Immune response to hepatitis B vaccine in asthmatic children

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Abstract
Asthma is a disease that demonstrates chronic Th2 lymphocyte‐mediated pulmonary inflammation. We hypothesized that cytokines produced by asthmatic lung inflammation bias the immune response to antigens administered systemically toward a Th2 response, as assessed by serum IgE antibody and lymphocyte‐secreted IL‐4 and IL‐5. We also hypothesized that treatment of asthmatic children with local anti‐inflammatory agents reduces this cytokine‐mediated Th2 influence. We systemically immunized groups of asthmatic children (n = 29) who were participating in a long‐term, randomized, placebo‐controlled clinical trial of inhaled anti‐inflammatory therapy (Childhood Asthma Management Program) and nonasthmatic children (n = 12) with hepatitis B (Hep B) antigen, and examined their antigen‐specific antibody and lymphocyte cytokine secretion profiles. The asthmatic population demonstrated an increased amount of Th2‐mediated serum IgE anti‐Hep B antibody, as compared to nonasthmatic children; but comparable amounts of IgG1, IgG2, IgG3, IgA, and IgM anti‐Hep B antibody and lymphocyte IFNγ, IL4, and IL5. There was no significant difference of antibody isotype or cytokine production between asthmatic subjects receiving treatment with budesonide or nedocromil, as compared to placebo. In conclusion, there is a subtle bias in responses to systemic immunization in children with asthma, but anti‐inflammatory therapy does not affect this bias. The findings support the concept that the Th2 bias may be largely genetic. Importantly, we confirmed that children with asthma, including even those on inhaled corticosteroids, responded to Hep B immunization as well as did nonasthmatic children with the major isotypes of anti‐Hep B antibody, suggesting that vaccine protection against hepatitis B is not influenced by inhaled steroid therapy. Pediatr Pulmonol. 2003; 36:522–528.