Serum 25-hydroxy vitamin D in asthmatic children and its relation to disease severity
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20185510Keywords:
Asthma, Vitamin D, Asthma severity, ChildrenAbstract
Background: Asthma is a chronic immunological disorder of the lungs. Vitamin D has several effects on the innate and adaptive immune systems. Little is known about vitamin D level and its impact on severity of asthma in children. This study aimed to determine vitamin D levels in asthmatics versus control children; studying the relation if any between these levels and asthma severity.
Methods: This cross-sectional study was conducted on 60 asthmatic children and 20 apparently healthy children as controls. Asthma patients were divided into 3 groups (mild, moderate, severe; 20 each). Asthma severity was based on GINA criteria. Vitamin D level was measured to all study group.
Results: The difference between the mean values of vitamin D level in control and asthmatic patients was statistically significant (p<0.001). This difference between control group and each asthma subgroup and between asthma subgroups versus each other were statistically significant being highest in control and lowest in patients with severe asthma (p<0.001). Differences in vitamin D status in control and all asthmatic patients were statistically significant (p<0.001). The difference between control group and each asthma subgroup according to vitamin D status were statistically significant (p<0.001). Concerning asthma subgroups the difference in vitamin D status between severe versus mild and moderate asthma were statistically significant (p<0.001), while between mild and moderate asthma it was not.
Conclusions: Significantly lower vitamin D level in asthmatic children compared to controls and a differential decrease in vitamin D levels in asthmatic children being lowest in severe asthma was confirmed.
References
Moore WC, Meyers DA, Wenzel SE, Teague WG, Li H, Li X, et al. National heart, lung, and blood institute’s severe asthma research program, identification of asthma phenotypes using cluster analysis in the severe asthma research program. Am J Respir Crit Care Med 2010; 181:315-23.
Zedan M, Settin A, Farag M, Ezz-Elregal M, Osman E, Fouda A. Prevalence of bronchial asthma among Egyptian school children .Egypt J Bronchol 2009; 3(2):124-30.
Alaa-Eldin A. Hassan, Sabah Abdou Hagrass. Prevalence of Bronchial Asthma in Primary School Children. American Journal of Medicine and Medical Sciences 2017; 7(2): 67-73.
Fitzpatrick AM, Teague WG, Meyers DA, Peters SP, Li X, Li H, et al. National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. J Allergy Clin Immunol 2011; 127:382-9.
Holt PG, Strickland DH. Interactions between innate and adaptive immunity in asthma pathogenesis: new perspectives from studies on acute exacerbations. J Allergy Clin Immunol 2010; 125:963-72.
National Hospital Discharge Survey, Mortality Component of the National Vital Statistics System, National Center for Health Statistics, CDC, 2011.
Allan K, Devereux G. Diet and asthma: nutrition implications from prevention to treatment. J Am Diet Assoc 2011; 111:258-68.
Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis. J Allergy Clin Immunol 2011; 127:724-33.
Mason RS, Sequeira VB, Gordon-Thomson C. Vitamin D: the light side of sunshine. Eur J Clin Nutr 2011; 65:986-93.
Reed CE.The natural history of asthma. JAllergy Clin Immunol.2006;118(3):543-8.
Antonella LoMauro A, Aliverti A. Sex differences in respiratory function. Breathe (Sheff). 2018; 14(2): 131–140.
Niloufer S Ali, Kashmira Nanji. A Review on the Role of Vitamin D in Asthma. Cureus. 2017; 9(5): e1288.
Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB J (2005)19: 1067-1077.
Matheu V, Bäck O, Mondoc E, Issazadeh-Navikas S .Dual effects of vitamin D–induced alteration of TH1/TH2 cytokine expression: enhancing IgE production and decreasing airway eosinophilia in murine allergic airway disease. J Allergy Clin Immunol (2003) 112: 585-592.
Sandhu MS, Casale TB. The role of vitamin D in asthma. Ann Allergy Asthma Immunol (2010) 105: 191-199.
Penna G, Roncari A, Amuchastegui S. Expression of the inhibitory receptor ILT3 on dendritic cells is dispensable for induction of CD4_Foxp3_ regulatory T cells by 1, 25-dihydroxyvitamin D3. Blood 2005; 106:3490–7.
Ghoreishi M, Bach P, Obst J, Kmoba M, Fleet JC, Dutz JP. Expansion of antigen-specific regulatory T cells with the topical vitamin D analog calcipotriol. J Immunol 2009; 182:6071–8.
McGlade JP, Gorman S, Zosky GR. Suppression of the asthmatic phenotype by ultraviolet B-induced, antigen-specific regulatory cells. Clin Exp Allergy 2007; 37:1267–76.
Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, Hunninghake GW. Respiratory epithelial cells convert inactive vitamin D to its active form: potential effects on host defense. J Immunol 2008; 181: 7090-9.
Hansdottir S, Monick MM, Lovan N, Powers L, Gerke A, Hunninghake GW. Vitamin D decreases respiratory syncytial virus induction of NF-kappa Blinked chemokines and cytokines in airway epithelium while maintaining the antiviral state. J Immunol 2010; 184:965-74.
Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol 2007, 120:1031-5.
Aloia JF, Li-Ng M. Re: epidemic influenza and vitamin D. Epidemiol Infect 2007; 135:1095–8.
Grant WB. Variations in vitamin D production could possibly explain the seasonality of childhood respiratory infections in Hawaii. Pediatr Infect Dis J 2008; 27:853-9.
Busse WW, Boushey HA, Camargo CA, Evans D, Foggs MB, Janson SL, et al.National asthma education guidelines for the prevention program expert panel report 3, guideline for the diagnosis and management of asthma. 2007.
Ersfeld DL, Rao DS, Body JJ, Sackrison Jr JL, Miller AB, Parikh N, et al. Analytical and clinical validation of the 25 OH vitamin D assay for the LIAISON automated analyzer. Clin Biochem 2004; 37:867–74.
Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: an important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol 2007; 103(3-5):631-4.
Bouzigon E, Nadif R, Le Moual N, et al. Genetic and environmental factors of asthma and allergy: Results of the EGEA study. Rev Mal Respir. 2015; 32(8):822-40.
Jae-Hoon Chang, 1 Hye-Ran Cha, Dong-Sup Lee, 1,25-Dihydroxyvitamin D3 Inhibits the Differentiation and Migration of TH17 Cells to Protect against Experimental Autoimmune Encephalomyelitis. PLoS One. 2010; 5(9): e12925.
Weiss ST, Litonjua AA: Maternal diet versus lack of exposure to sunlight as the cause of the epidemic of asthma, allergies and other autoimmune diseases. Thorax 2007; 62: 746–8.
Brehm JM, Celedon JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, Laskey D, Sylvia JS, Hollis BW, Weiss ST, Litonjua AA: Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med 2009; 179:765–71.
Bener A, Al-Ali M, Hoffmann GF: High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem. Minerva Pediatr 2009; 61: 15–22.
Ginde AA, Mansback JM, Camargo CA Jr: Association between serum-25-hydroxyvitamin D level and upper RTI in the 3rd National Health and Nutrition Examination Survey. Arch Intern Med 2009; 39: 875–82.
Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, et al. High prevalence of vitamin D deficiency among inner-city African American youth with asthma in Washington, DC. J Pediatr 2010; 156:948-52.
El-banna EAM, Salah KM, Ahmed HS. Effects of vitamin D and the antimicrobial peptide in asthma, Egypt J Pediatr Allergy Immunol 2012;10(2):101-7.
Brehm JM, Celedon JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, Laskey D, Sylvia JS, Hollis BW, Weiss ST, Litonjua AA: Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med 2009; 179:765–71.
Chinellato I, Piazza M, Sandri M, Peroni D, Piacentini G, Boner AL. Vitamin D serum levels and markers of asthma control in Italian children. J Pediatr 2011; 158:437-4.
Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The relationship between serum 25 hydroxy vitamin D Levels and asthma in children. Allergy Asthma Immunol Res 2011;3(4):251-5.
Merve H, Cem HR, Ayse D Ali O. K,and Nesibe A. Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma Arch Argent Pediatr 2017;115(4):336-342
Menon J, Maranda L, Nwosu BU. Serum 25-hydroxyvitamin D levels do not correlate with asthma severity in a case-controlled study of children and adolescents. J Pediatr Endocrinol Metab 2012; 25 (7-8).