Cytokine pattern in allergic and non‐allergic chronic rhinosinusitis in asthmatic children

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Abstract
Background Rhinosinusitis represents one of the most common chronic diseases. The association of rhinosinusitis with asthma has been frequently reported. Eosinophils and Th2 cells play a pathogenic mechanism in asthma. Objective The aims of the study were to evaluate the cytokine pattern in chronic rhinosinusitis in asthmatic children and to compare the findings in allergic vs. non‐allergic asthmatics. Methods Thirty‐five asthmatic children were evaluated, 19 males and 16 females, with an average age of 8.7 years. All children were asthmatic and suffered from chronic rhinosinusitis. Twenty were allergic and 15 were non‐allergic. Ten healthy children were studied as normal controls. Evaluated parameters were the levels of the following cytokines: IL‐1β, IL‐4, IL‐6, IL‐8, IL‐12, IFN‐γ and TNF‐α. Cytokines were recovered from rhinosinusal lavage and measured by immunoassays. Nasal cytology was also performed in all subjects and inflammatory cells were counted by conventional staining. Results Allergic subjects showed a significant increase of IL‐4 (P < 0.01) and TNF‐α (P < 0.05) and a significant decrease of IL‐12 (P < 0.05) and of IFN‐γ (P < 0.0001), whereas IL‐1β, IL‐6 and IL‐8 were not significantly increased. Non‐allergic children showed a significant increase of IL‐4 (P < 0.05) and a significant decrease of IFN‐γ (P < 0.0001), IL‐12 was not significantly decreased, and IL‐1β, IL‐6 and IL‐8 were not significantly increased. A significant inflammatory infiltrate was present in all asthmatic children. Significant correlations were demonstrated between IL‐4 and IL‐12 (P < 0.001), IL‐12 and IFN‐γ (P < 0.001), IL‐8 and neutrophils (P < 0.01), and TNF‐α and monocytes/macrophages (P < 0.05), in allergic asthmatics. IL‐4 and IL‐12 were significantly correlated (P < 0.05) as well as IL‐8 and neutrophils (P < 0.01) in non‐allergic asthmatics. Conclusion This study shows that allergic asthmatic children with chronic rhinosinusitis have a typical Th2 cytokine pattern, but also non‐allergic asthmatic children share a similar pattern. These findings would suggest the existence of a common pathophysiological mechanism shared by upper and lower airways and are consistent with the concept of united airways disease.