Determinação dos níveis de IFN-y e IL-5 no fluido de lavado nasal de crianças com rinite alérgica após tratamento com mometasona, montelucaste ou desloratadina

Abstract

Allergic rhinitis (AR) is clinically defined by ARIA (Allergic Rhinitis and its Impact on Asthma) as a symptomatic disorder of the nose, induced after allergen exposure by an IgE mediated inflammation of the nasal membranes.The symptoms of allergic rhinitis include rhinorrhoea, nasal obstruction, nasal itching and sneezing. AR represents a global health problem and its prevalence has increased in the last years. Therapy for allergic rhinitis aims to control symptoms and improve the quality of life. Nowadays the treatment of allergic rhinitis includes allergen avoidance, environmental control, pharmacologic treatment and specific immunotherapy. The aim of this study is to evaluate the clinical efficacy and changes in IFN-y and IL-5 levels in nasal lavage fluid from children with allergic rhinitis after different groups of treatment (mometasone, montelukaste or desloratadine). This is a prospective randomized open study. Twenty-three children were selected aged from six to twelve years, with moderate persistent allergic rhinitis which were randomly distributed in three groups of treatment during four weeks- (I) nasal corticosteroid (mometasone); (II) anti-leukotriene (montelukaste); and (III) antihistamine (desloratadine). Patients were submitted to the following steps- full-filling a clinical questionnaire and a diary symptoms for determination of the total symptom score (TSS), skin prick tested, sampling nasal lavage fluid before and after treatment for measuring IFN-y e IL-5 cytokines by immunoassay (ELISA), blood sampling for red and white cell counting and measurement of total serum IgE. A reduction in IL-5 levels was observed in the treated groups with mometasone and montelukaste, although a significant reduction (p = 0.0469) has been observed only in the group treated with mometasone. In contrast, there was a significant augment in IL-5 levels (p = 0.0469) in the group treated with desloratadine. A tendency of increasing in the levels of IFN-y was observed, especially in the treated groups with desloratadine and mometasone, although with no statistical significance. A tendency of symptoms improving was verified by decreasing the TSS in all therapeutic groups, although this improvement was not significant. However, there was a clear clinical efficacy by parents perception means only in the group treated with mometasone (p< 0,05). It can be concluded that the group treated with mometasone showed improvement of clinical symptoms as well as reduction in IL-5 levels in the nasal lavage fluido of children with allergic rhinitis.