Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S91 (doi:10.1542/peds.2007-2022H)
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ALLERGOLOGY


CYTOKINE PROFILE IN LONG-TERM USE OF INHALED CORTICOSTEROID IN ASTHMATIC CHILDREN RECEIVING SPECIFIC IMMUNOTHERAPY

Ariyanto Harsono

Airlangga University, Jawa Timur, Indonesia

ABSTRACT

INTRODUCTION: Inhaled corticosteroids are widely used for the management of persistent asthma, including by those who receive specific immunotherapy.

OBJECTIVE: Our goal was to elucidate the cytokine profile in long-term use of corticosteroid inhalation in asthmatic children who were receiving specific immunotherapy.

METHODS: We performed a randomized, paralleled, comparative study of asthmatic children allocated into 3 groups: those in group A received inhaled budesonide, those in group B received specific immunotherapy, and those in group C received both specific immunotherapy and inhaled budesonide. The primary outcomes were interleukin 4 (IL-4), IL-5, interferon {gamma} (IFN-{gamma}), and IL-2 levels and forced expiratory volume in 1 second (FEV1) reversibility.

RESULTS: Significant differences were observed before and after treatment in all groups (P < .05). Patients who received inhaled budesonide showed attenuation of IL-4, IL-5, IFN-{gamma}, and IL-2 and 29% failure of FEV1 reversibility. Patients who received immunotherapy showed attenuation of IL-4 and IL-5, elevation of IFN-{gamma} and IL-2, and 24% failure of improvement of FEV1 reversibility. Patients who received inhaled corticosteroids and immunotherapy showed attenuation of IL-4 and IL-5, elevation of IFN-{gamma} and IL-2, and 100% improvement of FEV1 reversibility. Analysis of the discriminator yielded IL-2 as the primary discriminator, which correlated with the decrease of IL-5.

CONCLUSIONS: Long-term use of inhaled corticosteroids by children with asthma who received immunotherapy resulted in elevation of IFN-{gamma} and IL-2 and a decrease of IL-4 and IL-5. Addition of inhaled corticosteroids to immunotherapy resulted in marked attenuation of IL-5 and correlated with greater elevation of IL-2.

Submitted by Ariyanto Harsono