The effect of oral steroids with and without vitamin D3 on early efficacy of immunotherapy in asthmatic children.
BACKGROUND
The possibility of additional strategies to enhance the effectiveness of specific immunotherapy (SIT) is highly attractive.


OBJECTIVE
The aim of our study was to assess the influence of oral corticosteroids and oral corticosteroids combined with vitamin D(3) on the early clinical and immunological effects of SIT.


METHODS
It was a randomized, double-blind, placebo-controlled trial conducted in 54 asthmatic children allergic to house dust mites. Intervention was based on receiving a single dose of oral steroid, with or without vitamin D(3), or placebo only on the day of the build-up phase of SIT.


RESULTS
After 12 months of SIT, the median daily inhaled corticosteroid (ICS) dose, which controls the symptoms of asthma, was reduced by 25% in the steroid group. However, a 50% reduction of the median daily ICS dose was observed in the control group. The clinical effects of SIT were not affected in the steroid+D(3) group. Concomitantly, we found that intervention with prednisone significantly impaired the induction of T regulatory lymphocytes. Importantly, the clinical and immunological effects of SIT were not affected by intervention with steroids administered with vitamin D(3).


CONCLUSIONS
Our study failed to show a beneficial effect of oral corticosteroids on allergen-specific immunotherapy. We observed that the combined administration of a corticosteroid drug and allergen extract suppressed the early clinical and immunological effects of SIT and that vitamin D(3) prevented this 'adverse' influence of steroids.
Majak
P
P
Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
Rychlik
B
B
Stelmach
I
I
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D060829:Arthropod Proteins; D001249:Asthma / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D002112:Calcifediol / Q000097:blood; D002648:Child; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D040001:Dermatophagoides farinae / Q000276:immunology; D040002:Dermatophagoides pteronyssinus / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D051858:Forkhead Transcription Factors / Q000235:genetics; D015870:Gene Expression / Q000235:genetics / Q000276:immunology; D006801:Humans; D016753:Interleukin-10 / Q000378:metabolism; D018793:Interleukin-13 / Q000378:metabolism; D015848:Interleukin-5 / Q000378:metabolism; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000378:metabolism; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D050378:T-Lymphocytes, Regulatory / Q000276:immunology / Q000378:metabolism; D016212:Transforming Growth Factor beta / Q000378:metabolism; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D039741:Antigens, Dermatophagoides; D060829:Arthropod Proteins; C451163:Dermatophagoides pteronyssinus antigen p 2; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; C508609:IL10 protein, human; C508599:IL5 protein, human; D018793:Interleukin-13; D015848:Interleukin-5; D013256:Steroids; D016212:Transforming Growth Factor beta; D016753:Interleukin-10; D002762:Cholecalciferol; D002112:Calcifediol; D011241:Prednisone