Tissue and serum cytokine responses and indicators of remodeling in allergic rhinitis and asthma association

Both asthma and allergic rhinitis are the most commonly encountered chronic diseases of childhood and both constitute majority of the children admitting to the emergency departments and day time clinics. Asthma and allergic rhinitis are comorbid diseases, that are frequently accompanying each other in same child. Both conditions are known to be secondary to chronic inflammation. Remodeling process that has been characterized in bronchial structures better than nasal mucosa is responsible for manifestations of these diseases and also for irrevesible changes detected in both nasal and bronchial mucosa. Our aim with this study, in the light of united airway disease concept representing co-occurence of asthma and allergic rhinitis in same patient, was to compare levels of cytokines and mediators reponsible of the chronic inflamation and remodeling process both between asthmatic children and children with allergic rhinitis and between patient group and control group.This study was performed at Celal Bayar University, School of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Pulmonology between January 2011 and April 2011. 40 Children with newly diagnosed asthma and both asthma and allergic rhinitis, who has been detected to have polen sensitivity and who was between 6-18 years old has been involved in the study. Control group was comprised of 20 healthy children without any allergic symptoms and symptoms related to other chronic conditions. Study has been performed prospectively. P value of less than 0.05 was accepted as statistically significant. 20 asthmatic children (12 Boys [%60]; 8 girls [% 40] ), 20 children with both asthma and allergic rhinitis children (12 Boys [%60]; 8 girls [%40] ) and 20 healthy children (11 Boys [% 55]; 9 girls [% 45]) were included in the study. Nasal lavage and serum samples were obtained from every children at the time of admission. Asthma and alllergic rhinitis symptom scores and pulmonary function test results, total IgE results and family history of atopy if exists were also recorded at the time of first admission. IFN-gama, IL-10, IL-5, TGF-beta, IL-4, IL-13, MMP-9, ve TIMP-1 levels were studied from the nasal lavage and serum samples obtained using ELİSA method.3 groups were similar regarding age and sexes. Pulmonary function tests and IgE levels were also similar between groups. IFN-gama, IL-10, IL-5, TGF-beta, IL-4, IL-13, MMP-9, ve TIMP-1 levels studied in nasal lavage fluid samples were found to be similar and statistically insignificant when compared between control group and both patient groups. Results of serum samples obtained for IFN-gama, IL-10, IL-5, TGF-beta, IL-4, IL-13, MMP-9, ve TIMP-1 levels were again statistically insignificant between study groups. Asthma symptom score was higher in asthmatic group compared to group of children with asthma and allergic rhinitis and the difference was statistically significant.In conclusion, in our study group, mediators and cytokines which were thought to be determinants of both chronic inflamation and remodeling in asthma and allergic rhinitis were found to be similar. We thought that this may due to small sample size of the study.