A new study finds that children experiencing an asthma attack who are treated with a short burst of oral steroids may have a transient depression of immune response. According to the researchers, the findings, published in the journal Pediatric Allergy, Immunology and Pulmonology, have implications for asthmatic children who have flare-ups and who may be exposed to new contagious diseases.

While the researchers accept that administration of corticosteroids to reduce the risk and duration of hospital admission in children with acute asthma is the most effective treatment for moderate and severe asthma exacerbations, they wanted to look at new concerns linking severe chickenpox infections with corticosteroid administration.

The researchers evaluated the immune response of children aged 3 to 17 years, who had arrived at the emergency department (ED) with an asthma attack. All subjects were given immune triggers (known antigens) and the immune response between those who received corticosteroids versus those who did not were compared.

“Several corticosteroid-treated children had a significantly lower immune response, as measured by the amount of antibody produced, than non-treated kids,” says study author Francine M. Ducharme, MD, professor at the Université de Montréal and pediatrician at the Sainte-Justine University Hospital Research Center.

Five weeks following their initial ED visit, the children enrolled in the study were revaccinated with the antigen. Comparable immune responses were measured in children exposed to oral corticosteroids and not exposed to corticosteroids.

“These findings indicated there is a transient, not sustained, immune suppression in some children exposed to a new antigen at the same time as the corticosteroid administration,” says Ducharme.

“In summary,” she adds, “our finding suggest a transient immune suppression occurs in some children who are concomitantly exposed to a new antigen and corticosteroids during an asthma attack, with a recovery within six weeks.”

The researchers point out that given the high frequency use of these drugs over the past 20 years, and rare occurrence of severe infectious disease, the window of risk is very small and only applies to exposure to a new antigen. They recommend, however, that before prescribing oral corticosteroids, physicians should systematically enquire about recent exposure to chickenpox in children who did not have chickenpox or the vaccine. Moreover, all children with asthma who have not had chickenpox should be vaccinated for this condition.

Source: Université of Montréal