, Volume 185, Issue 2, pp 97–103

Serum Eosinophil-Derived Neurotoxin (EDN) in Diagnosis and Evaluation of Severity and Bronchial Hyperresponsiveness in Childhood Asthma

  • Kyung Won Kim
  • Kyung Eun Lee
  • Eun Soo Kim
  • Tae Won Song
  • Myung Hyun Sohn
  • Kyu-Earn Kim


This study sought to evaluate the use of serum eosinophil-derived neurotoxin (EDN), which has been proposed as a marker of airway inflammation in asthma in the diagnosis and evaluation of the severity and bronchial hyperresponsiveness in childhood asthma. We studied 72 children with atopic asthma, 36 children with nonatopic asthma, and 43 healthy controls. Skin prick tests, pulmonary function tests, and methacholine challenge tests were performed, in addition to total eosinophil count, serum ECP, and EDN being measured in all subjects. EDN levels were significantly higher in the atopic asthma group than those in the nonatopic asthma group or control group (p < 0.001), as were ECP levels (p < 0.001). EDN levels differed more significantly among groups divided by asthma severity (p < 0.001) than did ECP levels for these groups (p < 0.05). For the groups divided according to bronchial hyperresponsiveness, both EDN and ECP levels were significantly different (p < 0.005 and p < 0.01, respectively). Significant correlations were found between EDN and PC20 (γ = −0.281; p < 0.001), between ECP and PC20 (γ = −0.274; p < 0.005), and between EDN and ECP (γ = 0.443; p < 0.001). In conclusion, serum EDN, as another marker of eosinophilic inflammation together with ECP, may aid in the diagnosis of asthma, especially atopic asthma, and in the evaluation of the severity and bronchial hyperresponsiveness in childhood asthma.


Eosinophil-derived neurotoxin Eosinophil cationic protein Asthma Children Bronchial hyperresponsiveness 


  1. 1.
    American Thoracic Society (2000) Guidelines for Methacholine and Exercise Challenge Testing-1999. Am J Respir Crit Care Med 161:309–329Google Scholar
  2. 2.
    Bacharier LB, Strunk RC, Mauger D, et al. (2004) Classifying asthma severity in children mismatch between symptoms, medication use, and lung function. Am J Respir Crit Care Med 170:426–432PubMedCrossRefGoogle Scholar
  3. 3.
    Backman A (1994) Skin tests for epidemiologic studies. Allergy 49:493–494PubMedGoogle Scholar
  4. 4.
    Bousquet J, Chanez P, Lacoste JY, et al. (1990) Eosinophilic inflammation in asthma. N Engl J Med 323:1033–1039PubMedCrossRefGoogle Scholar
  5. 5.
    Brown WG, Halonen MJ, Kaltenborn WT, Barbee RA (1979) The relationship of respiratory allergy, skin test reactivity, and serum IgE in a community population sample. J Allergy Clin Immunol 63:328–335PubMedCrossRefGoogle Scholar
  6. 6.
    Ferguson AC, Vaughan R, Brown H, Curtis C (1995) Evaluation of serum eosinophilic cationic protein as a marker of disease activity in chronic asthma. J Allergy Clin Immunol 95:23–28PubMedCrossRefGoogle Scholar
  7. 7.
    Fujisawa T, Terada A, Atsuta J, et al. (1998) Clinical utility of serum levels of eosinophil cationic protein (ECP) for monitoring and predicting clinical course in childhood asthma. Clin Exp Allergy 28:19–25PubMedCrossRefGoogle Scholar
  8. 8.
    Gleich GJ (2000) Mechanisms of eosinophil-associated inflammation. J Allergy Clin Immunol 105:651–663PubMedCrossRefGoogle Scholar
  9. 9.
    Global Initiative for Asthma (GINA) (1995) Global strategy for asthma management and prevention, updated 2002, 2004, 2005. Washington, DC: National Institutes of Health, NIH Publication No. 02-3659. Available at (accessed 10 March 2006)
  10. 10.
    Gruber W, Eber E, Pfleger A, et al. (1999) Serum eosinophil cationic protein and bronchial responsiveness in pediatric and adolescent asthma patients. Chest 116:301–305PubMedCrossRefGoogle Scholar
  11. 11.
    Hohlfeld JM, Schmiedl A, Erpenbeck VJ, Venge P, Krug N (2004) Eosinophil cationic protein alters pulmonary surfactant structure and function in asthma. J Allergy Clin Immunol 113:496–502PubMedCrossRefGoogle Scholar
  12. 12.
    Joseph-Bowen J, Klerk N, Holt PG, Sly PD (2004) Relationship of asthma, atopy, and bronchial responsiveness to serum eosinophil cationic proteins in early childhood. J Allergy Clin Immunol 114:1040–1045PubMedCrossRefGoogle Scholar
  13. 13.
    Lonnkvist K, Hellman C, Lundahl J, et al. (2001) Eosinophil markers in blood, serum, and urine for monitoring the clinical course in childhood asthma: impact of budesonide treatment and withdrawal. J Allergy Clin Immunol 107:812–817PubMedCrossRefGoogle Scholar
  14. 14.
    Lowhagen O, Wever AMJ, Lusuardi M, et al. (2002) The inflammatory marker serum eosinophil cationic protein (ECP) compared with PEF as a tool to decide inhaled corticosteroid dose in asthmatic patients. Respir Med 96:95–101PubMedCrossRefGoogle Scholar
  15. 15.
    Martinez FD (1999) Present and future treatment of asthma in infants and young children. J Allergy Clin Immunol 104:169–174PubMedCrossRefGoogle Scholar
  16. 16.
    Morioka J, Kurosawa M, Inamura H, et al. (2000) Development of a novel enzyme-linked immunosorbent assay for blood and urinary eosinophil-derived neurotoxin: a preliminary study in patients with bronchial asthma. Int Arch Allergy Immunol 122:49–57PubMedCrossRefGoogle Scholar
  17. 17.
    Niimi A, Amitani R, Suzuki K, et al. (1998) Serum eosinophil cationic protein as a marker of eosinophilic inflammation in asthma. Clin Exp Allergy 28:233–240PubMedCrossRefGoogle Scholar
  18. 18.
    Park JW, Kim CW, Hong CS (1997) Clinical significance of eosinophil cationic protein (ECP) in bronchial asthma. J Korean Soc Allergol 17:260–269Google Scholar
  19. 19.
    Park Y, Kang H, Kang EK, Koh YY (2002) Blood eosinophil and serum eosinophil cationic protein as a marker of bronchial hyperresponsiveness in children with suspected asthma. J Korean Pediatr Soc 45:1577–1584CrossRefGoogle Scholar
  20. 20.
    Plager DA, Adolphson CR, Gleich GJ (2001) A novel human homolog of eosinophil major basic protein. Immunol Rev 179:192–202PubMedCrossRefGoogle Scholar
  21. 21.
    Prehn A, Seger RA, Faber J, et al. (1998) The relationship of serum-eosinophil cationic protein and eosinophil count to disease activity in children with bronchial asthma. Pediatr Allergy Immunol 9:197–203PubMedGoogle Scholar
  22. 22.
    Rao R, Frederick JM, Enander I, et al. (1996) Airway function correlates with circulating eosinophil, but not mast cell, markers of inflammation in childhood asthma. Clin Exp Allergy 26:789–793PubMedCrossRefGoogle Scholar
  23. 23.
    Remes S, Korppi M, Remes K, et al. (1998) Serum eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in childhood asthma: the influence of atopy. Pediatr Pulmonol 25:167–174PubMedCrossRefGoogle Scholar
  24. 24.
    Sedgwick JB, Vrtis RF, Jansen KJ, et al. (2004) Peripheral blood eosinophils from patients with allergic asthma contain increased intracellular eosinophil-derived neurotoxin. J Allergy Clin Immunol 114:568–574PubMedCrossRefGoogle Scholar
  25. 25.
    Sorkness C, McGill K, Busse WW (2002) Evaluation of serum eosinophil cationic protein as a predictive marker for asthma exacerbation in patients with persistent disease. Clin Exp Allergy 32:1355–1359PubMedCrossRefGoogle Scholar
  26. 26.
    Vanto T, Koskinen P (1998) Serum eosinophil cationic protein in the evaluation of asthma severity in children. Allergy 53:415–419PubMedGoogle Scholar
  27. 27.
    Vatrella A, Ponticiello A, Parrella R, et al. (1996) Serum eosinophil cationic protein (ECP) as a marker of disease activity and treatment efficacy in seasonal asthma. Allergy 51:547–555PubMedGoogle Scholar
  28. 28.
    Wolthers OD (2003) Eosinophil granule proteins in the assessment of airway inflammation in pediatric bronchial asthma. Pediatr Allergy Immunol 14:248–254PubMedCrossRefGoogle Scholar
  29. 29.
    Yoon KA, Lim HS, Kim H, Koh YY (1993) normal predicted values of pulmonary function test in Korean school-aged children. J Korean Pediatr Soc 36:25–37Google Scholar
  30. 30.
    Zimmerman B, Lanner A, Enander I, et al. (1993) Total blood eosinophils, serum eosinophil cationic protein and eosinophil protein X in childhood asthma: relation to disease status and therapy. Clin Exp Allergy 23:564–570PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Kyung Won Kim
    • 1
  • Kyung Eun Lee
    • 1
  • Eun Soo Kim
    • 1
  • Tae Won Song
    • 1
  • Myung Hyun Sohn
    • 1
    • 2
  • Kyu-Earn Kim
    • 1
  1. 1.Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical SciencesBiomolecule Secretion Research Center, Yonsei University College of MedicineSeoulKorea
  2. 2.Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical SciencesBiomolecule Secretion Research Center, Yonsei University College of Medicine, Severance HospitalSeoulKorea

Personalised recommendations