Circulating ICAM-1 levels in bronchial asthma and the effect of inhaled corticosteroids Reha Cengizlier,* Emin Demirpolat,† Necla Tu ¨lek,‡ and Fatmanur C ¸ akmak§ Background: Even mild asthma has an inflammatory component. Intercellular adhesion molecule-1 (ICAM-1) plays an important role in inflammation. Higher levels of circulating ICAM-1 (cICAM-1) in sera may reflect the upregulation of ICAM-1 expression in allergic inflammation. Objective: The aim of this study was to assess cICAM-1 levels in children with atopic bronchial asthma and to determine the effects of inhaled glucocorticoids on cICAM-1 levels. Methods: The study group consisted of 25 children with moderate atopic bron- chial asthma with a mean age of 9.9  4.2 years, and the control group consisted of 18 healthy children with a mean age of 9.6  2.6 years. Serum cICAM-1 levels and pulmonary function tests were measured. The patients were treated 2 months with inhaled budesonide 400 to 800 g (mean 440 g) per day. After this treatment, cICAM-1 levels and pulmonary function tests were compared with pretreatment levels. The pretreatment cICAM-1 values were compared with healthy control group. Results: The initial cICAM-1 levels of the patient group were significantly higher than the cICAM-1 levels of the control group (P = .001). The post-treatment cICAM-1 levels of the patient group were significantly lower than the pretreatment values (P = .007). Pulmonary function test results (FEV 1 , FEF 25–75 , and PEFR) rose significantly with the treatment in patients (P  .05). Conclusion: This study revealed the presence of inflammation in children with even moderate atopic asthma as reflected with elevated levels of cICAM-1 levels, which decreased following corticosteroid treatment as a result of decreased inflam- mation. Ann Allergy Asthma Immunol 2000;84:539–541. INTRODUCTION Recent studies have firmly established inflammation as the basic pathology of asthma. 1 Intercellular adhesion mole- cule-1 (ICAM-1) is a member of the immunoglobulin superfamily and in- volved in the adhesion of most types of leukocytes to other leukocytes and the epithelium, so that it plays an impor- tant role in inflammation. Intercellular adhesion molecule-1 is expressed in a variety of tissue sites, but this expres- sion is more widespread in inflamed tissue. 2 Higher levels of circulating ICAM-1 (cICAM-1) levels in sera may reflect the upregulation of ICAM-1 ex- pression in allergic inflammation. 3 Glucocorticoids have a variety of im- portant anti-inflammatory actions in the airways, including inhibition of T lymphocyte function and secretion of cytokines and other mediators. Antag- onism of ICAM-1 may provide a ther- apeutic approach to reducing airway inflammation, hyperresponsiveness, and asthma symptoms. 4 The aim of this study was to assess the importance of cICAM-1 levels in allergic inflammation and to determine the effects of inhaled glucocorticoids on cICAM-1 levels. METHODS The study group comprised 30 patients (18 boys and 12 girls) with atopic bronchial asthma with a mean age of 9.9  4.2 years (range 4 to 14 years). The control group compressed 18 healthy children (10 boys and 8 girls) with a mean age of 9.6  2.6 years (range 4 to 16 years). All patients with bronchial asthma met the American Thoracic Society Standards for the di- agnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. 5 The patients had moderate asthma and had not used any anti-inflammatory drug before the study. The patients were treated 2 months with inhaled budesonide 400 to 800 g (mean 440 g) per day and inhaled salbutamol on a prn basis. None of the children in the control group had a history of infection within 1 month and none was using any med- icine. Total serum IgE levels were measured and the skin prick test was applied to all the patients and the con- trol group. Skin prick test antigens (Stallergenes SA, France) consisted of grass and tree pollens, house dust mites (HDM), molds, animal danders, and some food antigens (egg white, cow’s milk, peanut, and banana). The wheal and flare reactions were com- pared with the histamine and negative control solution results of the same company. A wheal reaction greater than 2 mm or at least half the size of the histamine reaction was accepted as positive. Blood samples were collected from the patients and the control group at the beginning and repeated 2 months later only from the patients. All the sera were stored at -70°C until the study day. Circulating ICAM-1 levels were measured by commercially avail- *Reha Cengizlier, MD; Associate Professor, Pediatrician; Allergy specialist; Social Security Children’s Hospital; Ankara, Turkey. †Emin Demirpolat MD, Pediatrician; Social Security Children’s Hospital; Ankara, Turkey. ‡Necla Tu ¨lek MD; Infectious Diseases and Immunology Specialist; Social Security Chil- dren’s Hospital; Ankara, Turkey. §Fatmanur C ¸ akmak MD, Assoc. Prof., Pedi- atrician, Social Security Children’s Hospital, Ankara, Turkey. Received for publication January 5, 1999. Accepted for publication in revised form No- vember 24, 1999. VOLUME 84, MAY, 2000 539