METHODS: 98 patients with mild allergic asthma (J45.0), with seasonal exacerbations having pollen allergy and 109 patients with severe uncontrolled asthma (J 45.8) were studied including spirometry, induced sputum (IS) and ACQ questionnaire. EBS assessment included ELISA for serum anti-ET IgA, G, and M; specific IgE; secretory anti-ET sIgA; CRP; and LPS binding protein (LBP). Flow cytometry assessed TLR- 4 and ET binding receptors (ET-R) on monocytes and neutrophils.
RESULTS: IS was eosinophilic in 97.3% in allergic BA (J45.0), with preseasonal good control (ACQ: 0.213 to 0.28), and pollen seasonal deterioration (ACQ: 0.42 ± 0.12; p <0.01). Serum anti-ET antibodies, LBP, CRP, TLR 4, and ET-R were normal but allergic BA had increased LBP and decreased secretory anti-ET-sIgA in IS. Allergen immunotherapy with probiotics in seasonal asthma gave control of asthma in 80% including 91.7% during pollination, with increased anti-ET-IgM (1.3-fold, p <0.01), anti-ET-IgA (2-fold, p <0.05) and secretory anti-ET-sIgA (1.8-fold, p <0.05) and decreased both sputum LBP ( 1.9-fold, p <0.001) and allergen-specific IgE. Severe asthma (J 45.8), IS was eosinophilic-neutrophilic (51%), ACQ ranged from 3.5 to 4.0, with significant increase in serum anti-LPS IgM 1.9- 2.3 fold (p <0.01) and increased secretory anti-ET IgA and LBP in IS (p <0.01). Improvement in asthma control gave decreased IS anti-ET-sIgA and LBP and serum CRP.
CONCLUSIONS: Anti ET- immune responses have a role in pathogenesis of allergic BA and severe asthma.