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Eosinophil recruitment into the airways is a feature of asthma in children. However, the mechanisms by which these cells migrate into the airways are not fully understood. The present study investigated the presence of the eosinophilactivating chemokines regulated on activation, normal T-cell expressed and secreted (RANTES), monocyte chemotactic proteins (MCP)-3 and -4, and eotaxins-1 and -2 in the bronchoalveolar lavage (BAL) fluid obtained from both asthmatic (n=10, age 6-10 yrs) and normal children (n=10, age 5-10 yrs).Measurements of chemokines in BAL fluid showed that levels of RANTES, MCPs-3 and -4, and eotaxins-1 and -2 were significantly increased in fluid obtained from asthmatic children when compared with normal children. Among the different chemokines, RANTES was the cytokine released in greatest quantities in BAL fluid from asthmatic children. There was a significant correlation between the concentrations of MCP-4 and eosinophil numbers in BAL fluid and a trend between both chemokines MCP-3 and eotaxin-2 and eosinophils.Interestingly, the levels of most chemokines correlated with one another. These findings suggest that RANTES monocyte chemotactic proteins-3 and -4, and eotaxins-1 and -2 may regulate eosinophil trafficking into the airways of asthmatic children in a coordinated manner. Eur Respir J 2003; 22: 310-316.

Aspirin-exacerbated respiratory disease is a chronic and treatment-resistant disease, characterized by the presence of eosinophilic rhinosinusitis, nasal polyposis, bronchial asthma, and nonsteroidal anti-inflammatory drugs hypersensitivity. Alterations in arachidonic acid metabolism may induce an imbalance between pro-inflammatory and anti-inflammatory substances, expressed as an overproduction of cysteinyl leukotrienes and an underproduction of prostaglandin E2. Although eosinophils play a key role, recent studies have shown the importance of other cells and molecules in the development of the disease like mast cells, basophils, lymphocytes, platelets, neutrophils, macrophages, epithelial respiratory cells, IL-33 and thymic stromal lymphopoietin, making each of them promissory diagnostic and treatment targets. In this review, we summarize the most important clinical aspects of the disease, including the current topics about diagnosis and treatment, like provocation challenges and aspirin desensitization. We also discuss recent findings in the pathogenesis of the disease, as well as future trends in diagnosis and treatment, including monoclonal antibodies and a low salicylate diet as a treatment option.

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