Prevention and Causal Therapy of Asthma by

Immunomodulation

Summary

Asthma is the most common chronic disease in children and in adult . In allergic and asthma subjects the activity of T helper cells type 2 (Th2) predominates over that of  
T-helper  cells type 1 (Th1).

T-helper cells type 2 (Th2) with their cytokines such as IL-5 and IL-13 are responsible for increased synthesis of IgE , the activation and degranulation of mast cells and basophils , the differentiation and activation of eosinophils and their migration into the target organs and the enhanced expression of IgE receptors and adhesion molecules on various cell types.

The mechanism of specific immunotherapy (SIT) may involve a reorientation of the Th2 dominated response to the Th1 cells .

Purified naive and high molecular allergens unused in conventional immunotherapy increase the activity of Th1, but on the other hand may react with existing IgE and B cell epitopes which enhance the activity of Th2 and diminish the desired immunomodulatory effect .

T cells orientated specific immunotherapy is a new modified specific immunotherapy in which B cell epitopes are strongly reduced or eliminated , but T cell epitopes are retained by using allergoid preparation. Our study showed that this form of immunotherapy in patients with bronchial asthma modulates the immune system and improves the disturbed balance between Th1 and Th2 and leads to a remarkable and continuous clinical improvement.

Another interesting aspect is to prevent the occurrence of asthma in high risk children with a family history of atopy and in children with atopic dermatitis.

For the first time we have been able to show that a oral systemic treatment with selenium ( sodium selenite ) improves remarkably the skin condition of children with atopic dermatitis. Our data indicate that apart from its scavenger properties ,selenium modulates the immune system and improves especially disturbed balance between Th1 and Th2 and possibly between CD8+ cytotoxic T cells type 1 (Tcl) and CD8+ cytotoxic T cells type 2 (Tc2).

Follow-up examinations within our patients over 7 years did not show any occurrence of asthma in the study group compared with the control group. In several studies , the oral administration of non-pathogenic probiotic bacteria such as Lactobacillus and Bifid bacterium in children with atopic dermatitis showed a significant improvement of the skin condition and suppression of lymphocyte proliferation and down-regulation of IL-4 production. Fellow-up examinations within these patients over a number of years are necessary to evaluate whether probiotic therapy is able to prevent the switch of atopic dermatitis to asthma.