latex gloves commonly used in Siriraj Hospital. The method included a questionnaire survey which was completed by 405 health personnel. The questionnaire pertained to allergy history to latex products. Skin-prick testing, using latex glove extracts, was performed in 227 subjects. Sodium dodecyl sulphate polyacryamide gel electrophoresis (SDS-PAGE) was performed with protein extract preparations from latex gloves. The results showed that 50 subjects reported experiences of one or more latex-related allergic symptoms amounting to a prevalence of 12.4 percent (95 per cent confidence interval {CI}, 9.2 to 15.6). Seven of 227 participants (3.16 per cent) had positive skin-prick tests to latex. The following risk factors were significantly associated with latex allergy : age more than 35 years old (odds ratio {OR} = 2.58; 95 per cent CI = 1.35- 4.93), having a history of prior atopic diseases (OR = 2.06; 95 per cent CI = 1.08-3.93), and having worked with latex gloves for more than 10 years (OR = 2.00; 95 per cent CI = 1.05 –3.82). The most commonly reported symptoms of latex allergy were skin reactions (98 percent). Other symptoms such as rhinitis, conjunctivitis, asthma and anaphylaxis were encountered with lower frequencies. A preliminary study of the electrophoretic pattern of latex glove extracts revealed distinguishable protein bands at 14 kd, 20 kd and 30-43 kd. In conclusion, latex allergic symptoms are common complaints among healthcare personnel in Thailand. Severe symptoms, including anaphylaxis, were noted in one patient. Potential risk factors identified are age more than 35 years old, history of prior atopic diseases, and long contact duration with latex gloves. Measures to cope with such problems will need to be designed for such individuals in the future.
Evaluation of consistency between local and imported seafood allergen extracts.
(2002-08-31) Visitsunthorn, Nualanong; Tiranathanakul, Apiradee; Netrakul, Rawee; Vichyanond, Pakit
BACKGROUND: Seafood is a common cause of food allergy in Thai adults and children. Skin prick test is a safe and convenient way to screen seafood allergy. To date, the Allergy Unit, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University uses imported extracts for seafood skin prick test. The extracts are expensive and may not be the same species as seafood in Thailand. OBJECTIVES: To compare the consistency between local seafood allergen extracts prepared by the Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University and imported seafood allergen extracts. METHODS: The study was a prospective comparative trial performed in children who attended the Pediatric Allergy Clinic, Siriraj Hospital from March 1999 to October 2000. The skin prick test was performed with the local seafood allergen extracts prepared by a pharmacist from the Department of Pharmacology and the imported seafood allergen extracts included shrimp, fish and crab. Histamine and normal saline were used as positive and negative control respectively. The positive result was recorded when wheal reaction was > or = 3 mm larger than negative control. RESULTS: Eighty eight patients (57 boys and 31 girls) were included in this study. The average age was 7.7 years (1-15 years). Half of the patients had a history of seafood allergy. The study showed probable consistency between imported and local skin prick test of shrimp and crab extracts (kappa = 5-7) but no consistency between imported and local skin prick test of fish extracts (kappa < 5). The study also showed no consistency between history of seafood and skin prick test result. CONCLUSION: Local seafood allergen extracts from the Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University are safe but they cannot replace the imported seafood allergen extracts. Further investigations about sensitivity and specificity of both kinds of allergen extracts are necessary.
Exercise-induced asthma among Thai asthmatic children.
(2002-08-31) Vichyanond, Pakit; Anuraklekha, Premvadee; Ruengruk, Sirirut
BACKGROUND: Approximately seventy per cent of asthmatic children from temperate climates, with normal lung function, have exercise-induced asthma (EIA). There is certain evidence to suggest that EIA may be less frequently encountered among children who live in tropical climates. Prevalence of EIA in Asian asthmatic children has never been thoroughly studied. OBJECTIVE: To study the prevalence of EIA among Thai asthmatic children. METHOD: A prospective study was performed to determine the prevalence of EIA in 44 Thai asthmatic children who were able to perform the spirometric maneuver. Subjects were randomly selected asthmatic children from the Pediatric Allergy Clinic, Department of Pediatrics, Siriraj Hospital. They were subjected to exercise testing on a steady state, motor-driven treadmill for 6 minutes (mean speed +/- SD = 3.7 +/- 0.4 km/h, mean level of inclination + SD = 15.0 +/- 5.2 degrees). The testing was conducted in a temperature-controlled (mean temperature +/- SD = 24.4 +/- 0.8 degrees C) and humidity-controlled environment (mean relative humidity +/- SD = 41.7 +/- 2.1%). Lung function tests were performed before exercise, immediately after and at 3, 5, 10, 15, 20 and 30 minutes after exercise. Results of the lung function test were calculated as per cent falls of forced expiratory volume in 1 sec (FEV1), peak expiratory flow rate (PEFR), and forced expiratory flow at 25 per cent-75 per cent (FEF50) from baselines. EIAs were diagnosed when drops of FEV1, PEFR and FEF50 were greater than 20 per cent, 25 per cent and 25 per cent from baseline values, respectively. RESULTS: Of the 44 patients studied (31 boys and 13 girls; mean age 11.9 years), 34 per cent had mild asthma. Fifty-nine per cent had moderate asthma and 7 per cent had severe asthma. Eleven patients (25%) had EIA diagnosed by significant falls of FEV1's (26 +/- 12.6%), whereas, 13 patients (30%) and 20 patients (45%) had EIA defined by significant drops of PEFR's and FEF50's, respectively. A total of 23 patients (52%) had EIA by one or more diagnostic criteria. Peak times for EIA as diagnosed by FEV1, PEFR and FEF50 occurred at 3, 10, and 10 minutes respectively, after exercise. Most EIA episodes observed were of mild degree. CONCLUSIONS: The prevalence of EIA in Thai children is much lower than figures reported in studies from Western countries. By using a significant fall of FEV1's as the diagnostic criteria, only 25 per cent were diagnosed as having EIA. By PEFR and FEF50 criteria, percentages of EIA increased to 30 per cent and 45 per cent respectively. Screening for EIA, therefore, may not be an appropriate diagnostic tool for the diagnosis of childhood asthma in tropical climates.
IgA deficiency: a report of three cases from Thailand.
(2002-09-18) Phankingthongkum, Suwannee; Visitsunthorn, Nualanong; Vichyanond, Pakit
Selective IgA deficiency has been reported to be the most common primary immunodeficiency disease in Western countries. A markedly lower frequency of this condition has been reported in the Japanese population. While most of the IgA deficient cases are healthy, some patients develop significant recurrent sinopulmonary infections, allergic disorders and autoimmune diseases. Herein, we report three cases of IgA deficiency among Thai patients, all of whom suffered from chronic sinopulmonary infections. Two of the three patients had absolute IgA deficiency while the third had a partial IgA deficiency. The associated conditions found in these three patients were deficiencies of an IgG subclass, allergic rhinitis and lupus nephritis. The youngest child (5 years old boy with lupus nephritis) expired from Pneumocystis carrinii pneumonia complicated with adult respiratory distress syndrome.
Immediate type hypersensitivity to chemotherapeutic agents in pediatric patients.
(2009-12) Visitsunthorn, Nualanong; Utsawapreechawong, Wipa; Pacharn, Punchama; Jirapongsananuruk, Orathai; Vichyanond, Pakit
Nine patients (3 boys and 6 girls) with a median age of 9.5 years, with immediate type hypersensitivi-ty reactions to chemotherapeutic agents were reviewed. The presenting symptoms were urticaria (4/9) and ana-phylaxis (5/9). The causative agents were vincristine (2/9), L-asparaginase (2/9), mesna (1/9), cyclosporine (1/9), carboplatin (2/9) and cyclophosphamide (1/9). Three of the five patients with anaphylaxis were changed to alterna-tive chemotherapeutic agents. In two cases alternative drugs were not available and the patients underwent safe and successful desensitization. Three of the 4 patients with urticaria were successfully exposed to graded chal-lenges with cyclosporine, carboplatin and cyclophosphamide, respectively. In the other case with generalized urti-caria, mesna was withdrawn due to a positive intradermal test. In patients with immediate type hypersensitivity reactions to chemotherapeutic drugs, if effective alternative chemotherapeutic agents are not available and/or the skin test is negative, a careful drug challenge and/or desensitization should be performed.
In-vivo allergenic potency of Siriraj Mite Allergen Vaccine (SMAV) comparing with standardized vaccine in mite-sensitive patients.
(2011-03) Visitsunthorn, Nualanong; Bunnag, Chaweewan; Pacharn, Punchama; Assanasen, Paraya; Jirapongsananuruk, Orathai; Thongngarm, Torpong; Tantilipikorn, Pongsakorn; Vichyanond, Pakit
Background: The prevalence of allergic diseases, particularly asthma and allergic rhinitis, has increased tremendously in Thailand and worldwide. House dust mite (HDM) is the major IgE sensitizer among allergic children and adults. We have developed local standardized mite allergen extracts, Siriraj Mite Allergen Vaccine (SMAV) from Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) from our source materials which were highly purified (99%). Objective: To compare in-vivo allergenic potency of both SMAV Dp and Df with commercial standardized mite allergen vaccine by using skin prick testing in mite-sensitive individuals. Methods: This was a double-blind, randomized, self controlled study comparing SMAV and commercial standardized mite allergen vaccine (Dp and Df) by using skin prick testing in mite-sensitive adult volunteers, 18 – 60 years of age. Results: The study was performed in 54 adult volunteers (19 males, mean age 26.6 + 5.5 years old) who had positive skin test to commercial Dp and Df. Seventeen of them had no allergic disease. The most common allergic disease among the volunteers was allergic rhinitis (21/37). Mean wheal diameter of SMAV Dp and commercial Dp at the concentration of 10,000 and 5, 000 AU/ml were equivalent but at the concentration of 2,500 AU/ml was inequivalent. Mean wheal diameter of SMAV Dp was significantly larger than commercial Dp at concentration of 2,500 AU/ml (p < 0.05). Mean wheal diameter of SMAV Df and commercial Df at all 3 concentrations were equivalent. There was no systemic side effect in all subjects. Conclusion: The study demonstrated that in mite-sensitive adults, SPT using SMAV Dp (10,000 AU) and Df (10,000 AU) had equivalent allergenic potency to the commercial comparator without any systemic side effect.
Is silent sinusitis a cause of chronic urticaria in children.
(2009-06) Jirapongsananuruk, Orathai; Sangacharoenkit, Preeda; Pongpreuksa, Sureerat; Visitsunthorn, Nualanong; Vichyanond, Pakit
The etiologies of chronic urticaria (CU) comprise a wide variety of disorders including chronic infec-tions. The association of sinusitis and CU is controversial due to the lack of a control group. The objective of this study was to investigate the role of silent sinusitis as a cause of CU in children. A sinus X-ray (SXR) was performed in 107 children with CU. SXR abnormalities were found in 52.3% of the patients. Nine patients (8.4%) had symp-toms of sinusitis and were treated with amoxicillin/clavulanate. Five of these patients (55.6%) had CU remission. Forty-seven patients (43.9%) who had an abnormal SXR without sinusitis symptoms were randomized into treated (23 patients) and control (24 patients) groups. Eighteen patients (78.3%) in the treated group and 15 patients (62.5%) in the control group had CU remission (p = 0.24). These data did not support a causal relationship of si-nusitis and CU in children.
The levels of cockroach allergen in relation to cockroach species and allergic diseases in Thai patients.
(2004-12-30) Tungtrongchitr, Anchalee; Sookrung, Nitat; Munkong, Nantiya; Mahakittikun, Vanna; Chinabut, Pisith; Chaicumpa, Wanpen; Bunnag, Chaweewan; Vichyanond, Pakit
Recently, cockroaches have been established as the second most Important allergen, producing allergic diseases, especially in low socioeconomic populations. In Thailand, about 44-61% of atopic patients were positive to cockroach extract by a skin-prick test. This study examined cockroach allergen levels in relation to cockroach species and allergic diseases in the houses of cockroach-sensitive patients. Sixty households of allergic patients in the Bangkok metropolitan area were surveyed using open- and closed-ended questionnaires. Cockroaches were collected using commercial cockroach traps, while dust samples were obtained from the bedrooms, kitchens and living rooms of the houses using a vacuum cleaner. The cockroaches were counted and their species Identified. The levels of cockroach allergens were determined by specific monoclonal antibodies using a monoclonal antibody-polyclonal antibody based sandwich ELISA kit. Six cockroach species were Identified: Periplaneta americana (American cockroach, 72.15%), Supella longlpalpa (2.75%, found in only one house), Periplaneta brunnea (0.78%), Periplaneta australaslae (0.78%), Neostylopyga rhombifolla (0.78%), Blattella germanica (German cockroach, 0.39%) and nymphs (22.35%). Allergens of the predominant species, P. americana, were detectable in all homes studied, with the highest levels in the kitchen areas. The range of allergen levels in house dust varied from 0.40-162.00 microg per g of dust. The median and mean allergen levels in kitchen dust were 59.16 microg and 62.80 microg per g of dust, respectively, while the median allergen level in bedroom dust was only 15.90 microg per g of dust. The German cockroach allergen (Bla g 2) was undetectable in any of the houses. IN CONCLUSION: P. americana was the most common cockroach and may be the species causing allergic diseases, especially asthma, in Thailand, which differs from the USA and Europe

Browsing by Author "Vichyanond, Pakit"

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