frequency of vitamin D deficiency among asthmatic Egyptian children

Background: Vitamin D plays a role in the pathogenesis of asthma as it has a potent immunomodulatory effect acting on the cells of the innate immunity. It also reduces the risk of respiratory viral infections which are important initiators of asthma exacerbations. Besides, it potentiates the antiinflammatory action of corticosteroids which are considered the most effective controllers of asthma

Objective: To detect the frequency of vitamin D insufficiency and deficiency among Egyptian asthmatic children and to correlate vitamin D levels to the severity of asthma

Methods: This case control study was conducted on 60 asthmatic children and 40 healthy controls. All were subjected to clinical history taking including history of sun exposure and asthma medications and full clinical examination. Laboratory investigations included measurement of serum calcium, serum alkaline phosphatase and serum 25-OH-D levels and lung functions [spirometery]

Results: There was a significant correlation between vitamin D deficiency and severity of asthma, yet there was no significant relation between sun exposure and 25-OH-D level. Moreover, there was a significant relation between decreased serum 25-OH-D levels and the intensity of corticosteroid use. Vitamin D was also significantly lower in asthmatic patients with coexistent allergic rhinitis

Conclusion: Vitamin D deficiency is prevalent in Egyptian children with asthma .Lower levels of serum vitamin D are associated with high asthma severity, reduced asthma control and increased corticosteroid use

Monocyte chemotactic protein-4 [MCP-4/CCL-13] and CC chemokine receptor 3 [CCR3] in the sputum of asthmatic children

Monocyte chemotactic protein-4 [MCP-4/CCL-13] is a potent chemoattractant to eosinophils, monocytes and lymphocytes. We aimed to investigate MCP-4 and its CC chemokine receptor 3 [CCR3] expression on cells of induced sputum during acute asthma exacerbation. Immunohistochemistry was used to assess MCP-4 and CCR3 expression on induced sputum cells of 30 children during asthma exacerbation and 20 healthy matched controls. Patients were divided into three groups according to exacerbation severity; mild, moderate and severe [n = 10 for each]. Patients were followed until quiescence, when sputum was re-examined. MCP-4 and CCR3 were expressed on eosinophils and monocytes. Lymphocytes expressed only MCP-4. The percentages of sputum total cells, eosinophils and lymphocytes expressing MCP-4 and/or CCR3 were significantly higher during asthma exacerbation than in controls and negatively correlated with peak expiratory flow rate, whereas that of monocytes was not. The percentages of sputum total cells, eosinophils, monocytes and lymphocytes expressing MCP-4; and total cells and eosinophils expressing CCR3 were significantly higher in patients with severe than those with mild and moderate exacerbations. When patients were followed till remission, the percentages of sputum cells expressing MCP-4 and CCR3 decreased. Sputum eosinophil percentage correlated positively with the percentage of eosinophils expressing MCP-4 and CCR3 [r = 0.69, p < 0.0001; r = 0.62, p < 0.001, respectively]. The percentage of sputum eosinophils expressing MCP-4 correlated positively with that of cells expressing CCR3 [r = 0.95, p < 0.0001]. The expression of MCP-4 and CCR3 on sputum cells increases during acute asthma exacerbation and this increase correlates with exacerbation severity, and it decreases during remission. Modification of their expression could be a potential target for asthma therapy

Sputum epithelial cell-derived neutrophil-activating peptide-78 [ENA-78/CXCL5] in asthmatic children: relation to eosinophil activation

Epithelial cell-derived neutrophil-activating peptide-78 [ENA-78] is a chemokine that recruits, and activates neutrophils, possesses angiogenic properties and promotes, connective tissue remodeling. Thus, it could play a pathogenic role in allergic airway inflammation. Eosinophils are the major source for this chemokine in inflamed airways. To evaluate sputum ENA-78 expression and its relation to acute asthma exacerbations of varying severity, and eosinophil cationic protein [ECP] as a marker of eosinophil activation, as well as eosinophil counts in blood and sputum. Sputum ENA-78 and serum ECP were measured by ELISA in 21 children, during and after acute asthma exacerbation and 21 healthy matched controls. Patient, were subdivided according to exacerbation severity into three equal subgroups; mild moderate and severe. Sputum ENA-78 was significantly higher in asthmatic children during acute exacerbation than controls [310.1 +/- 156.9 pg/ml vs 65.9 +/- 11.6 pg/ml, p<0.0001]. It was significantly higher in severe than moderate and in moderate than mild exacerbations, and was negatively correlated to the expiratory flow rate. Sputum ENA-78 showed significant positive correlations with serum ECP and eosinophil counts in blood and sputum. By flow up of patients with acute asthma exacerbation till remission of symptoms and signs, sputum ENA-78, serum ECP and eosinophil counts in blood and sputum decreased significantly, but their levels remained significantly higher than the control values. Sputum ENA-78 is increased during acute asthma exacerbation and it positively correlates with exacerbation severity and eosinophil activation. Thus, it may play a role in the evolution of acute asthma exacerbation and may be a future target for new asthma therapeutic madalities