Background: The surface expression of T cell costimulatory molecules CTLA-4 and CD28 and their counter-ligands, B7 molecules (CD80, CD86), is differentially induced for T cell activation and expansion in allergic asthma. However, the role of their soluble forms in plasma has not yet been elucidated. In this study, we investigated whether expression is altered and whether soluble costimulatory molecules are clinically relevant in asthmatic patients. Methods: Plasma concentrations of soluble CTLA-4 (sCTLA-4), CD28, CD80 and CD86 in 51 children with chronic allergic asthma with or without inhaled corticosteroid treatment, and 22 sex- and age-matched control subjects were measured by enzyme-linked immunosorbent assay. Plasma total IgE concentration was measured using a microparticle immunoassay. Results: Asthmatic patients had higher logarithmic plasma total IgE concentration (IgE<sub>log</sub>) than healthy subjects (p < 0.0001). In non-steroid-treated patients, plasma sCTLA-4, sCD28 and sCD80 but not sCD86 concentrations were significantly higher than those of control subjects (all p < 0.05). Plasma sCD80 and sCD86 but not sCTLA-4 and sCD28 concentrations correlated significantly with IgE<sub>log</sub> of all subjects (p < 0.05). There were also significant positive correlations between sCTLA-4 and sCD28 (p = 0.0007), and between sCD80 and sCD86 in all asthmatic patients (p = 0.001). Conclusions: Plasma sCTLA-4, sCD28 and sCD80 concentrations are elevated in allergic asthma. The increased expression of these soluble proteins may reflect the dysregulation of T cell activation, contributing to the immunopathogenesis of allergic asthma.