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 γ (IFN-γ), 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-γ, and IL-2 and 29% failure of FEV1 reversibility. Patients who received immunotherapy showed attenuation of IL-4 and IL-5, elevation of IFN-γ 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-γ 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-γ 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
- Copyright © 2008 by the American Academy of Pediatrics