BACKGROUND: the lining of the nasal and sinuses gets inlamed, infected or irritated, become swollen, and create Rhinosinusitis occurs when\ud
extra mucus, the swollen lining may also interfere with\ud
drainage of mucus. Chronic rhinosinusitis (CRS) is a\ud
more persistent problem that requires a speciic treatment\ud
approach. Aim of this study was to determine changes in\ud
interleukin (IL)-10 as an anti-inlammatory cytokines in\ud
allergic and non-allergic CRS at Makassar.\ud
METHODS: A prospective cohort study was designed\ud
to assess the level of IL-10 for three times during two\ud
weeks of therapy. Medication of Cefadroxil 500 mg 2x1,\ud
Pseudoephedrine 30 mg 2x1, Terfenadine 40 mg 2x1 and\ud
Methylprednisolone 4 mg 3x1, was conducted during two weeks for 13 subjects in allergic CRS group and 12 subjects\ud
non-allergic CRS group. Results were statistically analyzed\ud
with student t-test and paired t-test.\ud
RESULTS: The changes in levels of IL-10 in allergic CRS\ud
group were increased, but not signiicant (5.??9?? to 5.769,\ud
p=0.058), and in non-allergic CRS group were decreased,\ud
but not signiicant (6.1??5 to 5.475, p=0.10??).\ud
CONCLUSION: The serum levels of IL-10 were not\ud
signiicant increased in allergic CRS group and not\ud
signiicant decreased in non-allergic CRS group

Punagi, Abdul Qadar

Hasanuddin University Repository

 1͸͵
Dynamics of Interleukin-10 in Chronic Rhinosinusitis (Punagi AQ, et al.)
Indones  Biomed J.  2015; 7(3): 163-6DOI: 10.18585/inabj.v7i3.182
R E S E A R C H  A R T I C L E
Dynamics of Interleukin-10 Levels in Chronic Rhinosinusitis with/without Allergy  
Abdul Qadar Punagi1,, Sutji Pratiwi Rahardjo1
1Department of Ear, Nose and Throat, Faculty of Medicine, Hasanuddin University, Jl. Perintis Kemerdekaan Km.10, Makassar, Indonesia
Corresponding author. E-mail: qa_dar@yahoo.co.id
Received date: May 20, 2015; Revised date: Aug 24, 2015; Accepted date: Sep 2, 2015
B
ACKGROUND: Rhinosinusitis occurs when 
the lining of the nasal and sinuses gets inlamed, 
infected or irritated, become swollen, and create 
extra mucus, the swollen lining may also interfere with 
drainage of mucus. Chronic rhinosinusitis (CRS) is a 
more persistent problem that requires a speciic treatment 
approach. Aim of this study was to determine changes in 
interleukin (IL)-10 as an anti-inlammatory cytokines in 
allergic and non-allergic CRS at Makassar.
METHODS: A prospective cohort study was designed 
to assess the level of IL-10 for three times during two 
weeks of therapy. Medication of Cefadroxil 500 mg 2x1, 
Pseudoephedrine 30 mg 2x1, Terfenadine 40 mg 2x1 and 
Methylprednisolone 4 mg 3x1, was conducted during two 
Abstract
Introduction
Rhinosinusitis is an issue for general practitioners and Ear, 
Nose, and Throat (ENT) specialists due to its complex 
etiology, high prevalence and also its management which 
has not been coincident. Commonly, rhinogenic chronic 
rhinosinusitis (CRS) was developed because of untreated 
acute rhinosinusitis.(1) Rhinosinusitis inluences about γ5 
million American people in a year and at least 16 million 
people admitted to hospital with related diagnosis according 
to National Ambulatory Medical Care Survey (NAMCS). 
weeks for 13 subjects in allergic CRS group  and 12 subjects 
non-allergic CRS group. Results were statistically analyzed 
with student t-test and paired t-test.
RESULTS: The changes in levels of IL-10 in allergic CRS 
group were increased, but not signiicant (5.β9γ to 5.769, 
p=0.058), and in non-allergic CRS group were decreased, 
but not signiicant (6.1β5 to 5.475,  p=0.10γ). 
CONCLUSION: The serum levels of IL-10 were not 
signiicant increased in allergic CRS group and not 
signiicant decreased in non-allergic CRS group.
KEYWORDS: interleukin-10, chronic rhinosinusitis, 
allergy, Cefadroxil, Pseudoephedrine, Terfenadine, 
Methylprednisolone
Indones Biomed J. 2015; 7(3): 163-6
About 14% adult people suffering episodic rhinosinusitis 
every year and received antibiotic medication for the 
diagnosis. The incidence of rhinosinusitis in adult patients 
who came to outpatient clinic of Department of ENT, Dr. 
Cipto Mangunkusumo National Central General Hospital, 
during January to December β005 was 4γ5 patients (44.5%). 
While in Makassar, 109β visits (41.5%) of rhinologic cases 
were reported in teaching hospitals, during β00γ-β007.(β)
 Rhinosinusitis, one of public medical issues, has 
became an economic burden on society. It may be caused 
by allergy, anatomical abnormality, polyp formation, 
and mucociliary dysfunction. Right diagnosis and proper 
1͸Ͷ
The Indonesian Biomedical Journal, Vol.7, No.3, December 2015, p.163-6 Print ISSN: 2085-3297, Online ISSN: 2355-9179
Methods
into groups with and without allergy. We measured the 
level of IL-10 using Enzyme Linked Immuno Sorbent 
Assay (ELISA) method for plasma samples. Therapy was 
conducted based on Indonesian Rhinology Study Group 
and Indonesian ENT Specialist Association: Cefadroxil 
500 mg 2x1, with addition of Pseudoephedrine 30 mg 2x1, 
Terfenadine 40 mg 2x1 and Methylprednisolon 4 mg 3x1. 
Specimens were collected three times: before, during and 
post therapies. Student’s t-test and paired t-test were used 
in the statistical analysis to compare two mean values with 
signiicance p<0.05.
This study was performed on 25 CRS subjects, where as 
13  subjects were in allergic and 12  subjects were in non-
allergic groups. Table 1 showed the general distribution 
treatment were obtained after a good anamnesis, and 
thorough physical assessment and work up. 
 Nasal obstruction and headache are the most 
common symptoms of CRS.(γ) CRS could be caused by 
allergic and non allergic factors. Allergic CRS is caused 
by immunologically mediated inlammation, most often 
Immunoglobulin-E dependent, where as non allergic CRS is 
more likely caused by infection of gram negative bacterias 
and anaerobes. Rhinology study group of  PERHATI-KL 
has recommended antibiotic combined with symptomatic 
therapy (such as decongestant, steroids, mucolytic, and nasal 
douching), therefore in this study we used Cefadroxil 500 
mg 2x1, Pseudoephedrine 30 mg 2x1, Terfenadine 40 mg 
2x1 and Methylprednisolone 4 mg 3x1,  as the protocol of 
CRS management.(4) Antihistamines and immunotherapy 
are given in severe allergic CRS. 
 Sharma, et al., has reported increase of iniltrated 
inlammatory cells and decrease of interference of regulatory 
T cells (T-reg).(5) However, there is no difference on T-reg 
in peripheral blood count which observed on subject whose 
CRS with nasal polyp (NP) and without NP. The lower 
level of interleukin (IL)-10 and transforming growth factor 
(TGF)-1 with higher level of pro-inlammatory cytokines 
(tumor necrosis factor (TNF) dan IL-6) were observed 
more in CRS than in control subjects. IL-10 was known as 
an anti-inlammatory cytokine, which could inhibit antigen 
presentation.
 Study by Sobol, et al., showed different inlammatory 
cells and cytokine proiles between subjects with CRS 
and cystic ibrosis (CF).(6) Higher level of neutrophil, 
macrophage, and cells expressing mRNA for interferon Ȗ 
and IL-8 was found higher in CF subjects compared to CRS 
subjects or control group. Eosinophil and cells expressing 
mRNA for IL-4, IL-5, and IL-10 were higher in the CRS 
subjects compared to CF subjects and control. 
A cohort study was performed  involving 25 subjects from 
ENT outpatient clinic of Dr. Wahidin Sudirohusodo Hospital 
from July to October 2013. Subjects signed the informed 
consent prior to the study engagement. Ethical approval for 
this study was released by the Ethics Committee of Human 
Protection in Biomedical Research, Faculty of Medicine, 
Hasanuddin University, number 10γ6/H4.8.4.5.γ1/PPγ6-
KOMETIK/2013.
 Skin Prick test was performed to divide the subjects 
Results
Aspects n %
Gender
Women 17 68
Men 8 32
Total 25 100
Age
10 - <20 years 4 16
20 - <30 years 9 36
30 - <40 years 8 32
40 - <50 years 3 12
 50 years 1 4
Total 25 100
Chief complaints
Rhinorrea 9 36
Nasal Obstruction 5 20
Cephalgia 11 44
Total 25 100
Table 1. Distribution of the sample by gender, age, and chief 
complaints
 1͸ͷ
Dynamics of Interleukin-10 in Chronic Rhinosinusitis (Punagi AQ, et al.)
Indones  Biomed J.  2015; 7(3): 163-6DOI: 10.18585/inabj.v7i3.182
data of subjects population. Table 2 showed the changes 
of IL-10 concentrations in  allergic group during two 
weeks of therapy. There were slight increases for IL-10 
concentrations, but not signiicant. Table γ showed the 
changes of IL-10 concentrations in non-allergic group 
during two weeks of therapy. There were slight increases 
for IL-10 concentration, but not signiicant. 
Our study involved 68% females and γβ% males, or β:1 
in ratio. File and Rismayanti reported similar ratios, 1.7:1 
and 1.γ:1, respectively.(7,8) Most of our subjects aged 
from 20-39 years old. Rahmi, et al.,  suggested that CRS 
are commonly found in productive age, 24-29 years old 
(18.8%).(γ)
 Our study showed a different phenomenon of IL-10 
level after therapy, between allergic and non-allergic CRS 
groups. In allergic group, the IL-10 levels were increased, 
while in non-allergic group the IL-10 levels were decreased. 
IL-10 levels were found to be higher in non-allergic group. 
These results were in accordance to the results reported by 
Perić, et al., who also reported a higher level of IL-10 in 
patient with NP without asthma than NP with asthma.(9) 
 On the last day of two weeks therapy, levels of IL-
10 were higher in the allergic than non-allergic groups. 
The persistent allergen exposure may lead to the persistent 
inlammation, it could be the reason of this condition. 
Statistical analysis showed no signiicant differences for IL-
10 level of each group at nasal lavage specimen collection 
time (before, 1-week and β-week post-therapies). However, 
changes in the level of IL-10 after 2-week therapy indicated 
a good response to therapy and showed an evidence-based 
protocol of 10 to 15 days therapy as recommended by 
Rhinology study group of  PERHATI-KL.
 Another study conducted by Savolainen, et al., 
showed a signiicant increase level of  IL-10, after one 
year of pollen immunotherapy.(10) Bolard, et al., evaluated 
Mean (pg/ml) SD P
1 Before therapy 13 5.293 0.446 0.183
After 1-week therapy 13 5.731 1.172
2 After 1-week therapy 13 5.731 1.172 0.907
After 2-week therapy 13 5.769 0.67
3 Before therapy 13 5.293 0.446 0.058
After 2-week therapy 13 5.769 0.67
No.
IL-10
n
Mean (pg/ml) SD P
1 Before therapy 12 6.125 1.306 0.832
After 1-week therapy 12 6.117 1.699
2 After 1-week therapy 12 6.117 1.699 0.088
After 2-week therapy 12 5.475 0.733
3 Before therapy 12 6.125 1.306 0.103
After 2-week therapy 12 5.475 0.733
No. n
IL-10
Table 3. IL-10 level of  non-allergic CRS group during therapy.
Table 2. IL-10 level of allergic CRS group during therapy.
Discussion
1͸͸
The Indonesian Biomedical Journal, Vol.7, No.3, December 2015, p.163-6 Print ISSN: 2085-3297, Online ISSN: 2355-9179
the characteristics (cells and mediators) of nasal lavages 
in 9 untreated NP patients (A group), 17 patients treated 
with topical steroids (B group), β1 patients treated with 
endonasal ethmoidectomy associated with topical steroids 
(C group), and 1β healthy subjects (control group).(11) IL-
8, IL-10, and IL-1ȕ levels were signiicantly higher in C 
group than in A and B and control groups. TNF-α level was 
signiicantly lower in C group than in  A and B and control 
groups; and there was a negative correlation between IL-10 
and TNF-α.  In C group, asthmatic patients had a signiicant 
higher level of IL-10 than non-asthmatic patients. They 
concluded that topical steroid treatment was associated with 
a decrease of inlammatory cells and mediators. In marked 
contrast, nasal surgery was associated with marked changes, 
in cytokine proile in nasal secretions, that are clearly 
different from those of controls and topical steroid-treated 
NP patients, where as steroids up-regulated constitutive IL-
10 production. 
 As we mentioned earlier, the different mean level of 
IL-10 after 2-week therapy among the two groups might 
caused by persistent allergic exposure that may lead to the 
persistent inlammation. The possible pathologic overviews 
were an overlapping stimulation from infectious and non-
infectious factors. Prolonged inlammation proposed the 
secondary infection.
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S, Kentjono WA, Harmadji S, Herawati S, editors. Naskah 
Lengkap Perkembangan Terkini Diagnosis dan Penatalaksanaan 
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Universitas Airlangga/RS Dr. Soetomo; β004. p.17-β4.
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et al. Peripheral blood and tissue T regulatory cells in chronic 
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8. Rismayanti. Pengaruh Rinosinusitis Kronis terhadap gangguan 
fungsi ventilasi tuba Eustachius (Thesis). Makassar: Universitas 
Hasanuddin; 2009.
9. Perić A, Vojvodić D, Radulović V, Vukomanović-Durdević B, Perić 
AV, Miljanović O. Proinlammatory cytokine levels in nasal luid as 
indicators of severity of nasal polyposis. Acta Clin Croat. 2010; 49: 
395-403.
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Increased expression of allergen-induced in vitro interleukin-10 
and interleukin-18 mRNA in peripheral blood mononuclear cells 
of allergic rhinitis patients after speciic immunotherapy. Clin Exp 
Allergy. 2004; 4: 413-9.
11. Bolard F, Gosset P, Lamblin C, Bergoin C, Tonnel AB, Wallaert B. 
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References
Conclusion
The serum levels of IL 10 were not signiicant increased in 
allergic CRS group and not signiicant decreased  in non-
allergic rhinosinusitis CRS subjects.
Figure 1. IL-10 level of allergic and non-allergic CRS groups 
differences during therapy. White bar: allegic CRS; Black bar: 
non-allergic CRS.


Dynamics of Interleukin-10 Levels in Chronic Rhinosinusitis with/without Allergy

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Dynamics of Interleukin-10 Levels in Chronic Rhinosinusitis with/without Allergy

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