ABSTRACT
A 9 yr old girl with a history of eczema and asthma was admitted to our specialist asthma service and recruited into a trial designed to investigate systemic as well as therapeutic benefits of inhaled corticosteroids. Eight months after referral the patient died from an acute asthma attack. This childhood asthma death during an inhaled steroid trial has facilitated identification of risk factors. Despite good clinical response to inhaled corticosteroids, the patient was distinguishable from the other patients by: increased variability of the morning and evening peak flow rates; increased reactivity, though not sensitivity, to histamine; and an unprecedented rise in serum soluble interleukin-2 receptor levels immediately after commencing inhaled steroids. The immunological basis for corticosteroid resistance and immunohistochemical studies on postmortem specimens from asthma deaths suggest that T-cell activation markers may be indicators of the fatality prone asthmatic.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Asthma/drug therapy , Administration, Inhalation , Adolescent , Adrenal Cortex Hormones/therapeutic use , Asthma/blood , Asthma/physiopathology , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/therapeutic use , Budesonide/administration & dosage , Budesonide/therapeutic use , Child , Circadian Rhythm/physiology , Clinical Trials as Topic , Drug Resistance , Fatal Outcome , Female , Humans , Male , Pulmonary Ventilation/physiology , Receptors, Interleukin-2/blood , Risk FactorsABSTRACT
Soluble interleukin-2 receptor (sIL-2R) concentrations were measured in the sera of 18 healthy adult volunteers, 40 healthy children aged 5 months -16 years 8 months and cord blood from 10 babies, using two commercially available ELISA kits (T-cell Sciences and Serotec). In the presence of normal C-reactive protein (CRP) children (aged 0-16 years 8 months) had significantly higher sIL-2R concentrations than adults aged (18-37 years). In children up to the age of 16 years there was a significant negative correlation between age and sIL-2R (r = -0.725 p < 0.0001 T-Cell Sciences, r = -0.646 p < 0.0001 Serotec). A comparison was also made between the two kits, which indicated that both kits yielded reproducible results but the T-Cell Sciences kit had a larger working concentration range than the Serotec kit. Following 12-h sampling in adult volunteers, a lower concentration of sIL-2R was observed at 4 am compared with 10 am (p = 0.0052) which indicates diurnal variation. These observations emphasize the importance of the study of normals as part of any research, and raises further questions regarding the many factors which influence immune function.
Subject(s)
Enzyme-Linked Immunosorbent Assay/instrumentation , Reagent Kits, Diagnostic/standards , Receptors, Interleukin-2/analysis , Adolescent , Adult , C-Reactive Protein/analysis , Child , Child, Preschool , Fetal Blood/immunology , Humans , Infant , Infant, Newborn , Reference Values , Reproducibility of ResultsABSTRACT
Soluble interleukin-2 receptor (sIL-2R-CD25) concentrations were measured in the sera of 115 children with cystic fibrosis and 45 aged matched controls. Above the age of 4 years children with cystic fibrosis had significantly raised concentrations irrespective of disease status as judged by Shwachman score, lung function, or evidence of pseudomonas colonisation. It is believed that these data indicate that T lymphocyte activation can be detected before there is clinical evidence of lung inflammation due to infection in cystic fibrosis. They support the notion that early use of anti-inflammatory (immunosuppressive) drugs may have a role in delaying the progress of lung damage in cystic fibrosis.
