The prevalence of allergic diseases has increased dramatically in recent decades, and are now considered major chronic diseases at the global level. The increasing burden of allergic diseases has led to numerous worldwide and local researchers to investigate the time trends in its prevalence and identify its driving factors. Environmental changes such as urbanization and industrialization have been suggested to explain the increasing prevalence, but recent reports from Western countries suggest that this prevalence has reached a plateau or even possibly, started to decrease. However, such environmental changes are still occurring in many Asia-Pacific countries, including Korea, and it is speculated that the peak in allergy epidemics has yet to come. The present systematic literature review aimed to explore the time trends in the prevalence of allergic diseases in Korea and to identify the unmet needs for facilitating further studies.

Tacrolimus and cyclosporine have been used in various formulations, but their hypersensitivity reactions are rare in practice. Castor oil derivatives are nonionic surfactants used in aqueous preparations of hydrophobic active pharmaceutical ingredients. Castor oil derivatives that can be used as additives to tacrolimus and cyclosporine may play a role in the development of hypersensitivity reactions, especially anaphylaxis. Various immunologic and nonimmunologic mechanisms have been implicated in hypersensitivity reactions induced by castor oil derivatives. Physicians should be aware that not only the drug itself, but also its additives or metabolites could induce hypersensitivity reactions. We report a case of anaphylaxis caused by vitamin K (phytonadine), serotonin antagonist (granisetron), intravenous tacrolimus, and cyclosporine. Interestingly, the patient tolerated oral cyclosporine, which did not contain Cremophor EL or polysorbate 80.

Severe asthma (SA) presents in about 3%–5% of adult asthmatics and is responsible for over 60% of asthma-related medical expenses, posing a heavy socioeconomic burden. However, to date, a precise definition of or clear diagnostic criteria for SA have not been established, and therefore, it has been challenging for clinicians to diagnose and treat this disease. Currently, novel biologics targeting several molecules, such as immunoglobulin E, interleukin (IL)5, and IL4/IL13, have emerged, and many new drugs are under development. These have brought a paradigm shift in understanding the mechanism of SA and have also provided new treatment options. However, we need to agree on a precise definition of and its diagnostic criteria for SA. Additionally, it is necessary to explain the diagnostic criteria and to summarize current standard and additional treatment options. This review is an experts' opinion on SA from the Korean Academy of Asthma, Allergy, and Clinical Immunology, the Working Group on Severe Asthma, and aims to provide a definition of and diagnostic criteria for SA, and propose future direction for SA diagnosis and management in Korea.

Chronic cough is a significant medical condition with high prevalence and a strong negative impact on the quality of life. Cough hypersensitivity is thought to underlie chronic cough, with several environmental and host factors interacting to cause neuronal sensitization and chronicity. Comorbid conditions affecting cough reflex pathways, such as upper airway diseases, asthma, and gastroesophageal reflux, play important roles in chronic cough. However, their prevalence may vary in patients living in different geographical regions or with different ethnicities. We conducted a literature review to examine common comorbidities in Korean adult patients with chronic cough, their clinical implications, and the issues that still need to be addressed in the development of clinical evidence of chronic cough in Korean adult patients.

Clinical features were collected through a standardized form. Written informed consents were obtained from all patients according to the French legislation and the principles of the Declaration of Helsinki. The study was approved by the research ethics committee from the Hôpitaux Universitaires de Strasbourg, France (N°ID RCB 2008-A01295-50).

Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca 2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.

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