[The effect of triamcinolone acetonide, montelukast, nedocromil sodium, formoterol on levels levels of sICAM-1, sIL-2R in serum and clinical course of asthma in children]

Abstract

One of the characteristics of asthma is the variability of inflammation. Thus, it is important to monitor inflammation serially in asthma, e.g. by the use of peripheral blood markers. To evaluate the effect of treatment on allergic inflammation, we measured serum levels of sIL-2R, sICAM-1 and clinical parameters before and after 4 weeks treatment with triamcinolon, montelukast, nedocromil and formoterol. It was 8 week, placebo-controlled and randomized, double blind trial of 158 children with moderate atopic asthma. Patients were randomly allocated to received 400 micrograms triamcinolon (n = 28), 5 or 10 mg (according to age) montelukast (n = 27), 16 mg nedocromil (n = 30), 24 micrograms formoterol (n = 29) or placebo (n = 44). 140 children completed the study. After treatment with triamcinolon, montelukast and nedocromil sIL-2R and sICAM-1 serum level significantly decreased, and all clinical parameters improved; treatment with triamcinolon had the strongest effect on most parameters (except of FEV1). Mean sIL-2R before and after treatment with triamcinolon were 724.1 pg/ml and 486.1 pg/ml respectively (p < 0.001); with nedocromil were 760.2 pg/ml and 596.7 pg/ml respectively (p < 0.001); with montelukast were 617.9 pg/ml and 491.2 pg/ml respectively (p < 0.001); with formoterol were 705.4 pg/ml and 698.9 pg/ml respectively (p = 0.8). Mean sICAM-1 serum levels before and after treatment with triamcinolon were 262.4 ng/ml and 210.4 ng/ml respectively (p < 0.001); with nedocromil were 292.9 ng/ml and 258.4 ng/ml respectively (p < 0.001); with montelukast were 277.7 ng/ml and 242.9 ng/ml respectively (p < 0.001); with formoterol were 262.6 ng/ml and 260.0 ng/ml (p = 0.6). We found significant correlation between: sIL-2R and hyperresponsiveness, sICAM-1 and hyper responsiveness, FEV1 and sICAM-1, FEV1 and sIL-2R, sIL-2R and sICAM-1 after treatment. This study shows that triamcinolon, montelukast and nedocromil contribute to inhibition of allergic inflammation by decreasing sIL-2R and sICAM-1 serum levels. The serum level of sIL-2R and sICAM-1 seem to be a good clinical marker of monitoring the disease; their levels decrease after treatment together with improvement in hyperresponsiveness and clinical parameters.