Immunological differences in allergic and intrinsic asthma
Intrinsic asthmatics have a different pattern of T cell activation which can be observed in periphal blood but more pronouced in BAL. In contrast to allergic asthmatics CD23+ B cells are not elevated in the periphal circulation of intrinsic asthmatics.
The spectrum of cytokines measured in bronchoalveolar lavage and in T lymphocyte supernatants from allergic asthmatics is compatible with recent data reporting mRNA expression of TH2 type cytokine profiles in BAL from allergic asthmatics  which have, however, not been compared to intrinsic asthmatics. The production of IL-2 and IL-5 is incompatible with either a TH1 or TH2 type pattern. The elevation of IL-5 could be due to a secondary increase in IL-2 as found in treatment with rIL-2 . Either one of these cytokines could also be produced by e. g. activated CD8+ cells which are present particularly in intrinsic asthmatics.
In intrinsic asthma but not in allergic asthma a redistribution from antigen-naive CD45RA+ to antigen-experienced memory CD45RO+ T lymphocytes which is correlated with the duration of the disease has been observed. Finally there is preliminary evidence suggesting differences in V-β receptor family usage in allergic and intrinsic asthma.
Taken together these results strongly suggest a key role for T lymphocytes in the pathogenesis of both allergic and nonallergic asthma with, however, distinct mechanisms for T cell activation and subsequent cytokine production in the two variants of the asthma syndrome. Additionally the observed redistribution from antigen-inexperienced to antigen-experienced T cells and the preliminary evidence for differential V-β receptor family usage in allergic and intrinsic asthma support the hypothesis of fundamental differences in the immunology and pathogenesis of allergic and intrinsic asthma. Further studies aimed at the specific mechanisms of antigenic T lymphocyte activation in intrinsic asthma will lead to even better understanding of this disease and are likely to offer new approaches to therapy.
KeywordsAllergy Clin Immunol Allergic Asthmatic Bronchial Hyperreactivity Acute Severe Asthma Immunological Difference
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