Immuno-Inflammatory Phenotype in Autism Spectrum Disorder
Antonella Gagliano, Carola Costanza, Valeria Marletta, Valentina Finocchiaro, Irene Di Modica, Eva Germanò
This study describes the clinical experience with corticosteroid therapy in a subgroup of children with autism spectrum disorder (ASD) characterized by regressive onset and immune-allergic comorbidities or recurrent infections associated with symptom exacerbations. Based on a neuroinflammatory rationale and clinical analogies with PANS-like presentations, corticosteroids were considered as a potential therapeutic intervention. A multicentre analysis was conducted on 30 patients aged 3–18 years with a confirmed diagnosis of ASD, regressive or plateau/mixed onset, and the presence of active immune-allergic conditions. Corticosteroid treatment (prednisone or methylprednisolone; mean dose 1.5 mg/kg/day in pulse therapy) was administered either as monotherapy or combined with low-dose azithromycin. Clinical outcomes were monitored over 12 months using the ABC, CY-BOCS, and YGTSS scales. Significant improvements were observed across all clinical domains. The regressive subtype showed the most pronounced response, with mean reductions of 24–38% in behavioural, obsessive–compulsive, and tic symptoms. Younger age, regressive onset, and immune-allergic comorbidities emerged as predictors of greater treatment benefit. At 24-month follow-up, 60% of patients showed a reduction in ASD severity level, and 10% no longer met diagnostic criteria. No moderate or severe adverse events were reported. These findings suggest that corticosteroid therapy may modulate behavioural and neuropsychiatric symptoms in ASD, particularly in immunoreactive and regressive phenotypes.
Keywords
Autism spectrum disorder (ASD), Neuroinflammation, Corticosteroid therapy, Immunomodulation, Regressive autism.