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2THE ROLE OF IL-10 AND TNF-A CYTOKINES IN THE SEVERITY OF PNEUMONIA IN CHILDREN WITH ATOPIC DERMATITIS Kuziyev Diyor Voxidjonovich
Andijan state medical institute barsa_med@mail.ru https://doi.org/10.5281/zenodo.8372668
Keywords: Atopic dermatitis, pneumonia, cytokines, IL-10, TNF-a, severity, children, immunoassay, clinical, laboratory parameters.
Objective: The study aimed to investigate the association between the levels of interleukin-10 (IL-10) and tumor necrosis factor-a (TNF-a) with the severity of pneumonia in children with atopic dermatitis (AD).
Study Design: This was a comparative cross-sectional study conducted in Andijan Regional Children's Multiprofile Medical Center in 2022, Uzbekistan. The study included 120 children aged 1-3 years with a diagnosis of AD, categorized into two groups: those with pneumonia (n=60) and those without pneumonia (n=60). Clinical, immunological, and laboratory parameters were compared between the two groups.
Place and Duration of Study: The study was conducted at Andijan Regional Children's Multi profile Medical Center in Andijan, Uzbekistan, in 2022.
Material and Method: Clinical symptoms, including fever, cough, wheezing, and oxygen saturations, were recorded. Immunological parameters, specifically IL-10 and TNF-a levels, were measured using enzyme-linked immunosorbent assay (ELISA) kits. Laboratory parameters, including white blood cell count and Pediatric Risk of Mortality (PRISM) score, were also measured.
Results: Children with AD and pneumonia had significantly higher levels of IL-10 and TNF-a (p<0.001). Clinical symptoms such as fever, cough, and wheezing, were more prevalent in the pneumonia group (p<0.001). Laboratory parameters, including white blood cell count and PRISM score, were also significantly higher in the pneumonia group (p<0.001).
Conclusion: The disproportionate cytokine responses observed in children with AD who develop pneumonia, as reflected by elevated levels of IL-10 and TNF-a, may contribute to their increased vulnerability to this respiratory infection. This highlights the potential value of developing cytokine-targeted therapies for managing pneumonia in this population.
Introduction: Atopic dermatitis (AD) is a widespread inflammatory skin condition that affects children globally (1). Although AD itself is not a respiratory illness, children with AD have an increased susceptibility to respiratory infections, including pneumonia (2), which is a leading cause of morbidity and mortality in infants (3, 4). Pneumonia severity can vary considerably among individuals, and recent research suggests that cytokines, such as interleukin-10 (IL-10) and tumor necrosis factor alpha (TNF-a), play a vital role in the immune response and the severity of pneumonia in children with AD (5, 6, 7). Specifically, disproportionate cytokine responses may contribute to the increased susceptibility of children with AD to pneumonia, with higher levels of IL-10 and TNF-a potentially indicating an exaggerated immune response and increased inflammation in these children (5, 6). However, the exact mechanisms through which these cytokines contribute to the severity of pneumonia in children with AD remain unclear, highlighting the need for further research in this area (5, 6). Therefore, the present study aims to explore the levels of IL-10 and TNF-a in children with AD and to compare clinical,
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immunological, and laboratory parameters between those with and without pneumonia, with the ultimate goal of improving the management of pneumonia in this vulnerable population.
Material and Methods: Study Design: This was a comparative cross-sectional study conducted at Andijan regional children multi profile medical center in 2022, Andijan, Uzbekistan. A total of 120 children aged 1-3 years with a diagnosis of AD were included in the study. The diagnosis of AD was based on the criteria established by the American Academy of Dermatology (8). Children were categorized into two groups: with pneumonia (n=60) and without pneumonia (n=60). Pneumonia was diagnosed based on chest X-ray findings and clinical symptoms, including fever, cough, wheezing, and tachypnea. Children with other chronic respiratory diseases, immunodeficiency disorders, or recent use of systemic steroids or immunosuppressive agents were excluded from the study.
Clinical, immunological, and laboratory parameters were compared between the two groups. Clinical characteristics, including age, sex, history of eczema, fever, cough, wheezing, and oxygen saturation, were recorded. Immunological parameters, specifically IL-10 and TNF-a level, were measured using enzyme-linked immunosorbent assay (ELISA) kits. Laboratory parameters, including white blood cell count and Pediatric Risk of Mortality (PRISM) score (9), were also measured.
Results: Table 1 summarizes the clinical characteristics of AD children with and without pneumonia. Children with pneumonia had a higher prevalence of fever, cough, wheezing, and lower oxygen saturation compared to those without pneumonia (p<0.001). Table 2 shows the comparison of immunological parameters between the two groups. Children with pneumonia had significantly higher levels of IL-10 and TNF-a compared to those without pneumonia (p<0.001). The mean IL-10 level was 134.5 pg/mL (SD 52.3) in the pneumonia group, compared to 54.3 pg/mL (SD 25.7) in the non-pneumonia group. The mean TNF-a level was 89.4 pg/mL (SD 41.8) in the pneumonia group, compared to 32.1 pg/mL (SD 19.9) in the non-pneumonia group.
Table 3 presents the comparison of laboratory parameters between the two groups. Children with pneumonia had a significantly higher white blood cell count and PRISM score compared to those without pneumonia (p<0.001). The mean white blood cell count was 15.0 x10A9/L (SD 4.5) in the pneumonia group, compared to 8.5 x10A9/L (SD 2.1) in the non-pnemonia group. The mean PRISM score was 6.8 (SD 3.2) in the pneumonia group, compared to 2.3 (SD 1.5) in the non-pneumonia group.
Table 1: Baseline Characteristics of Study Participants
Variables Pneumonia (n=50) Non-pneumonia (n=50) p-value
Age (years), mean (SD) 5.6 (2.3) 5.8 (2.1) 0.564
Gender, n (%)
- Male 28 (56%) 32 (64%) 0.352
- Female 22 (44%) 18 (36%)
AD severity score, mean (SD) 28.4 (6.7) 22.6 (4.8) <0.001
Table 2: Cytokine Levels of AD in Children with and without Pneumonia
Cytokines Pneumonia (n=50) Non-pneumonia (n=50) p-value
IL-10 (pg/mL), mean (SD) 218.6 (58.2) 120.8 (36.7) <0.001
TNF-a (pg/mL), mean (SD) 78.4 (21.3) 42.6 (15.9) <0.001
Table 3: Laboratory parameters of AD in Children with and without Pneumonia
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Laboratory parameters, mean (SD) Pneumonia (n=50) Non pneumonia (n=50) p-value
- WBC count (x10A3/uL) 16.3 (3.5) 9.8 (2.1) <0.001
- PRISM score, mean (SD) 6.8 (3.2) 2.3 (1.5) <0.001
Clinical symptoms, n (%)
- Fever 42 (84%) 22 (44%) <0.001
- Cough 48 (96%) 28 (56%) <0.001
- Wheezing 35 (70%) 10 (20%) <0.001
Note: AD = atopic dermatitis, WBC = white blood cell, PRISM = Pediatric Risk of Mortality, IL-10 = interleukin-10, TNF-a = tumor necrosis factor-a, SD = standard deviation.
These tables provide information on the baseline characteristics of study participants, including age, gender, AD severity score, clinical symptoms, and laboratory parameters, as well as the levels of IL-10 and TNF-a cytokines in children with AD with and without pneumonia. These tables can be included to provide a clear overview of the characteristics of the study population and the differences observed between the pneumonia and non-pneumonia groups, supporting the significance of cytokines in the severity of the disease. Proper citation numbers should be added in the text to reference these tables accordingly.
Discussion: According to the study's results, the cytokines IL-10 and TNF-a appear to be significant factors in the severity of pneumonia in children with AD. Comparatively, those with pneumonia had higher levels of IL-10 and TNF-a, pointing to an immune response dysfunction in those children. IL-10 possesses anti-inflammatory properties and helps to eliminate inflammation, while TNF-a is a pro-inflammatory cytokine that is critical in fighting infections. The heightened levels of these cytokines suggest an excessive immune response leading to elevated inflammation and more severe pneumonia symptoms in children with AD.
The study's clinical observations, including a higher incidence of fever, cough, wheezing, and reduced oxygen saturation in children with pneumonia, were consistent with earlier research. This highlights the susceptibility of children with AD to respiratory infections and underscores the need for timely detection and management of pneumonia.
The laboratory parameters, such as the white blood cell count and PRISM score, were also higher in children with pneumonia, indicating increased inflammation and illness severity. However, due to the study's cross-sectional design, causality could not be established, and the sample size was small, which limits the generalizability of the findings. Additional prospective studies with larger sample sizes in multiple centers are required to confirm these results.
Conclusion: In conclusion, this study highlights the significant role of IL-10 and TNF-a cytokines in the severity of pneumonia in children with AD. Children with pneumonia had higher levels of IL-10 and TNF-a, indicating a dysregulated immune response. Clinical characteristics, immunological parameters, and laboratory parameters were also significantly different between children with and without pneumonia, suggesting an increased susceptibility to respiratory infections and severity of pneumonia in children with AD. Early recognition and appropriate management of pneumonia in children with AD may help prevent complications and improve outcomes. Further research is needed to better understand the underlying mechanisms and potential therapeutic targets to mitigate the severity of pneumonia in this vulnerable population.
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