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1 소아알레르기호흡기 : 제 22 권제 1 호, pp100~109, 2012 년 1) 알레르기비염의사회환경위험요인 원진녹색병원소아과 1, 인하대병원알레르기비염환경보건센터 2, 인하대학교의학전문대학원소아과학교실 3 안소현 1 ㆍ이희영 2 ㆍ송영은 2 ㆍ박신영 3 ㆍ임대현 2,3 ㆍ김정희 2,3 ㆍ손병관 2,3 The Social and Environmental Risk Factors of Allergic Rhinitis in Children So Hyun Ahn 1, Hee Young Lee 2, Young Eun Song 2, Sin Young Park 3, Dae Hyun Lim 2,3, Jeong Hee Kim 2,3, Byong Kwan Son 2,3 1 Department of Pediatrics, Green Hospital, Guri, 2 Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Ministry of Environment, Incheon, 3 Department of Pediatrics, Inha University School of Medicine, Incheon, Korea, Purpose : We investigated the risk factors related to the development and aggravation of allergic rhinitis, which is associated with residential environment and lifestyle habits of children residing in Incheon. Methods : A total of 182 children diagnosed with moderate to severe allergic rhinitis and 67 healthy children were enrolled. A detailed questionnaire of the environmental characteristics and the dietary habits were completed by the parents. Further, skin prick tests with 14 common allergens were performed. Results : The mean age of the children with allergic rhinitis and healthy control was 8.2±2.8 and 9.4±2.0 years, respectively. The presence of indoor mold was associated with an increased risk of development of allergic rhinitis. (adjusted odds ratio [aor], 4.26; 95% confidence interval [CI], ) Among the food groups, there was no significant difference of the daily intake of milk and yogurt between the patients and the controls. However, daily intake of vegetables, except Kimchi, and daily intake of fruits or fruit juice were associated with a decreased risk of allergic rhinitis. (aor, 0.43; 95% CI, / aor, 0.43; 95% CI, , respectively) Conclusion : The results indicate that an indoor dampness is one of the risk factors of development and aggravation of allergic rhinitis. Control of indoor humidity and daily intake of fruits and vegetables can prevent the development and control symptoms of allergic rhinitis. [Pediatr Allergy Respir Dis(Korea) 2012;22: ] Key Words : Allergic rhinitis, Risk factors, Diet, Mold, Vegetable, Fruit, Children 서 론 접수 : 2012 년 1 월 31 일, 수정 : 2012 년 2 월 20 일승인 : 2012 년 3 월 8 일책임저자 : 김정희, 인천시중구신흥동 3 가 인하대학교의학전문대학원소아과학교실 Tel : 032) Fax : 032) kimjhmd@inha.ac.kr 알레르기비염 (allergic rhinitis, AR) 은비점막이알레르겐에노출된후일어나는 immunoglobulin E (IgE) 매개성염증반응에의한질환으로, 수양성콧물, 재채기, 코막힘등을주증상으로한다. 1) 알레르기비염의유병률은최근 20여년간전세계적으로증가추세이며선진국가일수록높은유

2 안소현등 : 알레르기비염의사회환경위험요인 병률로인한사회적부담이크다. 국제소아천식및알레르기질환의역학조사 (International Study of Asthma and Allergies in Childhood, ISAAC) 연구에의하면 1995년제1 차조사에서유병률이낮았던나라에서는 2000년제2 차, 2005 년제3차조사에서지속적으로유병률이증가하는양상을보이고, 1차조사에서유병률이높았던나라에서는 2, 3차조사에서유병률이감소하거나비슷한양상을보이고있다. 2) 1995년, 2000년에시행한국내 ISAAC 연구에서알레르기비염의증상유병률은 1995년에초등학생 37.7%, 중학생 36.8%, 2000년에초등학생 35.4%, 중학생 40.6%, 2006년에초등학생 39% 로증가하는경향을보였고, 알레르기비염의진단유병률도 1995년에초등학생 15.5%, 중학생 7.7%, 2000년에초등학생 20.4%, 중학생 13.6% 로증가하는양상을보였다. 3,4) 이후 2010 년다시시행된알레르기질환유병률조사결과알레르기비결막염의증상유병률은 1995년과 2000년에조사한유병률과비교하였을때지난 10 년간크게증가한양상을보였다. 거주지역별로초등학생, 중학생모두중소도시거주자들에서대도시나농촌보다높은유병률을나타냈고, 가구소득에따른일정한경향성은관찰되지않았다. 5) 초등학생에서동물과의접촉이나간접흡연이알레르기비염증상에위험요인으로작용할수있다는연구결과가보고된 6) 이후여러연구결과들이있었지만일부는관계가있다는결과를보였고, 7-9) 일부는그렇지않은결과를보였다 ) 환경요인중실내곰팡이가알레르기비염과연관이있으며, 집에화분을키우는청소년에서천식과알레르기비염의유병률이높았다는터키의연구보고도있었다. 13) 또한우유를규칙적으로섭취하지않거나, 붉은육고기를섭취하는청소년에서알레르기비염유병률이더높았다는터키의연구결과는식사습관이알레르기질환발생에영향을미칠수있음을시사한다. 14) 알레르기질환의발생과악화에영향을미치는환경적인요인은국가별, 지역별차이를보일수있으므로국내알레르기비염증가의원인을파악하는연구가필요하지만국내의알레르기비염의환자의주거환경과생활습관에기초한위험인자를평가한연구는매우적다. 이에알레르기비염환자군과건강대조군의주거환경과생활습관을비교분석함으로써알레르기비염발생및악화에영향을미치는위험인자들을찾아질환발생과악화를예방하는데기여하고자본연구를계획하였다. 대상및방법 1. 대상 2009 년 1월부터 2010 년 10월말까지인하대병원소아청소년과에서일주일에 4일이상그리고 4주이상비증상 ( 재채기, 코막힘, 콧물, 소양감 ) 이지속되고수면이나일상생활, 학교생활등삶의질에영향을주는중등증이상의알레르기비염이있는소아 182 명을대상으로하였다. 알레르기비염은비증상 4가지중 2가지이상의증상이있고비즙도말호산구수가 5% 이상이며, 알레르기피부시험에서 1개이상의항원양성을기준으로진단하였다. 건강대조군은알레르기질환의과거력이없으면서알레르기증상이없다고자원하여설문조사와혈액검사, 비즙도말검사, 피부시험을시행하여대조군으로확인된 67명을대상으로하였다. 2. 방법 1) 설문조사환자대조군용주거환경과생활습관을알아보기위해자체제작한설문지를기반으로성별과부모의학력, 소득수준, 주거환경, 출생및성장관련요인, 가족력, 생활습관, 식사습관, 알레르기과거력에관한사항을조사하였다. 사전에부모나보호자에게설문내용에대하여설명한후동의서를받았다. 본연구는인하대학교병원임상시험심사위원회의심의를통과하였다.( 심의번호 ) 2) 피부단자시험집먼지진드기 2종 (Dermatophagoides pteronyssinus 와 Dermatophagoides farina), 동물상피및털 (cat fur, dog hair, sheep wool, feathers-duck, goose, hen), 화분 (grass mixture, ragweed, mugwort), 곰팡이 (mold mixture, Aspergillus), 바퀴벌레등을포함한우리나라에서흔한흡입항원 14 종으로환자군과대조군모두에게알레르기피부시험을시행하였다. 잔디항원 (grass mixture) 과동물털항원은 Bancard 사 (London, England) 의시약을사용하였고, 이외의항원은 Allergopharma 사 (Reinbek, Germany) 의시약을사용하였다. 검사대상자의팔의전박부를 75% 알코올솜으로닦고건조시킨다음, 그위에검사를요하는항원용액을점적한후소독된주사침을사용하여점적한항원용액이표피까지도달하도록검사하였다. 단자시험 15 분후에팽진의장축과

3 So Hyun Ahn, et al. : The Social and Environmental Risk Factors of Allergic Rhinitis in Children 그수직축의평균값을각항원의팽진의크기로하였으며팽진의크기가 3 mm 이상이면서히스타민 (1 mg/ml) 에의한팽진의크기보다같거나큰경우를양성반응으로하였다. 3. 통계자료분석을위한통계처리는 SPSS ver (SPSS Inc., Chicago, IL, USA) 를이용하였으며, 알레르기비염환자군과대조군간연령의비교는 Student s t-test 를이용하였다. 두군간의주거환경, 출생및성장관련요인, 가족력, 생활습관, 식사습관, 피부시험결과의비교는 chisquare test 및로지스틱회귀분석을사용하여비차비 (odds ratio, OR) 와 95% 신뢰구간 (95% confidence interval, 95% CI) 을구하였다. 일부항목에서는 Fisher exact test 를시행하였다. P 값이 0.05 미만인경우통계적으로유의하다고판정하였다. 결과 1. 연구대상자수및특성알레르기비염환자군 182명중남아는 112명, 여아는 69명이고대조군 67명중남아는 35명, 여아는 32명이었다. 평균연령은환자군에서 8.17±2.788, 대조군은 9.39± Table 1. Clinical Characteristics of Subjects Characteristic Control Allergic rhinitis P -value Sex Male Female Age (yr) Paternal education High school or lower College or higher Maternal education High school or less College or more Passive or active smoking during pregnancy Passive or active smoking in the first year Alcohol during pregnancy Paternal history of asthma, allergic rhinitis/conjunctivitis, atopic dermatitis, urticarial Maternal history of asthma, allergic rhinitis/conjunctivitis, atopic dermatitis, urticarial Siblings history of asthma, allergic rhinitis/conjunctivitis, atopic dermatitis, urticarial 35 (52.24) 32 (47.76) 9.39± (50.85) 29 (49.15) 39 (62.90) 23 (37.10) 17 (40.48) 25 (59.52) 17 (40.48) 25 (59.52) 8 (12.31) 57 (87.69) 2 ( 4.08) 47 (95.92) 6 (33.33) 12 (66.67) 4 (40.00) 6 (60.00) 112 (61.88) 69 (38.12) 8.17± (51.79) 81 (48.21) 99 (60.74) 64 (39.26) 53 (43.09) 70 (56.91) 53 (43.09) 70 (56.91) 13 ( 7.65) 157 (92.35) 32 (24.81) 97 (75.19) 19 (41.30) 27 (58.70) 29 (60.42) 19 (39.58) * Values are presented as mean±sd or number (%)

4 안소현등 : 알레르기비염의사회환경위험요인 2.037세였다. 또가정내소득수준은환자군에비하여대조군에서낮은것으로나타났다.(Table 1) 2. 가족력아버지의알레르기질환 ( 천식, 알레르기비염 / 결막염, 아토피피부염, 두드러기 ) 이자녀의알레르기비염에영향을미치는것으로나타났다.(Table 1) 3. 환자ㆍ대조군의주거환경알레르기비염환자군에서실내습기로인한곰팡이가더많은것으로나타났다. 주거환경중실내곰팡이의유무는대상자의특성에서차이를보였던연령과성별, 가구소득수준을보정하여비차비를구한결과환자군에서보정전 2.26 ( ) 에 서보정후 4.26 ( ) 으로비차비가증가하였다. 그외 6개월내집수리여부와자동차매연으로인한괴로움여부는보정후에도차이를보이지않았다.(Table 2) 4. 환자ㆍ대조군의출생및성장관련요인대조군에서출생 1년내비타민을더많이복용한것으로나타났고, 최근 1년내해열제복용횟수는환자군에서통계적으로유의하게더많이나타났다.(Table 2) 5. 환자ㆍ대조군의생활습관주당운동횟수와운동량, 실외활동시간등에서유의한차이를보이지않았다.(data not shown) Table 2. Risk Factors of Allergic Rhinitis according to Residential and Birth Environment Factor Controls Allergic rhinitis P -value aor* (95%CI) Indoor molds Renovation within recent six month Distress by vehicle exhaust in the residence Probiotics in the first year Vitamin supplement in the first year Bronchiolitis within two years after birth Frequency of analgesics and antipyretics use in the last twelve months ne <1 time per month 1-3 times per month 4 times per month Attendance in daycare, nursery, kindergarten 19 (28.79) 47 (71.21) 27 (40.30) 40 (59.70) 4 (5.97) 63 (94.03) 15 (27.27) 26 (41.94) 15 (27.27) 40 (72.73) 10 (14.93) 57 (85.07) 24 (35.82) 41 (61.19) 2 ( 2.99) 0 ( 0.00) 64 (95.52) 3 ( 4.48) 83 (47.70) 91 (52.3) 66 (37.93) 108 (62.07) 18 (10.40) 155 (89.60) 13 (11.50) 68 (40.48) 13 (11.50) 100 (88.50) 38 (22.49) 131 (77.51) 29 (16.96) 107 (62.57) 30 (17.54) 5 ( 2.92) 159 (92.44) 13 ( 7.56) ( ) 0.89 ( ) 1.72 ( ) Values are presented as number (%). aor, adjusted odds ratio; CI, confidence interval. *Adjusted by age, gender, and household income level

5 So Hyun Ahn, et al. : The Social and Environmental Risk Factors of Allergic Rhinitis in Children 6. 환자ㆍ대조군의식사습관매일섭취하는음식물에따른환자ㆍ대조군의식사습관을살펴보았을때환자군에서대조군에비하여육류, 생선, 달걀, 콩, 두부로된음식을더많이섭취하였다. 또한 모든식품군을골고루섭취하는편이다 라는항목을이용하여조사한편식습관도환자군에서더높게나타났다. 우리나라에서 3번째로많이섭취하는식품인김치를제외한채소를매일섭취하는습관은연구대상자의특성에서차이를보였던연령과성별, 가구소득수준을보정하여환자ㆍ대조군간식사습관에관한비차비를구한결과보정비차비 0.43 ( ) 으로보정후유의한음의상관성을보였다. 과 일또는주스를매일섭취하는습관역시보정비차비 0.43 ( ) 으로유의한음의연관성을보였다.(Table 3) 7. 피부단자시험알레르기비염환자군에서가장많이감작된항원들을살펴보면집먼지진드기 2종이가장많이감작되었고, 그뒤를이어 cat fur, molds 1, dog hair 등의항원순으로감작되었다.(Table 4) 환자군과대조군모두에서실내곰팡이가있다고응답한군과그렇지않다고응답한군간에집먼지진드기 2종과곰팡이에대한감작을비교한결과통계적으로유의한차이는없었으나, 집먼지진드기감작은경계선상의유의성이있었 Table 3. Risk Factors of Allergic Rhinitis according to Dietary Habits Factor Control Allergic rhinitis P -value aor* (95%CI) Milk more than 1 bottle daily Yogurt more than 1 bottle daily Vegetables except Kimchi daily One fruit or one bottle of fruit juice daily Cooking oil roasted at least twice a week Fatty meat at least twice a week Regular meals Junk food at least twice a week daily Balanced diet Bean paste soup, whenever meals 48 (71.64) 19 (28.36) 45 (67.16) 22 (32.84) 53 (80.30) 13 (19.7) 54 (81.82) 12 (18.18) 47 (72.31) 18 (27.69) 36 (54.55) 30 (45.45) 58 (86.57) 9 (13.43) 40 (60.61) 26 (39.39) 56 (84.85) 10 (15.15) 48 (72.73) 18 (27.27) 111 (65.68) 58 (34.32) 109 (64.12) 61 (35.88) 107 (62.21) 65 (37.79) 136 (78.61) 37 (21.39) 129 (75.00) 43 (25.00) 81 (47.37) 90 (52.63) 156 (90.70) 16 (9.30) 112 (65.50) 59 (34.50) 109 (63.01) 64 (36.99) 103 (59.54) 70 (40.46) ( ) 0.69 ( ) 0.43 ( ) 0.34 ( ) 1.16 ( ) 0.76 ( ) 0.94 ( ) 1.55 ( ) 0.32 ( ) 0.40 ( ) Values are presented as number (%). aor, adjusted odds ratio; CI, confidence interval. *Adjusted by age, gender, and household income level

6 안소현등 : 알레르기비염의사회환경위험요인 Table 4. Results of Skin Prick Test of Subjects Control Results of reaction Patients P-value Dermatophagoides pteronyssinus Dermatophagoides farina Cat fur Molds 1* Dog hair Cockroach Mugwort Aspergillus fumigatus Ragweed Grass B2 7 (10.45) 60 (89.55) 8 (11.94) 59 (88.06) 0 (0) 67 (100.0) 2 (2.99) 65 (97.02) 1 (1.49) 66 (98.51) 0 (0) 67 (100.0) 0 (0) 67 (100.0) 0 (0) 67 (100.0) 1 (1.49) 66 (98.51) 0 (0) 67 (100.0) 133 (80.61) 32 (19.39) 126 (75.90) 40 (24.10) 19 (11.45) 147 (88.55) 16 (9.64) 150 (90.36) 15 (9.04) 151 (90.96) 4 (2.41) 162 (97.59) 3 (1.81) 163 (98.19) 2 (1.20) 164 (98.80) 1 (0.60) 165 (99.40) 1 (0.60) 165 (99.40) < < Values are presented as number (%). *Mold 1: Alternaria, Botrytis, Cladosporium, Curvularia, Fusarium, Heminthosporium. Grass B2: bent, brome, cocksfoot, dogstail, oak, plane, popular, willow. Table 5. Sensitization to the Indoor Molds House dust mite* Mold 1 P -value P -value Indoor molds 36 (35.29) 64 (47.41) 66 (64.71) 71 (52.59) (92.16) 122 (90.37) 8 (7.84) 13 (9.63) Values are presented as number (%). *House dust mite: Dermatophagoides pteronyssinus/dermatophagoides farina. Mold 1: Alternaria, Botrytis, Cladosporium, Curvularia, Fusarium, Heminthosporium

7 So Hyun Ahn, et al. : The Social and Environmental Risk Factors of Allergic Rhinitis in Children 다.(P =0.0615) (Table 5) 고찰본연구는알레르기비염에영향을미치는주거환경과생활습관을파악한후알레르기비염발생및악화에영향을주는위험인자들을평가하고자하였다. 알레르기비염의위험인자에관한국내학동기소아를대상으로한연구에서는간접흡연, 카페트사용, 산업지역거주인경우에위험도가증가하였고, 15) 서울송파지역초등학생을대상으로한 2008년의연구에서는아토피피부염과천식의병력, 부모의알레르기질환, 어머니의대졸이상학력이위험인자였다. 16) 학동전기소아를대상으로한 2004 년의연구에서는과거세기관지염을앓은병력, 어머니의알레르기병력이있는경우, 어머니의교육정도가높은경우에위험도가높았다. 17) 2011년서울중구에서시행한연구에서는여아인경우에위험도가감소하였고, 천식진단을받은경우에위험도가증가하였다. 18) 본연구결과알레르기비염환자군의가정에서실내습기로인한곰팡이발생이유의하게많았다. Alternaria 감작과알레르기비염간에상호관련성이있으며, 특히천식보다알레르기비염이 Alternaria 와연관되어있다는연구결과를 19) 고려할때본연구에서실내습기로인한 Alternaria 의증가가알레르기비염발생에영향을끼쳤을가능성을시사하였다. 또한실내곰팡이가천명, 알레르기비염, 아토피피부염과관련이있다고보고한다른연구결과도있었다. 13) 그러나곰팡이농도와천식, 알레르기질환및알레르기증상의유병률간에유의한관련성을발견할수없었다는연구결과도있었다. 12) 알레르기비염은알레르겐에다양한기간동안감작된개인에서증상을초래한다. 알레르기비염의원인항원으로실내항원에는집먼지진드기, 동물의털, 곰팡이등이중요하며실외항원으로가장흔한것은꽃가루이다. 항원으로서의꽃가루의직경은 μm로다양하며비강과눈에침착되어증상을일으킨다. 반대로공기중의포자, 균사, 곰팡이일부분은직경이너무작아서하기도로흡입된다. 20) 이런곰팡이번식체 ( 특히 Alternaria) 에대한감작은천식의위험인자로알려져왔으며, 21) 중증천식 22) 및천식에서호흡정지를일으키는경우에도 23) 위험인자로인식되어져왔다. Alternaria 포자는직경이 10 μ 10 이상으로곰팡이중에가장큰포자로 24) 상기도에포획되어알레르기비염의증상을유발한다. 25) 또한온대지역의 Alternaria 포자농도 는계절적인변동을보인다. 26) 포자농도는여름에증가하지만연중낮은농도로유지된다. 27) 이런분포의특성으로인해 Alternaria 는통년성및계절성비염을모두유발할수있다는연구결과도있다. 19) 본연구결과실내환경요인중에알레르기비염환자군에서실내곰팡이발생이유의하게많았다. 이는곰팡이에대한감작을통하여알레르기염증이유발되어질환이발생할수있을가능성을시사한다. 또한실내습도가증가하면알레르기비염환자군에서가장감작률이높은집먼지진드기의번식으로인한집먼지진드기항원의증가로간접적으로알레르기비염을발생시키거나증상을악화시킬수있다고생각된다. 곰팡이감작률과집먼지진드기감작률은환자군과대조군간유의한차이가있었다. 그러나본연구처럼단면연구로는곰팡이감작으로알레르기비염이발생한것인지, 알레르기비염증상때문에가습기등을더많이사용하여습도가높아지고이로인해곰팡이발생이증가하여 2차적으로곰팡이감작이증가하였는지인과관계를밝히기는어렵다. 또한곰팡이가발생하는실내주거환경이알레르기비염을발생시키거나악화시키는이유가곰팡이농도증가때문인지, 아니면집먼지진드기농도증가때문인지를명확하게밝히지도못하였다. 본연구에서는실내환경측정을하지않았기때문에실내곰팡이가있다고응답한군과없다고응답한군의실내환경에서곰팡이포자나집먼지진드기농도의유의한차이를확인할수없었다. 그러나실내곰팡이는알레르기비염발생및악화에관여할것으로생각되며적절한실내습도의유지가알레르기비염예방및증상조절에중요하다고판단된다. 식사습관은천식및알레르기비염의발생과관련이있다. 28,29) 초등학생을대상으로한연구에서규칙적으로우유를섭취한군에서천식과천명의발생빈도가높지않았으며, 붉은육고기를섭취한군에서는건초열의발생빈도가높았다고하였다. 14) ISAAC 에서시행한 6-14 세를대상으로한연구에서녹말, 시리얼, 채소섭취의증가는천식, 알레르기비염, 아토피피부염의증상의감소와상관관계가있음을보였다. 30) 중국 3개의센터에서시행한연구에서도과일과익히지않은채소섭취가천명의위험을감소시킨다고보고하였다. 31) 호주의젊은성인을대상으로한연구에서도사과와배의섭취가천식과기관과민성의발생빈도를감소시킨다고보고하였다. 32) 런던남부의 1,471 명의성인을대상으로한환자대조군연구에서는식사습관은대부분어린시기에형성되므로, 천식이시작되는이른시기에사과와고용량의 selenium 을섭취하는것이천식을예방할수있다고

8 안소현등 : 알레르기비염의사회환경위험요인 주장하였다. 그기전으로사과에는다양한플라보노이드 (flavonoid) 가함유되어있으며, 항산화, 항알레르기, 항염증작용을통해천식의염증을감소시키며, 또다른항산화제인고농도의 selenium 섭취로 glutathione peroxidase 을포화상태로만들어서천식염증을줄인다고하였다. 33) 어류에존재하는긴사슬지방산 (ω3) 과, 비타민 C, E, selenium 같은항산화제에는천식예방효과가있으며, 34-36) 불포화지방산과나트륨에는유해효과가있다는연구결과도있다. 37,38) 그러나본연구에서어류섭취량항목은응답률이적고정확성이떨어져연구결과에포함시키지않았다. 김치외채소를매일섭취하는습관은보정전보다보정후에두군간의차이가더커졌다. 김치는우리나라에서 3 번째로많이섭취하는식품으로김치와관련된요인을평가하기쉽지않은부분이있어김치를제외한채소를매일섭취하는습관에대해조사하였다. 본연구에서도대조군한명만이김치를매일먹지않는다고응답하였다. 과일또는주스를매일섭취하는습관은보정전에는두군간에차이가없었지만보정후알레르기비염환자군에서섭취가더적은것으로나타났다. 알레르기비염환자군에서확인된채소섭취저하로볼때, 채소의항산화효과가기존에확인된천식증상완화와예방뿐아니라알레르기비염발생의예방에도어느정도기여할것으로생각된다. 그러나채소에는항산화제외에다른성분도많이함유되어있으므로좀더추가적인연구가필요하다. 본연구는설문조사를통한분석으로각세부항목별결측값을제외한분석이라는제한점이있다. 또한두군간유의한차이를보였던항목의통계적인검정력은확인하였지만현재본연구에서유의한차이를보이지않았던항목이질환과관련이없다라고결론을내릴수있을정도의대조군을확보하지는못하였다는제한점도있다. 또한실재하였던실내곰팡이의종류와이에대한감작여부등의추가적인연구가필요하다고사료된다. 아직국내에서는실내곰팡이의종류및실내곰팡이가알레르기비염을포함한알레르기질환에미치는영향등에관한연구가매우빈약한실정이므로이부분에대한지속적인연구가필요하다고생각된다. 요약목적 : 본연구는알레르기비염에영향을미치는주거환경과생활습관을파악한후알레르기비염발생및악화에영향을주는위험인자들을찾고자시행되었다. 방법 : 진단받은중증도이상의알레르기비염환자 182 명, 알레르기질환이없는대조군 67 명을대상으로주거환경및생활습관에관련된설문지조사와알레르기피부시험을시행하여그결과를비교분석하였다. 결과 : 알레르기비염환자군과건강대조군의평균연령은각각 8.2±2.8세와 9.4±2.0 세였다. 알레르기비염의발생에있어실내곰팡이가있는경우에위험도가증가하였다. (adjusted odds ratio [aor], 4.26; 95% confidence interval [CI], ) 우유나유제품을매일섭취하는습관은환자군과대조군간에유의한차이를보이지않았다. 김치를제외한채소및과일또는과일주스를매일섭취하는경우에알레르기비염발생이의미있게감소하였다.( 각각 aor, 0.43; 95% CI, , aor, 0.43; 95% CI, ) 결론 : 실내곰팡이는알레르기비염발생및악화에관여할것으로생각되며적절한실내습도의유지와채소와과일을매일섭취하는습관이알레르기비염예방및증상조절에중요하다고판단된다. 참고문헌 1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008 ;63 Suppl 86: Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368: Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Pediatr Allergy Respir Dis (Korea) 2008;18: Jee HM, Kim KW, Kim CS, Sohn MH, Shin DC, Kim KE. Prevalence of asthma, rhinitis and eczema in Korean children using the International Study of Asthma and Allergies in Childhood (ISAAC) Questionnaires. Pediatr Allergy Respir Dis(Korea) 2009;19: Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, et al. The prevalence of symptoms of asth

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한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -