A Case of Korean Ginseng-Induced Anaphylaxis Confirmed by Open Oral Challenge and Basophil Activation Test

Two case reports discussing Korean ginseng-induced allergic reactions have been published; both were inhalation-induced respiratory allergies in occupational settings. In this report we discuss the first case of anaphylaxis that developed after an oral intake of ginseng, confirmed by an open oral challenge, a skin prick test (SPT), and a basophil activation test (BAT). A 44-year-old man experienced rhinorrhea and nasal stiffness, followed by respiratory difficulty with wheeze and abdominal pain 10 minutes after oral intake of fresh ginseng. He had suffered from episodes of allergic rhinitis during the spring season for several years. Upon presentation, a physical examination, chest radiograph, and routine laboratory tests were unremarkable. Total serum IgE level was 41 IU/mL. The SPT results showed strong positive responses to alder, birch pollens, and ginseng extracts (1:500 w/v). The methacholine bronchial challenge test revealed a positive result at PC20 of 5.83 mg/mL. The open oral challenge was performed using 50 g of fresh ginseng and showed immediate onset of facial flushing, cough, respiratory difficulty with wheeze, and abdominal pain combined with a significant decrease in FEV1 levels (54% from the baseline). Serum-specific IgE and IgG4 antibodies were not detectable by enzyme-linked immunosorbent assay. BAT showed a remarkable increase in the expression of CD203c and CD63 with the addition of ginseng extract in a dose-dependent manner, while no changes were noted in the controls. In conclusion, oral intake of Korean ginseng could induce anaphylaxis, which is mediated by non-IgE-dependent direct activation of basophil/mast cells.     

A Case of Acquired Idiopathic Pterygium Inversum Unguis

Pterygium inversum unguis (PIU) is a rare nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate, with obliteration of the distal groove. Because of the rarity of this condition, its exact origin is unknown. This disorder can be either congenital or acquired, with or without a family history. The acquired forms may be idiopathic or secondary to systemic connective tissue diseases or other causes such as stroke, neurofibromatosis, leprosy, or the use of nail fortifiers. We present an unusual case of acquired idiopathic PIU of the 10 fingernails in a 22-year-old man.     

Preparation and characterization of isosorbide 5-mononitrate extended-release tablets

The objective of this study was to prepare isosorbide 5-mononitrate tablets with an extended-release base using paraffin wax. The goal was to develop a tablet formulation equivalent to the commercially available Imdur^? Long Acting Tablet 60?mg. We investigated the effect of paraffin wax on the dissolution rate of isosorbide 5-mononitrate and performed an in vitro dissolution test using the paddle method. The paddle stirring rates were varied from 50 to 150?rpm to mimic pre- and postprandial conditions and determine the effect of food uptake affects on drug absorption. In the dissolution study, isosorbide 5-mononitrate tablets with paraffin wax exhibited extended-release behaviors from 72 to 90?% over an 8-h period, of which the #4 formulation (110-mg paraffin wax) was comparable to the Imdur^? Long Acting Tablet 60?mg. From the f ₂ factor, the paddle stirring rate did not affect the dissolution both pH 1.2 and 6.8 between the formulation #4 and Imdur^? Long Acting Tablet 60?mg for 10?h. The results suggest that the properties of oral extended-release tablet of isosorbide 5-mononitrate containing paraffin wax were comparable to those of the Imdur^? Long Acting Tablet 60?mg, and satisfied the guidelines of the Korea Food and Drug Administration.