PENGARUH VAKSINASI BCG TERHADAP RASIO IL-4/IFN-γ DAN PERBAIKAN GEJALA KLINIK RINITIS ALERGI (THE EFFECT OF BCG VACCINATION ON IL-4/IFN- γ RATIO AND THE IMPROVEMENT OF CLINICAL SYMPTOMS IN ALLERGIC RHINITIS)

Abstract

Latar belakang : vaksinasi Bacillus Calmette-Guerin (BCG) pada manusia dapat menginduksi respon imun Th 1. Hubungan antara sistem imun sel Th 1 dan Th 2 bersifat timbal balik, yang berarti kenaikan respon imun sel Th 1 akan menghambat Th 2 dan sebaliknya. Rinitis alergi adalah suatu penyakit yang ditandai dengan dominasi respon Th 2, sehingga dengan pemberian vaksin BCG diharapkan terjadi penurunan dominasi respon Th 2. Tujuan : untuk menilai pengaruh vaksinasi BCG pada rinitis alergi terhadap rasio IL-4/ IFN-γ , suatu prototipe sitokin sel Th 2 dan Th 1 dan manfaat kliniknya. Metoda penelitian : suatu penelitian intervensi, randomized control group pretest-posttest design. Penderita rinitis alergi derajat sedang/berat pada kelompok BCG diberi suntikan BCG intrakutan 0,1 ml (2 x 105 CFU) dan kelompok kontrol diberi suntikan pelarut BCG pada hari pertama penelitian. Sebelum dan sesudah 8 minggu perlakuan dilakukan pemeriksaan kadar IL-4 dan IFN-γ. Skor gejala klinik dicatat oleh penderita setiap hari mulai sebelum perlakuan sampai selesai waktu pengobatan. Hari penderita minum obat selama waktu penelitian juga dicatat. Hasil : 40 penderita rinitis alergi derajat sedang/berat (BCG = 21 ; kontrol = 19) termasuk dalam penelitian. Pada kelompok BCG kadar IL-4, IFN-γ, rasio IL- 4/IFN-γ sebelum dan sesudah vaksinasi tidak terdapat perbedaan bermakna (IL-4 :19,7 dan 44,6 pg/ml ; IFN-γ : 1446,8 dan 1900,7 pg/ml ; rasio IL-4/IFN-γ : 0,016 dan 0,0,123). Pada kelompok kontrol kadar IL-4, IFN-γ, rasio IL-4/IFN-γ sebelum dan sesudah perlakuan juga tidak terdapat perbedaan bermakna (IL-4 :19,7 dan 44,6 pg/ml ; IFN-γ : 1446,8 dan 1900,7 pg/ml ; rasio IL-4/IFN-γ : 0,016 dan 0,123). Kadar IL-4, IFN-γ, rasio IL-4/ IFN-γ antar kelompok juga tidak terdapat perbedaan bermakn (p > 0,05). Skor gejala klinik sebelum dan sesudah perlakuan pada kelompok BCG dan kontrol terdapat perbedaan bermakna (p < 0,01), meskipun perubahan gejala klinik antar kelompok tidak terdapat perbedaan bermakna. Jumlah hari bebas gejala dan hari nyaman lebih tinggi pada kelompok BCG, meskipun perbedaan tidak bermakna. Jumlah hari minum obat pada minggu 1 dan 2 lebih rendah pada kelompok BCG dengan perbedaan bermakna (p < 0,05), meskipun secara keseluruhan tidak ada perbedaan bermakna. Kesimpulan : vaksinasi BCG tidak dapat menurunkan rasio IL-4/IFN-γ dan tidak memperbaiki gejala rinitis alergi. Background : Bacillus Calmette-Guerin (BCG) vaccination in human induces Th 1 immune responses. Th 1 and Th 2 cells are reciprocally regulated, that means the increasing of Th 1 immune may be inhibited by Th 2 immune responses and vise versa. Allergic rhinitis is marked by a predominant Th 2 responses, so that BCG injection may reduce the domination of Th2 responses. Objectives : To evaluate the effect of BCG vaccination on IL-4/IFN-γ ratio, as a prototype of Th 2 and Th 1 cytokine and its clinical benefits in allergic rhinitis patients. Methods : This was 8 weeks clinical trial, randomized control group pre test-post test design. A moderate/severe grade of persistent allergic rhinitis patients divided into two groups. In first group, the samples received intracutaneus BCG injection of 0,1 ml (2 x 105 CFU), and the control group was administered by intracutaneus injection of BCG solution in the first day of the study. The IL-4 and IFN-γ level were measured before and after 8 weeks of treatment. The clinical symptoms were assessed by 0 – 3 scale everyday during the study, as well as the number medication days. Results : 40 moderate/severe grade persistent allergic rhinitis patients were included this study (BCG = 21 ; control = 19). The IL-4, IFN-γ levels, as well as IL-4/IFN-γ ratio before and after treatment were not significantly different in BCG group (IL-4 :19,7 vs 44,6 pg/ml ; IFN-γ : 1446,8 vs 1900,7 pg/ml ; ratio IL-4/IFN-γ : 0,016 vs 0,0,123), and also in control group (IL-4 : 19,7 vs 44,6 pg/ml ; IFN-γ : 1446,8 vs 1900,7 pg/ml ; ratio IL-4/IFN-γ : 0,016 vs 0,123). The IL-4, IFN-γ levels, and IL-4/IFN-γ ratio between groups were not significantly different (p > 0,05). The clinical symptom scores pre and post treatment in both groups were decreased significantly (p < 0,01), however the improvement of clinical symptoms between group were not significantly different. The cumulative of asymptomatic and comfortable days were higher in BCG group although not significantly different. The medication days between groups at first and second weeks were significantly different (p < 0,05), however that differences were not significantly different at whole time of study. Conclusions : The BCG vaccination did not decreased IL-4/IFN-γ ratio, as well as improving the clinical symptoms of allergic rhinitis.