Allergic rhinitis and house dust mite sensitization determine persistence of asthma in children.

Abstract

Background: MAS study revealed that chronic course of asthma characterised by airway hyper-responsiveness and impairment of lung function at school age is determined by continuing allergic airway inflammation which begin in the first 3 years of life. Respiratory tract infections early in life, childhood allergic comorbidities, exposure to environmental determinants of asthma and active smoking may all contribute to increased risk of allergic disorders. While these correlations have been established, there is little understanding of the immunological mechanisms by which asthma develops into a persistent disease, or by which symptoms regress. Methods: Eighty patients were included into the analysis. Clinical and immunoregulatory predictors of asthma were analyzed. Results: Presence of mAPI criteria as well as the presence of house dust mite-allergy and allergic rhinitis at present, were associated with a reduced prevalence of asthma remission. The presence of increased eosinophil blood count in API (Asthma Predictive Index) criteria was associated with a lower expression of CD25 positive cells. Current presence of HDM-allergy was associated with a higher FeNO level and higher expression of CD25CD71 positive cells. Allergic rhinitis was associated with a higher expression of PPAR and CD25CD71 positive cells; in the same group of patients a lower expression of GARP positive cells were observed. Conclusions: Probability of persistence of childhood asthma was largely determined by the presence of allergic rhinitis and sensitization to HDM. Our results suggest natural remission of clinical symptoms of asthma in children are not fully related to immunoregulation processes. Additionally, API criteria are related to asthma persistence.