Characteristic of cellular immunity in children with recurrent respiratory diseases , depending on the level of immunoglobulin E production

Results. In 55.56 % of children with recurrent respiratory diseases, the IgE level has exceeded the reference values of the age norm. Cellular immunity in 53.33 % of children with recurrent respiratory diseases and high IgE levels was significantly more often characterized by decrease in the relative amount of CD3+, CD4+ T-lymphocytes phenotype and increase in the relative values of CD25+ lymphocytes phenotype with a moderate positive direct correlation between CD25+ lymphocytes and IgE levels (R = 0.35, P < 0.05). In children with recurrent respiratory diseases and normal IgE levels the relative amount of СD3+, CD4+, CD8+ lymphocytes phenotype was decreased and increased CD16+, CD19+ phenotypes in 38.89 %, and increase in the relative values of CD25+ lymphocytes phenotype in 11.1 %. Regardless of the ability to IgE production the cellular immunity parameters within the age standard were recorded in 53.09 % of the examined children and violation of the cellular immunity was observed in 46.91 % of cases.


Introduction
Often, particularly severe respiratory diseases in children result in various types of cellular and antibody mediated immunity and its functional activity disturbances and are often accompanied by formation of both chronic inflammatory processes within respiratory organs and various allergic pathologies [1].In addition to the anatomical and physiological features of the respiratory tract the main causes of recurrent respiratory diseases in younger children are age-related transient changes in the immune system.As a number of studies show, not the frequency of recurrent respiratory tract infections itself, but its nature, the combination of viral and bacterial infections and severe prolonged bacterial infections allow assuming the presence of immune pathology [2][3][4].At the same time, an increased infectious morbidity is a characteristic not only in children with classical immune pathology, but also in so-called immunocompromised children with various allergic reactions [5].This group is characterized by repeated, uncomplicated, local or chronic, often mono-infections, associated with external contacts, pathogenic flora and an external antigens effect [6].In this case genetic tendency to imbalance in the immune system often appears to be endogenous basis for these diseases development [7].The fact that an increased level of IgE is involved in a number of allergic reactions development and represents one of the main elements of protection against various agents or parasites is also of particular academic and practical interest [8,9].

Purpose
The aim of this study was to analyze and identify the relationship of cellular immunity indices in children with recurrent respiratory diseases depending on the IgE level production.

Materials and methods
Cellular immunity and the level of IgE production were studied in 81 children with recurrent respiratory diseases, aged from 2 to 6 years old.Subsequently, 45 children with IgE index above the reference values of the age norm were included into the first group of observation, and 36 children with a normal IgE level were included into the second group.
Statistical processing of data was carried out using conventional variational statistical methods with licensed software package Statistica for Windows 6.1.RU, serial number АХХR712D833214SAN5.We used nonparametric statistical methods: the medians and interquartile ranges, the χ 2 criterion, the "2 × 2 Table ", the Mann-Whitney U-test.Correlation analysis was used to calculate the correlation coefficient (R): for an abnormal distribution of indicators, the Spearman method.Differences P < 0.05 were considered statistically significant [10].

Results and discussion
Results of the study showed that among all the examined children with recurrent respiratory diseases the priduction of IgE was increased in 45 children (55.56 %) and its median (Me) was 459 [273.6-520.8]IU/ml (the 1 st group of observation), and in 36 (44.44 %) children the IgE level was within the age norm, Me = 21.4 [12.3-27.5]IU/ml (the 2 nd group of observation), see Fig. 1.
Within the 1 st group in 53.3 % (24 of 45) children with recurrent diseases various allergic reactions were registered, and there was a decrease in the relative number of the CD3+ T-lymphocytes phenotype (Me = 59.3 [57.0-60.1]%) and CD4+ ] %) in the immunogram.Within the 2 nd group 38.89 % (14 of 36) of children with recurrent diseases showed a decrease in the relative indices of cellular immunity: CD3+ (Me = 56.0[53.4-57.1]%) and CD4+ (Me = 25.7 [22.4-27.6]%).The excess of the normal values of the CD25+ lymphocytes phenotype relative level was significantly more often regi stered in the I group of children than in the II group (53.3 % of cases versus 11.1 %, P < 0.05), which confirmed the theory of the T-activated receptor and predisposition to allergic pathology connection due to the hyperactivity of immunity [7].Average values of median CD25+ in the group I was 21. 6 [19.0-22.5]%), and in  %.The correlation analysis also showed that IgE had a moderate positive direct correlation with CD25+ (R = 0.35, P < 0.05).More often, in 38.89 % (14/36) children from the group II a decrease in the relative amount of CD8+lymphocytes phenotype (Me = 16. 1 [14.7-16.7 Оригинальные исследования [29.8-31.6]%), P < 0.05 lymphocytes phenotype levels were registered (Table 1).
In 44.4 % (20 of 45) of the examined children with recurrent respiratory diseases and allergic reactions in the anamnesis from the 1 st group and in 61.11 % (22/36) of children from the 2 nd group all the parameters of cellular immunity were within the age limit, P > 0.05.And the only 1 (2.2 %) among the children from the 1 st group with recurrent respiratory diseases with high level of IgE, has shown neither deviations in the immunogram, no any allergic pathology.

Conclusions
1.In 55.56 % of children with recurrent respiratory diseases the IgE level has exceeded the reference values of the age norm.
2. In 53.33 % of children with recurrent respiratory diseases and high IgE levels the relative amount of CD3+, CD4+ T-lymphocytes phenotype was decreased and the relative amount of CD25+ lymphocytes phenotype was increased.
3. In children with recurrent respiratory diseases and normal IgE levels in 38.89 % of children the relative amount of СD3+, CD4+, CD8+ lymphocytes phenotype was decreased and increased in the CD16+, CD19+ phenotype and the relative values of CD25+ lymphocytes phenotype were increased in 11.1 %.
4. Regardless of the ability to IgE production the cellular immunity parameters within the age standard were recorded in 53.09 % of the examined children and violation of the cellular immunity was observed in 46.91 % of cases.
5. In children with recurrent respiratory diseases changes in the cellular immunity were registered 14,44 % more often in the group of children with high IgE level.

Fig. 1 .
Fig. 1.The 1 st and 2 nd groups of children, depending on the level of IgE production.