Markers of allergic inflammation in peripheral blood of children with asthma after treatment with inhaled triamcinolone acetonide

Background: It is important to monitor inflammation regularly in asthma in addition to clinical symptoms, and there is a great need for noninvasive te sts that could routinely be used in clinical practice. Objective: Our hypothesis was that the improvement of clinical parameters, together with decreased airway responsiveness, could be correlated with cha nges in the levels of serum markers of inflammation after a 4-week treatmen t with triamcinolone. Methods: In this double-blind, randomized, placebo-controlled trial, 48 chi ldren, aged 6 to 18 years, with mild to moderate atopic asthma, were random ly allocated to receive triamcinolone or matching placebo for 4 weeks. The following parameters were measured: the symptom score, forced expiratory vo lume in I second (FEV1), provocative concentration of histamine causing a 2 0% fall in FEV1 (PC20) for histamine and peripheral blood eosinophil count, serum levels of the inflammatory markers eosinophil cationic protein (ECP) , soluble receptor of interleukin-2 (sIL-2R), interleukin-4, soluble interc ellular adhesion molecule-1 before and after treatment. Results: The clinical parameters significantly improved after treatment wit h triamcinolone, the mean value of FEV1 changed from 74% of predicted value before, to 90% of predicted after treatment (P < 0.0001). PC20 for histami ne after treatment with triamcinolone increased significantly from the mean value 2.5 mg/mL to 4.7 mg/mL (P < 0.001). Treatment with triamcinolone sig nificantly (P < 0.05) decreased serum levels of all the measured inflammato ry markers. The mean concentration of eosinophil blood count was 380 and 26 1 cells/mm(3); ECP, 83 and 58 ng/mL; serum sIL-2R, 734 and 487 pg/mL; solub le intercellular adhesion molecule-1, 266 and 210 ng/mL, before and after t reatment, respectively. The values of interleukin-4 were low and close to t he sensitivity of the assay. A significant correlation was found between EC P and sIL-2R levels before and after treatment with triamcinolone. Conclusions: A significant decrease of all the measured serum parameters wa s observed after treatment with triamcinolone; however, no significant corr elation was found among any of those parameters and clinical markers of dis ease severity (such as FEV1 or PC20H).