Pengaruh vitamin D3 terhadap kadar vitamin D (25(OH)D) dan sel T Regulator pada rinitis alergi

Abstract

Latar belakang: Rinitis alergi (RA) adalah peradangan atau inflamasi pada mukosa atau selaput lendir hidung yang didasari oleh reaksi hipersensitivitas tipe 1 dan diperantarai IgE. Rinitis alergi merupakan tipe rinitis kronis yang sering dijumpai. Sebanyak 30-50% penderita rinitis memiliki pemicu alergi dan prevalensinya cenderung meningkat. Vitamin D mempunyai peran memodulasi respon imun alamiah dan adaptif. Banyaknya pengaruh vitamin D dalam sistem imun diharapkan dapat mengatur aktivitas berbagai sel kekebalan, serta fungsi kekebalan tubuh dari epitel sel pada RA, namun konsensus sebagai bagian terapi RA saat ini masih belum ada. Tujuan: Mengetahui pengaruh pemberian vitamin D3 terhadap kadar vitamin D (25(OH)D) dan sel T Regulator (T reg) pada rinitis alergi. Metode: Penelitian eksperimental murni dengan rancangan penelitian randomized clinical trial (RCT) double blind, pre and post test control group dengan perlakuan berupa pemberian terapi sesuai ARIA (Allergic Rhinitis and its Impact on Asthma) dan vitamin D3 oral diberikan selama 4 minggu. Dilakukan penilaian VAS (Visual Analogue Scale), TNSS (Total Nasal Symptom Score), serta kadar vitamin D darah dan persentase sel T reg pada awal dan 4 minggu setelah perlakuan. Hasil: Pada kelompok perlakuan terdapat perbedaan bermakna kadar vitamin D sebelum dan sesudah perlakuan (p=0,01). Terdapat perbedaan yang bermakna dari peningkatan persentase sel T reg pada kelompok perlakuan dibandingkan kelompok kontrol (p=0,02). Terdapat hubungan antara peningkatan persentase sel T reg dengan kadar vitamin D pada kelompok perlakuan (p=0,01). Kesimpulan: Vitamin D3 dapat meningkatkan kadar vitamin D dan persentase sel T reg secara bermakna pada pasien rinitis alergi persisten sedang berat.

Kata kunci: Rinitis alergi, vitamin D, sel T regulator

ABSTRACT

Background: Allergic rhinitis (AR) is an inflammatory disease of nasal mucosa based on type 1 hypersensitivity reaction and mediated by IgE. Allergic rhinitis is the most common type of chronic rhinitis. About 30±50% of patients with allergic rhinitis have trigger factors and its prevalence is increasing. Vitamin D has a function in modulation of innate and adaptive responses. The role of vitamin D in immune system is expected to regulate various immune cells activity, and the immune function of AR epithelial cells, but there were no consensus yet about vitamin D as part of AR therapy. Objective: To identify the effect of vitamin D3 on level of vitamin D (25(OH)D) and T regulator (T reg) cells in allergic rhinitis patients. Methods: This study was purely experimental research with randomized clinical trial, double-blind, pre and post test control group treated with appropriate therapy according to ARIA (Allergic Rhinitis and its Impact on Asthma) and vitamin D3 given orally for 4 weeks. Evaluations of VAS (Visual Analogue Scale) and TNSS (Total Nasal Symptom Score) value, vitamin D levels and the percentage of T reg cells were carried out at baseline and 4 weeks after treatment. Results: In the treatment group there was a significant difference between vitamin D levels before and after treatment (p=0.01). There was a significant difference on increased percentage of T reg cells in the treatment group compared with the control group (p=0.02). There was a correlation between the increasing percentage of T reg cells with vitamin D levels in the treatment group (p=0.01). Conclusion: Vitamin D supplementation could increase the level of vitamin D and the percentage of T reg cells significantly in patients with severe persistent allergic rhinitis.

Keywords: Allergic rhinitis, vitamin D, T regulatory cell