MODULATION OF IMMUNE RESPONSE IN LONG-TERM USE OF INHALED CORTICOSTEROID IN CHILDHOOD ASTHMA RECEIVING SPECIFIC IMMUNOTHERAPY
ABSTRACT: Inhaled
corticosteroid is widely used in the management of mild to moderate persistent
asthma including those receiving specific immunotherapy. Immunological
mechanism underlie the improvement until now has not fully elucidated. Objective:
To elucidate the modulation of immune response in long-term use of
corticosteroid inhalation in asthmatic children receiving specific
immunotherapy. Materials and Methods: Parents signed informed consent after receiving
information of the study prior to enrollment. Randomization was done using
"systematic random sampling". Patients were divided into three groups: group A receiving inhaled budesonide, group B receiving
specific immunotherapy, and Group C receiving both specific immunotherapy and
inhaled budesonide. Patients aged 6-16 years received either inhaled budesonide
or specific immunotherapy for 3 months. The daily budesonide dose was 400 mg
for children aged 6-11 years or 200 mg for children younger than 11 years. The
primary outcome was IL-4, IL-5, IFN-γ and IL-2 and FEV-1 reversibility. Ethical
Committee of Dr. Soetomo Hospital Surabaya approved ethical clearance. Results:
Significant differences were observed between pre and post treatment in all
group (p<0.05). Patients receiving inhaled corticosteroid and immunotherapy
showed attenuation of IL-4 and IL-5, elevation of IFN-γ and IL-2, and improvement
of FEV-1 reversibility. Analysis of discriminant yielded IL-2 as primary
discriminator and correlated with the decrease of IL-5. Conclusion: Addition of
inhaled corticosteroid to immunotherapy results in marked attenuation of IL-5
correlates with greater elevation of IL-2 and play an important role in the
modulation of immune response resulting in the improvement of FEV-1 reversibility.
Author: Ariyanto Harsono
Journal Code: jpkedokterangg050018
