The Effect of Antihelminthic Treatment on Subjects with Asthma from an Endemic Area of Schistosomiasis: A Randomized, Double-Blinded, and Placebo-Controlled Trial
This is a prospective, double-blinded, and placebo-controlled trial evaluating the influence of antihelminthic treatments on asthma severity in individuals living in an endemic area of schistosomiasis. Patients from group 1 received placebo of Albendazole or of Praziquantel and from group 2 received Albendazole and Praziquantel. Asthma severity was assessed by clinical scores and by pulmonary function test. There was no significant difference in the asthma scores from D0 to D1–D7 after Albendazole or Praziquantel and from D0 to D30–90 after Albendazole or Praziquantel in both, group 1 and 2. It was observed, however, a clinical worsening of the overall studied population after 6 months and 12 months of antihelminthic treatments. Additionally, we observed increased frequency of forced expiratory volume in 1 second (FEV1) < 8 0 % on 12 and 18 months after treatment. The worsening of asthma severity after repeated antihelminthic treatments is consistent with the hypothesis of the protective role conferred by helminths in atopic diseases. 1. Introduction Helminthic infections and allergic diseases are highly prevalent in many parts of the world, and both lead to type 2 immune response with secretion of IL-4, IL-5, and IL-13, with a consequent increase in the production of IgE and eosinophilia. Lynch et al. [1] studying the skin prick test (SPT) response in children from an ascariasis endemic area observed a decreased reactivity to the test and subsequently an increased response after treatment of intestinal helminths [2]. Studies conducted by the Immunology Service (SIM) of the Federal University of Bahia, Brazil, demonstrated a negative association between the cutaneous immediate hypersensitivity response to the skin prick test to aeroallergens and Schistosoma mansoni parasite load, measured by a quantitative assessment of the number of eggs per gram of stool [3]. Over a year-long follow-up study in the state of Bahia, a group of researchers from SIM compared three populations from impoverished areas of the state, including one group from an endemic area of S. mansoni, one group from a rural nonendemic area, and a third group from a slum area in Salvador, the capital of the state. In the study, it was observed that asthma severity indicators were lower in individuals living in the endemic areas of schistosomiasis when compared to the other two areas in which there were no recorded cases of S. mansoni transmission [4]. Several factors may explain the lower frequency of positive SPT and lower asthma severity in populations infected with helminths. The
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