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Severe preschool asthmatics have altered cytokine and anti‐viral responses during exacerbation
Author(s) -
Lejeune Stéphanie,
Pichavant Muriel,
Engelmann Ilka,
Béghin Laurent,
Drumez Elodie,
Le Rouzic Olivier,
Dessein Rodrigue,
Rogeau Stéphanie,
Beke Timothée,
Kervoaze Gwenola,
Delvart Céline,
Ducoin Héloïse,
Pouessel Guillaume,
Le Mée Armelle,
Boileau Sophie,
Roussel Juliette,
Bonnel Cécile,
Mordacq Clémence,
Thumerelle Caroline,
Gosset Philippe,
Deschildre Antoine
Publication year - 2020
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.13268
Subject(s) - wheeze , exacerbation , medicine , asthma , sputum , immunology , atopy , cytokine storm , cytokine , pathology , tuberculosis , covid-19 , disease , infectious disease (medical specialty)
Background Preschool asthma/recurrent wheeze is a heterogeneous condition. Different clinical phenotypes have been described, including episodic viral wheeze (EVW), severe intermittent wheeze (SIW), and multiple‐trigger wheeze (MTW). Objective To compare clinical, viral, and inflammatory/immune profiling at exacerbation between MTW, SIW, and EVW phenotypes. Methods Multicenter, prospective, observational cohort (VIRASTHMA‐2). Children (1‐5 years) with preschool asthma were enrolled during hospitalization for a severe exacerbation. History and anamnestic data, plasma, and nasal samples were collected at exacerbation (T1) and at steady state, 8 weeks later (T2), and sputum samples were collected at T1. Results A total of 147 children were enrolled, 37 (25%) had SIW, 18 (12.2%) EVW, and 92 (63%) MTW. They were atopic (47%), exposed to mold (22%) and cigarette smoke (50%), and prone to exacerbations (≥2 in the previous year in 70%). At exacerbation, at least one virus was isolated in 94% and rhinovirus in 75%, with no difference between phenotypes. Children with MTW and SIW phenotypes displayed lower plasma concentrations of IFN‐γ ( P = .002), IL‐5 ( P = .020), TNF‐α ( P = .038), IL‐10 ( P = .002), IFN‐β ( P = .036), and CXCL10 ( P = .006) and lower levels of IFN‐γ ( P = .047) in sputum at exacerbation than children with EVW. At T2, they also displayed lower plasma levels of IFN‐γ ( P = .045) and CXCL10 ( P = .013). Conclusion Among preschool asthmatic children, MTW and SIW, prone to exacerbations, display lower systemic levels of Th1, Th2 cytokines, pro‐ and anti‐inflammatory cytokines, and antiviral responses during severe virus‐induced exacerbation.