대한내과학회지 : 제 86 권제 4 호 2014 http://dx.doi.org/10.3904/kjm.2014.86.4.453 울산지역호흡기알레르기환자의흡입알레르겐감작률과대기중꽃가루농도와의관련성 울산대학교의과대학울산대학교병원 1 내과, 2 직업환경의학과, 3 환경보건센터, 4 울산대학교자연과학대학생명과학부 최승원 1 이지호 2 김양호 2 오인보 3 최기룡 4 Association Between the Sensitization Rate for Inhalant Allergens in Patients with Respiratory Allergies and the Pollen Concentration in Ulsan, Korea Seung Won Choi 1, Ji-Ho Lee 2, Yangho Kim 2, In-Bo Oh 3, and Kee-Ryong Choi 4 1 Departments of Internal Medicine, 2 Occupational and Environmental Medicine, and 3 Environmental Health Center, Ulsan University Hospital, University of Ulsan College of Medicine; 4 Department of Biological Science, University of Ulsan College of Natural Science, Ulsan, Korea Background/Aims: Pollinosis is an increasing problem, with allergenic pollen causing rhinitis, asthma, and other allergic diseases. This study examined the patterns of sensitization to inhalant allergens in patients with respiratory allergies and analyzed the regional pollen concentrations in Ulsan, Korea. Methods: A skin prick test was performed with 21 common inhalant allergens, including 18 types of pollen, in 634 patients with respiratory allergies from January of 2008 through December of 2010. Airborne pollen was collected daily from three different stations in Ulsan using a Durham sampler. Daily records and identification of the pollen types were made (2009-2010). Results: The sensitization rates for inhalant allergens were as follows: Dermatophagoides pteronyssinus (38.2%), Dermatophagoides farinae (38.0%), birch (15.8%), alder (15.3%), hazel (14.2%), oak (13.5%), beech (10.8%), mugwort (9.6%), and hop Japanese (5.2%). Airborne pollen has two peak seasons: tree pollen from February to June, followed by weed pollen from August to October. Pine tree, oak, and alder were the most frequently found pollen types in spring, whereas hop Japanese and mugwort were the most frequently found pollen types in autumn. Conclusions: House dust mites are the most common offending allergen in Ulsan. The sensitization rates to some tree pollen types, including birch, alder, and hazel were higher than those of weed or grass pollen. Causative allergens are changing in response to climate change and air pollution. Continuous aerobiological monitoring is the cornerstone for observing changes in pollen and a prerequisite for the study of the effect of climate change on allergic diseases. (Korean J Med 2014;86:453-461) Keywords: Allergens; Pollen; Sensitization Received: 2013. 6. 27 Revised: 2013. 7. 25 Accepted: 2013. 10. 4 Correspondence to Seung Won Choi, M.D. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 682-714, Korea Tel: +82-52-250-7029, Fax: +82-52-250-7048, E-mail: choisw@uuh.ulsan.kr * This study was financially supported by Ministry of Environment, Korea. Copyright c 2014 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution - 453 - Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- The Korean Journal of Medicine: Vol. 86, No. 4, 2014 - 서론꽃가루병 (pollinosis) 은항원성이있는꽃가루에의해발생되는알레르기질환으로알레르기비염, 알레르기결막염및천식등이있다 [1]. 알레르기를일으키는꽃가루의종류는지역별로매우다양하게분포하며수목류와목초류및잡초류로구분된다. 알레르겐꽃가루에관한연구는전세계적으로꾸준히진행되어지역별로알레르기질환과연관된꽃가루종류가규명되고있다. 우리나라의지역별꽃가루분포에관한연구는 1980년대부터본격화되었는데, 이에따르면우리나라에서꽃가루가비산되는시기는수목류가 3월부터 5 월에걸쳐나타나며목초류는 8월초에서 9월말까지, 잡초류는 8월말에서 10월사이에발견된다. 또한봄과가을연중두차례의꽃가루절정기가있는것으로알려졌다 [2-4]. 알레르겐꽃가루종류와비산량은해당지역의식물식생에좌우되며기온과풍량및강수량과같은기후특성과관련이깊다. 최근전세계적인지구온난화현상은식물식생에영향을끼치며도시화나공업화에따른오염물질의증가는다양한방법으로면역반응을증폭시켜알레르기질환이급증하게되는요인이되고있다 [5-7]. 이러한환경적변화로인해지역의알레르겐꽃가루양상이지속적으로변동할수있으므로광범위하고지속적인연구가필요하다. 하지만울산지역을대상으로하는알레르겐꽃가루관련역학조사나감작률등의연구는아직까지발표된바가없다. 특히, 울산은최근급속하게산업화와도시화를경험한지역이어서기후변화에따른알레르기질환의변동양상이다른지역과는차별될가능성이있다. 이에본연구는울산에소재한대학병원에내원하여문진과진찰에의해비염및천식으로진단되었던환자들을대상으로꽃가루를포함한주요흡입항원에대한감작률을분석하였다. 또한울산의세지역에서연중지속적으로대기중꽃가루종류와농도를측정하였으며지역적꽃가루분포특성과감작률에미치는임상적의의를조사하고자본연구를시행하였다. 대상및방법연구대상 2008년 1월부터 2010년 12월까지울산대학교병원알레르기내과및아토피센터에내원하여콧물, 코막힘, 재채기등 Table 1. Demographic data of the patients Patient number 634 Male:Female 320:314 Age (Mean ± SD) 34.1 ± 20.1 Age range 5-84 Age (yr), n (%) 15 183 (28.9) 16-30 114 (18.0) 31-45 116 (18.3) 46-60 155 (24.4) 61 66 (10.4) Disease, n (%) Rhinitis 417 (65.8) Asthma 332 (52.4) Rhinitis + Asthma 115 (18.1) 의증상을보여비염으로진단되었거나기침, 호흡곤란, 천명소견및기관지유발검사등을통해기관지천식으로진단되어서알레르기피부시험을시행한울산에거주하는 634 명의환자를대상으로하였다. 연령분포는 5세에서 84세로평균연령 (± 표준편차 ) 은 34.1 ± 20.1세로남자가 320명, 여자 314명이었다. 전체환자의 52.4% 는천식을호소했으며 65.8% 인 417명에서는비염증상이있었고 115명의환자는비염과천식증상을동시에호소하였다 (Table 1). 알레르기피부시험대상환자에게알레르기피부단자시험을시행하였다. 시험에사용된시약은 Allergopharma사 (Allergopharma, Reinbeck, Germany) 항원으로집먼지진드기 2종, 바퀴벌레, 수목류 10 종, 목초혼합항원 1종과목초및잡초류 7종을사용하였다. 시험에사용된알레르겐의종류는미국집먼지진드기 (Dermatophagoides farina, D. farinae), 유럽집먼지진드기 (Dermatophagoides pteronyssinus, D. pteronyssinus), 바퀴벌레, 오리나무 (alder), 물푸레나무 (ash), 너도밤나무 (beech), 자작나무 (birch), 딱총나무 (elder), 느릅나무 (elm), 개암나무 (hazel), 참나무 (oak), 포플러 (poplar), 버드나무 (willow), 목초혼합항원 (grass pollens mixture), 민들레 (dandelion), 환삼덩굴 (hop Japanese), 쑥 (mugwort), 쐐기풀 (nettle), 오리새 (orchard grass), 질경이 (plantain), 돼지풀 (ragweed) 이었다. 목초혼합항원에는켄터키목초 (Kentucky blue grass), 김의털 (meadow fescue), 오리새, 호밀풀 - 454 -
- Seung Won Choi, et al. Pollens and sensitization rate in Ulsan - (rye grass), 큰조아재비 (timothy grass), 및강아지풀 (velvet grass) 의항원이포함되었다. 피부시험은시약을등이나팔에떨어뜨린후단자 (prick) 후 15분이경과되면팽진크기를측정하여판독하였는데, 양성대조시약인히스타민액 (1.0 mg/ml) 에의한팽진과비교하여크기가큰경우양성으로판정하였다. 울산대기의꽃가루종류및농도조사 꽃가루채집지역 2009년 8월부터울산의지역별특성을고려한 3개장소를선정하여각각꽃가루를채집하여종류와농도를분석하였다 A지점은산지식생을대표하는곳으로도심지외곽의산지로정하였고 B지점은주거지역및하천변의식생을고려하여선정하였으며, C지점은해안가식생을반영하는곳으로하였다 (Fig. 1). 꽃가루채집방법및측정 꽃가루채집에는 Durham sampler가사용되었다. 기계는바람이잘통하며포집용슬라이드교환이용이하도록건물옥상에설치하였다. 직경 23 cm의스테인리스원판두개를높이 7.6 cm가되도록기둥 3개로받치고중앙에포집용슬라이드고정대가하부원판에서는높이 2.5 cm가되고지면에서는 1.5 m가되도록설치하였다. 포집용슬라이드표면에백색바셀린을발라고정대에 24시간설치한후매일오전 9시에교환하였다. 회수된슬라이드가비에젖은경우는자 Figure 1. Map showing the three pollen collecting stations in Ulsan. 연건조시켰다. 염색및봉입은 gentian violet glycerin jelly 법을이용하였다. 슬라이드는광학현미경으로검경하여일본알레르기협회 (Japan Allergy Foundation) 의공중꽃가루측정및정보표준화에준하여처리하였으며꽃가루수는 grain/cm 2 로표시하였다. 통계분석통계프로그램은윈도우용 SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA) 을이용하였다. 결과는평균 ± 표준편차혹은비율 ( 빈도수 ) 로표시하였다. 대상환자는 5개연령군이나질환에따라분류하였으며각군에따라알레르겐에대한감작률을측정하고비교하였으며빈도분석혹은카이제곱검정을이용하였다. p값이 0.05 미만인경우유의한것으로간주하였다. 결과알레르기피부시험양성률알레르기피부시험결과, 대상환자 634명중에서집먼지진드기를포함한한개이상의항원에양성을보인아토피환자는 327명 (51.6%) 이었으며한개이상의꽃가루에양성을보인경우는 145명 (24.3%) 이었다. 개별항원에대한감작률은집먼지진드기가가장높아서유럽집먼지진드기 38.2%, 미국집먼지진드기 38.0% 였다. 꽃가루에대한양성률은자작나무 15.8%, 오리나무 15.3%, 개암나무 14.2%, 참나무 13.5%, 너도밤나무 10.8%, 쑥 9.6% 의순으로높았다. 각항원에대한감작률의남녀차이는없었다 (Table 2). 연령별피부시험양성률환자를 5개연령군으로나누어서분석한결과 15세이하군에서는미국집먼지진드기 63.1%, 유럽집먼지진드기 60.3% 로양성률이높았으며자작나무 22.1%, 오리나무 22.0%, 개암나무 20.5%, 참나무 18.6% 순이었으며오리새에대해서도 12.5% 의감작률을보였다. 대부분연령층에서집먼지진드기, 오리나무, 자작나무, 너도밤나무, 개암나무, 참나무, 쑥에대한양성률이높게나타났다. 연령이증가할수록감작률은전반적으로낮아지는경향을보였는데, 특히 61세이상군에서는모든항원에대한감작률이 10% 이하였으며특히집먼지진드기와오리나무, 자작나무, 너도밤나무, 개암나무, 오리새에대한감작률은통계적으로유의하게낮았다 (Table 2). - 455 -
- 대한내과학회지 : 제 86 권제 4 호통권제 644 호 2014 - Table 2. Frequency of sensitization to inhalant allergens according to age Allergens Skin test reactivity rate (%) All 15 yr 16-30 yr 31-45 yr 46-60 yr 61 yr p-value Indoor allergens D. pteronyssinus 38.2 60.3 55.8 35.7 14.4 9.2 < 0.05 D. farinae 38.0 63.1 54.9 32.5 15.8 7.7 < 0.05 Cockroach 4.6 3.5 5.5 6.1 5.3 1.6 Tree pollens Alder 15.3 22.0 22.7 13.4 10.9 4.9 < 0.05 Ash 2.5 5.0 4.8 1.9 0.7 1.7 Beech 10.8 15.9 17.0 9.9 6.1 3.4 < 0.05 Birch 15.8 22.1 22.7 13.5 11.5 6.8 < 0.05 Elder 4.4 7.7 7.5 4.5 0.7 1.7 Elm 2.9 5.1 6.3 1.7 0 0 Hazel 14.2 20.5 20.0 13.6 9.8 5.3 < 0.05 Oak 13.5 18.6 20.8 13.4 7.5 6.6 Popular 2.1 7.0 2.9 0 0 1.7 Willow 2.3 4.6 1.9 3.6 0 1.7 Grass pollen mixture a 5.1 6.4 11.7 4.4 0 0 Weed/grass pollens Dandelion 5.2 7.3 6.3 5.2 5.3 0 Hop Japanese 5.2 7.1 10.4 6.8 1.3 3.1 Mugwort 9.6 7.0 17.1 13.2 6.6 3.1 Nettle 3.4 8.7 3.9 1.8 2.0 0 Orchard grass 5.1 12.5 10.4 1.7 1.3 0 < 0.05 Plantain 2.8 4.5 7.6 1.0 0.7 0 Ragweed 4.7 4.1 5.4 8.8 3.3 1.6 a Grass pollen mixture contains the following allergens: velvet grass, orchard grass, rye grass, timothy grass, Kentucky blue grass, and meadow fescue. 질환별피부시험양성률임상양상을비염과천식으로구분하여조사한결과, 비염을호소하는환자들이천식환자에비해서대부분의항원에대해감작률이높은경향을보였으나통계적차이는없었으며양성을보인항원의종류도차이를보이지않았다 (Table 3). 울산지역개별꽃가루농도의연중분석 2009년 8월부터 2010년 7월까지 1년간진행된울산대기중꽃가루조사에서는총 43과 46속의꽃가루가검출되었다 (Table 4). 수목류의경우 3개지점모두에서소나무가가장 많이검출되었고다음으로참나무와오리나무, 측백나무가높게측정되었다. 특히꽃가루의양은산지식생을나타내는 A지점이다른지점에비해높았고주로검출되는꽃가루는참나무속, 오리나무속, 자작나무속및옻나무속등이었다. 잡초류는 3지점모두에서환삼덩굴이가장많이측정되었으며쑥, 돼지풀및국화류화분도높게검출되었다. 특히주거및하천변식생을나타내는 B지점이다른지역보다더높은농도로나타났다. 목초류꽃가루는 1% 미만의미미한출현율을나타냈다. 꽃가루의연중분포에서는 2월부터 6월에걸쳐수목류꽃가루비산절정기가나타나고 8월에서 10월에걸쳐잡초류 - 456 -
- 최승원외 4 인. 울산지역꽃가루농도와감작률 - Table 3. Frequency of sensitization to inhalant allergens according to various diseases Allergen Skin test reactivity rate (%) Rhinitis Rhinitis + Asthma Asthma Indoor allergens D. pteronyssinus 59.4 56.3 39.6 D. farinae 59.7 59.3 40.4 Cockroach 6.8 7.7 2.8 Tree pollens Alder 28.2 27.0 13.7 Ash 5.0 4.8 3.0 Beech 23.9 20.4 11.8 Birch 29.1 27.4 14.3 Elder 8.7 9.4 5.9 Elm 9.2 3.7 2.3 Hazel 28.7 27.2 13.4 Oak 25.4 17.9 14.6 Popular 4.2 4.8 2.3 Willow 4.5 5.4 2.2 Grass pollen mixture a 8.6 8.8 5.1 Weed/grass pollens Dandelion 10.8 7.7 7.3 Hop Japanese 15.3 7.5 4.8 Mugwort 15.4 13.7 9.1 Nettle 5.8 7.5 3.4 Orchard grass 14.1 11.9 3.9 Plantain 5.3 6.3 3.8 Ragweed 7.4 5.3 5.0 a Grass pollen mixture contains the following allergens: velvet grass, orchard grass, rye grass, timothy grass, Kentucky blue grass, and meadow fescue. 가비산되는연중두차례의절정기를보였다. 일년중측백나무, 오리나무, 참나무, 소나무등의수목류가대량으로비산되는 5월이꽃가루농도가가장높은시기였다 (Fig. 2). 높은농도로검출되거나중요알레르겐꽃가루의개별연중분포특징은다음과같았다. 2월말부터측백나무와삼나무과의꽃가루가출현되기시작되고 3월에는오리나무가, 4 월에는참나무가비산하고, 5월이면소나무꽃가루가대량으로발현하였다. 환삼덩굴류, 쑥류, 돼지풀등의잡초류꽃가루는 9월에최고조에달했다 (Fig. 3). Table 4. Airborne pollen counts in Ulsan, South Korea Pollen type Count Pollen type Count Pinus 10909.3 Prunus 9.3 Quercus (Oak) 2444.6 Amorpha 8.4 Alnus (Alder) 977.7 Dorotheanthus 8.3 Humulus 647.3 Oleaceae 8.2 Gramineae (Grass) 185.1 Acalypha 6.9 Cupressac 164.8 Solanum 6.6 Artemisia (Mugwort) 162.8 Cruciferae 5.8 Castanea 107.4 Rhus 5.1 Taxodiaceae 106.8 Populus 4.9 Ulmus + Zelkova 67.4 Platanus 4.8 Ginkgo 61.4 Juglans 4.3 Betula (Birch) 47.8 Taxus 3.9 Morus 41.9 Typha 3.7 Celtis 41.1 Amaranthaceae 3.3 Platycarya 40.7 Plantago 2.8 Ambrosia (Ragweed) 32.9 Acer 2.5 Cypercareae 22.4 Syringa 2.2 Carpinus 21.5 Spiraea 2.1 Cyclobalanopsis 21.4 Buxus 1.9 Compositae 21.1 Pterocarya 1.8 Chenopodiaceae 19.6 Polygonum 1.4 Corylus (Hazel) 14.2 Aesculus 1.0 Rumex 13.5 Ligustrum 0.9 Salix (Willow) 10.8 Rhododendron 0.7 Photinia 9.4 Persicaria 0.4 All counts are given as grains/cm 2 /year. 고 찰 알레르기질환의발생에는유전적소인과함께환경적요 인이관여하는데특히거주환경에서장기간반복적으로노 출되는항원이중요하다. 이중꽃가루는계절성알레르기 질환의원인으로비염, 천식, 각결막염등을일으킨다. 알레 르기를일으키는꽃가루는지역별로매우다양한특징을가 지고있다. 우리나라는 1970년대일정지역에국한된꽃가루 조사가보고된이후꾸준한연구가이루어졌고 1990년대이 후에는다기관연구를통한전국규모의조사와함께꽃가 루력 (pollen calendar) 이발표된바있다 [8-12]. 반면, 울산의 경우는알레르겐꽃가루와관련된역학연구는아직까지보 고되지않았다. 울산은우리나라동남부에위치하며 ( 동경 128 58'~129 27', - 457 -
- The Korean Journal of Medicine: Vol. 86, No. 4, 2014 - Figure 2. Monthly total atmospheric pollen counts at the three collecting stations in Ulsan. 북위 35 19'~35 43'), 1,200 m 이상의고산지대와산으로둘러싸인분지및동해에접해있는지역적특성을가지고있다. 한편, 울산은 1962년에특정공업지구로지정된이후공업화와도시화가급속히일어난지역이다. 따라서본연구를통해수립된울산지역꽃가루종류와농도및흡입알레르겐감작률에대한자료는향후환경변화에의한알레르기질환의변동을모니터링하는연구의기초데이터를제공할수있을것으로판단된다. 본연구에서울산호흡기알레르기환자의가장중요한알레르겐은다른지역과유사하게집먼지진드기였다. 두종류집먼지진드기에대한감작률은 38% 내외로나타나서강원지역의 20% 보다는높았으나 [13] 서울, 경기및제주를포함하는다기관연구와부산지역환자들의감작률인 30% 내외와비슷한양상을보였다 [9,14,15]. 반면, 꽃가루항원의감작률은다른지역과는일부상이한양상을보였다. 수목류에대한감작률을조사한연구에따르면서울, 경기, 제주및충청지역을대상으로한연구에서오리나무와개암나무, 자작나무, 너도밤나무, 참나무등의감작률은대부분 5% 내외였다 [9,14]. 이에비해본연구에서울산지역환자들의자작나무, 오리나무, 개암나무, 참나무, 너도밤나무등에대한감작률이모두 10% 이상으로월등히높았다. 이러한소견은인근지역인부산에서시행된연구에서도유사하게나타나는데, 부산지역호흡기알레르기환자의감작률은오리나무 16.7%, 자작나무 14.9%, 개암나무 13.4%, 참나무 11.5%, 너도밤나무 9.6%, 쑥 6.8%, 돼지풀 3.5% 로나타나서일부수목류에대한감작률이국내의다른지역에비해높았다 [16]. 본 Figure 3. Annual patterns for individual pollen types in Ulsan. 연구에서시행된울산대기의꽃가루분포에관한조사에서도참나무, 오리나무등감작률이높은수목류의꽃가루가실제로도높은농도로측정되어서피부시험결과와도관련성을보였다. 이들결과를고려하면울산의호흡기알레르기환자에서수목류꽃가루에대한감작률이높은것이수목의지리적분포등과같은지역적특성이반영됐을가능성이있다. 하지만국토면적이좁은우리나라의경우지역에따른수목분포의현저한차이를설명할수있는객관적인자료가없는실정이다. 다만, 지형여건에의한식생차이나인공조림, 혹은온난화에따른기후변화로수목분포의변화가능성을추측할수있다. 일반적으로연령이증가할수록알레르겐에대한감작률은감소하며 [17] 본연구에서도나이가많을수록대부분의알레르겐에대한감작률이낮았다. 특히 61세이상에서는집먼지진드기를포함한대부분의항원에대한감작률이낮았고일부수목류에대한감작률이 5% 내외로기존에다른지역의결과와유사하게나타났는데, 이러한현상이고령화에따른감작률저하인지혹은환경변화의영향인지는추후규명되어야할과제라고판단되었다. 이번연구결과, 울산도다른지역과마찬가지로연중두차례의꽃가루비산절정기가있었고대기중꽃가루농도는 5월에가장높았다. 가장많이검출되는꽃가루는소나무이었고수목류에서는참나무, 오리나무, 측백나무가잡초류는환삼덩굴, 쑥, 돼지풀의꽃가루농도가높게측정되었다. 특히잡초류는주거지역과하천변식생지역에서높게측 - 458 -
- Seung Won Choi, et al. Pollens and sensitization rate in Ulsan - 정되었는데, 이는돼지풀과환삼덩굴등이하천이나주거밀집지역, 공장지대과같이이산화탄소가높은지역에서번식을하는특성을고려했을때가능한결과로판단된다. 다른지역과마찬가지로울산의목초꽃가루출현은낮았으며이에대한감작률도낮아서알레르겐으로서목초의역할이적음이확인되었다. 본연구결과는부산의꽃가루농도조사결과인봄철절정기에오리나무, 소나무, 개암나무등의꽃가루농도가높고가을철에는돼지풀꽃가루가높은소견 [8] 과유사하였다. 최근전국적으로가을철잡초류꽃가루농도가급증한다는연구가발표된바있는데 [10,18] 향후울산에서도이에대한추이를관찰할필요가있다. 본연구에서는중력채집법의일종인 Durham 방법으로꽃가루를채집하였다. 이방법은설치된슬라이드위를지나는공기흐름의난류에의해표면에부착된꽃가루를측정하는방법으로설치및관리가편리한반면바람이불지않는경우꽃가루가적게채집된다는단점이있다. 따라서국내의다른연구에서사용된 Burkard sampler 를이용한연구결과의꽃가루양및농도와의단순산술적비교는어려웠다. 최근알레르겐감작률의종적변화에대한연구들이보고되고있는데, 지난수년간꽃가루에대한감작이양적, 질적으로뚜렷한변화를보이며특히수목류및잡초꽃가루에대한감작률이유의하게증가한다는보고가많다. 충북지역호흡기알레르기환자에서 1995년을기준으로수목류와쑥에대한감작률이급증했으며 [19] 1993년부터 2002년까지소아알레르기환자의감작률을분석한결과에서는집먼지진드기의감작률은변화가없었으나잡초꽃가루에대한감작이증가했다 [20]. 서울지역천식환자들도집먼지진드기에대한변화는없으나꽃가루항원에대한감작률이유의하게증가하였다 [10,21]. 광주지역은 2003년에서 2008년까지수목과목초꽃가루에대한감작률이증가되는양상을보였으며 [22] 경기지역환자의오리나무, 떡갈나무, 쑥, 돼지풀및환삼덩굴에대한감작률이 1999년부터유의하게증가하였다 [23]. 대기중꽃가루농도는기온과강수량및풍속과같은기후특성과밀접한관련이있다. 그외에도지구온난화에따른기후변화와환경오염등이꽃가루감작률증가에영향을미칠것으로추정되고있다 [24,25]. 기온상승으로식물의개화가빨라지고꽃이피어있는기간이길어지면꽃가루에 노출되는기간도길어지고여기에공해의증가로알레르기질환이급증하게되는하나의요인이되고있다 [5,26]. 우리나라도지구온난화의영향으로평균기온이상승하여아열대기후로변하고있으며강수량증가, 고온일수의증가및계절길이의변화와같은징후가나타나고있는데, 울산지역도예외는아니어서기상청기후자료연별변화도에따르면 1950년이후지속적으로평균기온이상승하고있다. 지구온난화와관련하여대기중꽃가루의항원성변화가보고되고있으며대기오염과의상호작용을통해알레르기질환의발생을증가시키는것으로알려져있다. 온실가스인이산화탄소의증가는꽃가루농도증가와함께항원성에도변화를일으키는것으로알려져있다 [27,28]. 오존, 미세분진, 및이산화황과같은대기오염물질은꽃가루에직접작용하여항원성을증가시킬수있으며기도에작용하여염증을유발하고점막투과성을증가시켜항원성분이점막을쉽게통과하여면역세포와반응하도록한다. 또한, 대기오염물질은이미감작된환자에서천식을유발혹은악화시키는일으키는역할을한다 [29,30]. 매연은목초꽃가루와결합하여감작을증가시키며라텍스또는베타글루칸항원은오염물질과결합하여꽃가루항원에대한감작률을높일수있다 [27,31]. 본연구를통해울산지역은다른지역과비교하여수목류꽃가루에대한감작률이높았으며대기중수목류꽃가루비산정도가높아서관심을기울여야할대상항원으로판단되었다. 최근기후및환경변화와함께알레르기질환이빠른속도로증가하여경제적부담과함께삶의질을저하시키고있다. 향후지속적으로꽃가루항원의양상변화와감작률및알레르기질환발생을체계적으로모니터링하는것이필요하겠으며기후변화가알레르기질환에미치는다양한방식과그대응방법에대한연구도함께진행되어야할것이다. 요약목적 : 울산지역호흡기알레르기질환자의꽃가루를포함한주요흡입항원에대한감작률을조사하고지역적꽃가루분포특성과그임상적의의를조사하고자연구를시행하였다. 방법 : 비염및천식으로진단되었던환자를대상으로꽃 - 459 -
- 대한내과학회지 : 제 86 권제 4 호통권제 644 호 2014 - 가루를포함한주요흡입알레르겐에대한피부시험을시행하였으며울산의 3개지역에서연중지속적으로대기중꽃가루종류와농도를측정하였다. 결과 : 개별항원에대한감작률은집먼지진드기에대해높았으며자작나무 15.8%, 오리나무 15.3%, 개암나무 14.2%, 참나무 13.5%, 너도밤나무 10.8%, 쑥 9.6% 순의감작률을보였다. 울산에서는연중 2차례꽃가루비산절정기가있었으며봄철에는소나무, 참나무, 오리나무가가을철에는환삼덩굴과쑥꽃가루가높게측정되었다. 결론 : 최근의기후및환경변화와함께알레르기질환이증가되고있으며흡입알레르겐에대한종류나감작률도지속적으로변하고있다. 향후꽃가루항원에대한지속적인모니터링으로알레르기질환을체계적으로관리하는것이필요하다. 중심단어 : 항원 ; 꽃가루 ; 감작 REFERENCES 1. Cho YJ. Allergic diseases by pollens (Pollinosis). J Korean Med Assoc 2003;46:326-330. 2. Kang SY, Min KU. Aerobiological and allergic study of pollen in Seoul. Korean J Asthma Allergy Clin Immunol 1984;4:1-20. 3. Hong CS, Hwang Y, Oh SH, Kim HJ, Huh KB, Lee SY. Survey of the airborne pollens in Seoul, Korea. Yonsei Med J 1986;27:114-120. 4. Park CW, Sim SS, Jung M, et al. Survey of airborn pollens in Mokpo, 1992. Allergy 1993;13:342-350. 5. Beggs PJ. Impacts of climate change on aeroallergens: past and future. Clin Exp Allergy 2004;34:1507-1513. 6. D Amato G, Cecchi L. Effects of climate change on environmental factors in respiratory allergic diseases. Clin Exp Allergy 2008;38:1264-1274. 7. Shea KM, Truckner RT, Weber RW, Peden DB. Climate change and allergic disease. J Allergy Clin Immunol 2008; 122:443-453. 8. Kim MJ, Cheon KW, Kim SW. Aerobiological study for airborne pollen and mold in Pusan. Pediatr Allergy Respir Dis 2000;10:119-130. 9. Oh JW, Lee HR, Kim JS, et al. Aerobiological study of pollen and mold in the 10 states of Korea. Pediatr Allergy Respir Dis 2000;10:22-33. 10. Oh JW, Kang IJ, Kim SW, et al. The correlation between increased sensitization rate to weeds in children and the annual increase in weed pollen in Korea. Pediatr Allergy Respir Dis 2006;16:114-121. 11. Oh JW, Kang IJ, Kim SW, et al. The association between the concentration of pollen and outbreak of pollinosis in childhood. Pediatr Allergy Respir Dis 2009;19:4-11. 12. Oh JW, Lee HB, Kang IJ, et al. The revised edition of Korean calendar for allergenic pollens. Allergy Asthma Immunol Res 2012;4:5-11. 13. Lee MK, Lee WY, Yong SJ, et al. Sensitization rates to inhalant allergens in patients visiting a university hospital in Gangwon region. Korean J Asthma Allergy Clin Immunol 2011;31:27-32. 14. Kim TB, Kim KM, Kim SH, et al. Sensitization rates for inhalant allergens in Korea; a multi-center study. Korean J Asthma Allergy Clin Immunol 2003;23:483-493. 15. Oh YC, Kim HA, Kang IJ, et al. Evaluation of the relationship between pollen count and the outbreak of allergic diseases. Pediatr Allergy Respir Dis 2009;19:354-364. 16. Kim KH, Kim KT, Lee SK, et al. Sensitization rates for inhalant allergens in patients with respiratory allergy in Busan. Korean J Asthma Allergy Clin Immunol 2005;25: 59-63. 17. Skassa-Brociek W, Manderscheid JC, Michel FB, Bousquet J. Skin test reactivity to histamine from infancy to old age. J Allergy Clin Immunol 1987;80:711-716. 18. Oh JW. Characteristics of allergic pollen and the pollen amount was recently changed in Korea. Korean J Asthma Allergy Clin Immunol 2007;27:1-7. 19. Kim MK, Oh SW. Change of causative inhalant allergens in respiratory allergic patients in Chungbuk district. Korean J Asthma Allergy Clin Immunol 1999;19:696-702. 20. Kim YJ, Han JE, Kang IJ. Change of inhalant allergen sensitization in children with allergic respiratory diseases during recent 10 years. Korean J Asthma Allergy Clin Immunol 2004;24:241-246. 21. Kim JH, Oh JW, Lee HB, et al. Changes in sensitization rate to weed allergens in children with increased weeds pollen counts in Seoul metropolitan area. J Korean Med Sci 2012; 27:350-355. 22. Yoon BJ, Kim SH, Kim DH, Koh YI. Longitudinal changes of sensitization rates to inhalant allergens in patients with allergic diseases from Gwangju and Chonnam areas: their association with annual changes in temperature. Korean J Asthma Allergy Clin Immunol 2011;31:93-104. 23. Lee JW, Choi GS, Kim JE, et al. Changes in sensitization rates to pollen allergens in allergic patients in the southern part of Gyeonggi province over the last 10 years. Korean J Asthma Allergy Clin Immunol 2011;31:33-40. 24. Ariano R, Canonica GW, Passalacqua G. Possible role of climate changes in variations in pollen seasons and allergic - 460 -
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