DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20211885

Impact of serum vitamin D level on severity of asthma in children

Payasvi Baweja Sachdeva, Jusmita Dutta, Sheloj Joshi, Shweta Anand

Abstract


Background: Asthma is the most common chronic respiratory disease among children characterized by reversible airway obstruction. Vitamin D plays an important role in many immune and allergic diseases and it may have a role in asthmatic patients, however this association yet remains uncertain. The present study was designed to assess the level of serum Vitamin D in patients with bronchial asthma and it’s correlation with disease severity.

Methods: A prospective observational study was performed from April 2019 to February 2020 in the Paediatric OPD of LNMC and JK Hospital Bhopal. All 90 children with physician diagnosed bronchial asthma (mild, moderate and severe) aged 10 to 18 years of both genders who have come in the OPD (total enumeration sampling) during the above mentioned period were enrolled in to the study. The patients were grouped on the basis of Vitamin D sufficiency and Vitamin D levels were correlated with disease severity.

Results: The study comprised 54 boys (60%) and 36 girls (40%) with mean age of 15.1±3.96. Out of 90 children enrolled, 46 had good control over asthma and 37 had uncontrolled asthma. As regards asthma control, 25-OH Vitamin D was lowest among patients with uncontrolled asthma.

Conclusions: Vitamin D deficiency was highly prevalent in asthmatic patients and there was a direct and a significant relationship between serum Vitamin D levels, severity of asthma, control of asthma, serum IgE levels and blood eosinophils count. Thus, measuring serum levels of Vitamin D followed by supplementation could be considered in the routine assessment of patients with bronchial asthma.


Keywords


Allergy, Children, Disease severity, Serum IgE level

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References


Mutius VE. The burden of childhood asthma. Arch Dis Child. 2000;82(2):2-5.

Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, et al. Serum vitamin D levels and severe asthma exacerbations in the childhood asthma management program study. J Allergy Clin Immunol. 2010;126:52-8.

Goleva E, Searing DA, Jackson LP, Richers BN, Leung DY. Steroid requirements and immune associations with vitamin D are stronger in children than adults with asthma. J Allergy Clin Immunol. 2012;129:1243-51.

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. 2005;19:1067-77.

Matheu V, Bäck O, Mondoc E, Navikas S. Dual effects of vitamin D–induced alterations of TH1/TH2 cytokine expression: enhancing IgE production and decreasing airway eosinophilia in murine allergic airway disease. J Allergy Clin Immunol. 2003;112:585-92.

Sandhu MS, Casale TB. The role of vitamin D in asthma. Ann Allergy Asthma Immunol. 2010;105:191-9.

Hollis BW, Wagner CL. Normal serum vitamin D levels. N Engl J Med. 2005;352(5):515-6.

Gale CR, Robinson SM, Harvey NC, Javaid MK, Jiang B, Martyn CN, et al. Princess anne hospital study group maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr. 2008;62:68-77.

Oeffelen AA, Bekkers MB, Smit HA, Kerkhof M, Koppelman GH, Nies A, et al. Serum micronutrient concentrations and childhood asthma: The PIAMA birth cohort study. Pediatr Allergy Immunol. 2011;22:784-93.

Nwaru BI, Hadkhale K, Hämäläinen N, Takkinen HM, Ahonen S, Ilonen J, et al. Vitamin D intake during the first 4 years and onset of asthma by age 5: a nested case-control study. Pediatr Allergy Immunol. 2017;28(7):641-8.

Menem MT, Aziz MM, Guindy WM, Banna NA. The frequency of vitamin D deficiency among asthmatic Egyptian children. Egypt J Pediatr Allergy Immunol. 2013;11(2):69-73.

Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2014. Available at http://www.ginasthma.org/. Accessed on 01 May 2017.

Holick MF, Binkley NC, Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30.

Lindberg RE, Arroyave C. Levels of IgE in serum from normal children and allergic children as measured by an enzyme immunoassay. J Allergy Clin Immunol. 1986;78:614-8.

Mutius VE. The burden of childhood asthma. Arch Dis Child. 2000;82(2):2-5.

Brehm JM, Schuemann B, Fuhlbrigge AL, Hollis BW, Strunk RC, Zeiger RS, et al. Serum vitamin D levels and severe asthma exacerbations in the childhood asthma management program study. J Allergy Clin Immunol. 2010;126:52-8.

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;158:437-41.

Kavitha TK, Gupta N, Kabra SK, Lodha R. Association of serum vitamin D levels with level of control of childhood asthma. Indian Pediatr. 2017;54:29-32.

Searing DA, Zhang Y, Murphy JR, Hauk PJ, Goleva E, Leung DY. Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. J Allergy Clin Immunol. 2010;125:995-1000.

Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004;80:1717-20.

May E, Asadullah K, Zugel U. Immunoregulation through 1,25-dihydroxyvitamin D3 and its analogs. Curr Drug Targets Inflamm Allergy. 2004;3:377-93.

Banerjee A, Damera G, Bhandare R, Gu S, Lopez- Boado Y, Panettieri R, et al. Vitamin D and glucocorticoids differentially module chemokine and glucocorticoids differentially modulate chemokine expressionin human airway smooth muscle cells. Br J Pharmacol. 2008;155:84-92.

Beeh KM, Ksoll M, Buhl R. Elevation of total serum immunoglobulin E is associated with asthma in non allergic individuals. Eur Respir J. 2000;16:609-14.

Satwani H, Rehman A, Ashraf S, Hassan A. Is serum total IgE levels a good predictor of allergies in children? J Pak Med Assoc. 2009;59:698-702.

Borish L, Chipps B, Deniz Y, Gujrathi S, Zheng B. Total serum IgE levels in a large cohort of patients with severe or difficult to treat asthma. Ann Allergy Asthma Immunol. 2005;95:247-53.

Brehm JM, Celedon JC, Quiros ME, Avila L, Hunninghake GM, Forno E, et al. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med. 2009;179(9):765-71.

Krobtrakulchai W, Praikanahok J, Visitsunthorn N, Vichyanond P, Manonukul K, Pratumvinit B, et al. The effect of vitamin D status on pediatric asthma at a university hospital, Thailand. Allergy Asthma Immunol Res. 2013:5(5):289-94.