Astımlı Çocuklarda Tüberkülin Yanıtı Sağlıklı Çocuklardan Daha mı Düşük?

Öz

Amaç: Alerjik hastalıkların prevelansı tüm dünyada artmaktadır. Astım ve alerjik hastalıklarda Th1/Th2 dengesinin Th2 yönünde değişim hipotezi öne sürülmektedir. Tüberkülin yanıtından da Th1 yanıtı sorumlu olup, alerjik çocuklarda sağlıklı çocuklardan farkı ile ilgili çelişkili veriler mevcuttur. Bu çalışmada, Türkiye’deki okul öncesi çocuklarda astım-atopi-tüberkülin ilişkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Yaşları 2-5 yaş arasında olan doğumdan sonra ilk 2 ay içinde BCG aşısı yapılan 200 sağlıklı ve 200 astımlı çocuk çalışmaya alındı. Serum total Ig E, aeroalerjen duyarlılığı, hava yolu direnci, astım ağırlığı ve tüberkülin cilt testi kaydedildi.Bulgular: Astımlı çocuklarda anlamlı olarak sağlıklı çocuklara göre tüberkülin yanıtı daha düşük bulundu median=0 mm ve median= 7 mm p: 0,0001 . Tüberkülin yanıtı hava yolu direnci ve atopi belirteçleri ile ilişkili değildi. Mycobacterium tuberculozis enfeksiyonu astımlı çocuklarda %5 sağlıklı çocuklara %1 göre daha sık bulundu.Sonuç: Astımlı çocuklardaki düşük tüberkülin düzeyi ve Mycobacterium tuberculozis enfeksiyonuna artmış eğilim bu çocuklarda Th1 yanıtının daha az olması ile açıklanabilir. Tüberküloz prevelansının yüksek olduğu toplumlarda yaşayan astımlı çocuklarda, tüberküloz açısından klinik şüphe yüksek tutulmalıdır

Anahtar Kelimeler

• Tüberkülin,atopi,astım,mycobacterium tuberkülozis enfeksiyonu

Is Tuberculin Response Lower in Asthmatics Relative to Healthy Children?

Öz

Objective: The prevalence of allergic diseases has been increasing all over the world. It has been hypothesized that asthma and allergic diseases are disorders showing an imbalance of Th1/Th2 with a predominant Th2 response. There are conflicting data whether tuberculin reaction, which elicits a T helper 1-type immune response, differs in children with allergic diseases and healthy children. This study was aimed to investigate the relationship between asthma, atopy and tuberculin response in Turkish preschool children. Material and Method: A total of 200 asthmatic children and 200 healthy controls, aged 2 to 5 years, vaccinated with BCG within the first two months of life were enrolled into the study. Serum IgE levels, sensitization to common aeroallergens, airway resistance, asthma severity and response to tuberculin 5TU skin test were retrospectively evaluated from the records.Results: Asthmatic children had significantly lower tuberculin response than healthy children median=0 mm vs median=7 mm p=0.001 . Tuberculin response was not associated with atopy markers and airway resistance. Mycobacterium tuberculosis infection was found to be more frequent among asthmatics 5% than the control group 1% .Conclusion: Lower tuberculin response of asthmatics and tendency to Mycobacterium tuberculosisinfection may be explained by the decreased capacity of asthmatics to produce Th1-type cytokines. High index of clinical suspicion for tuberculosis should be needed in asthmatic children living in communities where tuberculosis prevalence is high

Anahtar Kelimeler

• Tuberculin,atopy,asthma,mycobacterium tuberculosis infection

Kaynakça

1. Romagani S. Induction of Th1 and Th2 responses: a key role for the natural immune response? Immunol Today 1992;13:450-5.
2. Shaheen SO. Changing patterns of childhood infection and the rise in allergic disease. Clin Exp Allergy 1995,25:1034-7.
3. https://doi.org/10.1111/j.1365-2222.1995.tb03248.x
4. Abbas Ak, murphy km, Sher A. Functional diversity of helper T lymphocytes. Nature 1996;383:787-93.
5. https://doi.org/10.1038/383787a0
6. Del Prete GF, De Carli m, mastromauro C, Biagiotti R, macchia D, Falagiani P, et al. Purified protein derivative of Mycobacterium tuberculosis and excreto- ry-secretory antigen (s) of Toxocaracanis expand in vitro human T cells with stable and opposite (type 1 T helper or type 2 T helper) profile of cytokine produc- tion. J Clin Invest 1991;88:346-50.
7. https://doi.org/10.1172/JCI115300
8. Grüber C, Paul kP. Tuberculin reactivity and allergy. Allergy 2002;57:277-80.

9. https://doi.org/10.1034/j.1398-9995.2002.03379.x
10. Shirakawa T, enomoto T,Shimazu S, Hopkin Jm. The inverse association between tuberculin responses and atopic disorder. Science 1997;275:77-9.
11. https://doi.org/10.1126/science.275.5296.77
12. Ota mO, van der Sande mA, Walraven Ge, Jeffries D, Nyan OA, marchant A, et al. Absence of associa- tion between delayed type hypersensitivity tuberculin and atopy in children in The Gambia. Clin Exp Allergy 2003;33:731-6.
13. https://doi.org/10.1046/j.1365-2222.2003.01599.x
14. Cookson W, moffatt mF. Asthma: An epidemic in the absence of infection. Science 1997;275(5296):41-2.
15. https://doi.org/10.1126/science.275.5296.41
16. Sander B, Skansen-Shapir U, Damm O, et al. Sequential production of Th1 and Th2 cytokines in response to live bacillus Calmette-Guerin. Immunology 1995;86:512-8.
17. Dauglelat S, Ladel CH, kauffmann SH. Influence of mouse strain and vaccine viability on T-cell responses induced by Mycobacterium bovis and bacillus Calmette- Guerin. Infect Immun 1995;63:2033-40.
18. Annus T, montgomery Sm, Riikjarv mA, Björkstein B. Atopic disorders among Estonian schoolchildren in relation to tuberculin reactivity and the age at BCG vaccination. Allergy 2004;59:1068-73.
19. https://doi.org/10.1111/j.1398-9995.2004.00557.x
20. Omenaas e, Jentoft HF, Vollmer Wm, Buist AS, Gulsvik A. Absence of relationship between tuberculin reactivity and atopy in BCG vaccinated young adults. Thorax 2000;55:454-58.
21. https://doi.org/10.1136/thorax.55.6.454
22. Aaby P, Shaheen SO, Heyes CB, Goudiaby A, Hall AJ, Shiell AW, et al. Early BCG vaccination and reduction in atopy in Guinea-Bissau. Clin Exp Allergy 2000-30:644-50.
23. https://doi.org/10.1046/j.1365-2222.2000.00803.x
24. Yılmaz M, Bingöl G, Altıntaş D, Kendirli SG. Correlation between atopic diseases and tuberculin responses. Allergy 2000;55:664-7.
25. https://doi.org/10.1034/j.1398-9995.2000.00486.x
26. Ozmen S, Tomac N, Uysal A, Arslan Z, kuyucu N, Toney A. Tuberculin responses in children with allergic diseases. Allergy 2002;57:1059-62.
27. https://doi.org/10.1034/j.1398-9995.57.s73.49_4.x
28. kale HS, Tastan y, Pince O, Altuncu e, erginoz e. Is the mycobacteria-derived purified protein response in atopic asthmatic children different? Int Arch Allergy Immunol 2004;135:229-34.
29. https://doi.org/10.1159/000081308
30. O’Donnell ma, Luo y, Chen X, Szilvasi A, Hunter Se, Clinton Sk. Role of IL12 in induction and poten- tiation of IFNg in response to BCG. J Immunol 1999; 163(8):4246-52.
31. Global Initiativeforasthma (GINA). Global strategy for asthma management and prevention: update 2016. (www.ginasthma.org).
32. Reference book for tuberculosis disease control and pre- vention in Turkey. Official publication of Turkish Health Ministry and Centers for Tuberculosis Disease Control and Prevention, Ankara 2003 [Türkiye’de tüberkülozun kontrolü için başvuru kitabı. TC Sağlık Bakanlığı, Verem Savaş Daire Başkanlığı, Ankara, 2003].
33. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am Respir Crit Care Med 2000;149:1376-95.
34. Alyasin S, katibeh P, Asadi S. Therelation ship between tuberculin response, BCG vaccine scar and asthma. Iran J Allergy Asthma Immunol 2009;8(4):205-10.
35. Jang AS, Son mH. The association of airway responsive- ness and tuberculin responses. Allergy 2002, 57:341-5.
36. https://doi.org/10.1034/j.1398-9995.2002.1s3379.x
37. Jentoft HF, Omenaas e, eide Ge, Gulsvik A. Absence of relationship between tuberculin reactivity and asthmatic symptoms, level of FEV1 and bronchial hyperresponsiveness in BCG vaccinated young adults. Allergy 2002;57:336-40.
38. https://doi.org/10.1034/j.1398-9995.2002.1s3342.x