The role of immunological biomarkers in the pathogenesis of atopic bronchial asthma

Introduction The identification of reliable biomarkers for bronchial asthma, particularly in pediatric patients, is a topic of growing interest. This is primarily due to diagnostic chal- lenges in children, including limited capabilities for pul- monary function testing and heterogeneous clinical man- ifestations. Traditional assessments such as peripheral eosinophil counts may not fully reflect the underlying in- flammatory phenotype. Therefore, alternative cellular and humoral biomarkers are being explored for their di- agnostic and prognostic relevance in atopic bronchial asthma. Materials and Methods The study included 983 pediatric patients (850 boys, 133 girls) diagnosed with varying severities of bronchial asthma. Flow cytometry was used to assess lymphocyte subpopulation markers (CD3+, CD4+, CD8+, CD16+/CD56+, CD19+), and enzyme-linked immuno- sorbent assays (ELISA) were performed to quantify total serum IgE levels. Data were analyzed using descriptive statistics, intergroup comparisons, and ROC-curve anal- ysis. Results T-cell subpopulations showed tendencies toward de- creased CD3+ counts and elevated CD4+, CD8+, and NK cell percentages, though differences did not reach statistical significance. Total serum IgE levels were sig- nificantly elevated in 81.3% of asthmatic patients (mean 651.7±66.3 IU/mL), with levels increasing in proportion to asthma severity. In contrast, CD19+ B-cell levels re- mained within reference ranges. ROC analysis demon- strated that total IgE had strong predictive value for atopic asthma, with an AUC of 0.741 (95% CI: 0.624– 0.859, p = 0.002). Conclusion Cellular immunity markers, including T-cell subpopula- tions, did not show significant alterations across asthma severities, suggesting that atopic asthma may not directly impair T-lymphocyte quantitative parameters. In con- trast, elevated serum IgE levels were strongly associated with atopic asthma and its severity, confirming its utility as a predictive and diagnostic biomarker in clinical set- tings.