title: Clinical efficacy and laboratory improvement of bacillus calmette-guerin vaccination on adult atopic asthma: a cohort study.
abstract: BACKGROUND
  : Recent studies have shown that Bacillus Calmette-Guerin (BCG) vaccination is inversely related to asthma, a Th2 cell-associated with allergic disease, which BCG in humans induces Th1-cell immune responses and prevents airway remodeling.
  
  
  OBJECTIVE
  : To investigate whether thrice BCG vaccinations are clinically effective and could induce laboratory improvement compared with placebo on phase 1 (12 weeks) and single BCG vaccination on phase 2 of the study, then finding out whether the effect might last until 9 months after thrice vaccination and 9 months after single vaccination on adult atopic extrinsic asthma.
  
  
  METHODS
  : According to the Global Initiative for Asthma criteria, 40 mild to moderate persistent atopic asthma patients were randomly assigned in a double-blind fashion into groups that received intradermal injection of 0.1 mL of BCG (n = 20) or 0.1 mL of placebo (n = 20) on the first day. On the first phase, subjects on BCG vaccinations were given intradermal injections 3 times on the deltoid region every 4 weeks. On the second phase, at the 12th week, the placebo group was given BCG vaccination once, and this group became the single BCG group. The symptom score (SS) and drug score (DS), lung function, eosinophil blood count (EBC), total serum immunoglobulin E, interferon-γ (IFN-γ), interleukin 4, and transforming growth factor-β1 (TGF-β1) were examined on the first phase (before the treatment and at the 12th week) and on the second phase (on the sixth and ninth months after the third vaccination for thrice BCG group or after single BCG for control group) to monitor the efficacy.
  
  
  RESULTS
  : There were some improvements of asthma SS (P < 0.05) and DS (P < 0.05), forced expiratory volume in 1 second (P < 0.05), peak expiratory flow rate (P < 0.05), EBC (P > 0.05), IFN-γ (P < 0.05), and TGF-β1 (P < 0.05) on thrice BCG group compared with prevaccination and with placebo on the first phase and second phase of the study compared with single BCG (formerly placebo).
  
  
  CONCLUSIONS
  : Based on the previous findings, we could confirm that thrice BCG vaccinations proved to be better than the placebo group and single vaccination. The efficacy of thrice BCG vaccinations on asthma was detected by the improvement of SS, DS, forced expiratory volume in 1 second, peak expiratory flow rate, EBC, IFN-γ, and TGF-β1 until 9 months from the last vaccination without any side effects.
authors.affiliation: From the *Divisions of Allergy-Immunology and †Pulmonology, Department of Internal Medicine, School of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia.
authors.forename: Eulis A
authors.initials: EA
authors.lastname: Datau
authors.forename: H
authors.initials: H
authors.lastname: Mewengkang
authors.forename: J C
authors.initials: JC
authors.lastname: Matheos
authors.forename: I
authors.initials: I
authors.lastname: Purnawan
authors.forename: M
authors.initials: M
authors.lastname: Wibisono
authors.forename: K
authors.initials: K
authors.lastname: Wongdjaja
authors.forename: C
authors.initials: C
authors.lastname: Wibowo
authors.forename: E
authors.initials: E
authors.lastname: Surachmanto
authors.forename: F P
authors.initials: FP
authors.lastname: Salim