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Clinical & Experimental Allergy

Changes in immune regulation in response to examination stress in atopic and healthy individuals

Authors


Correspondence:
Caroline Olgart Höglund, Department of Medicine Solna, Division of Respiratory Medicine, Lung Research Laboratory, L4:01, Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden.
E-mail: Caroline.Olgart@ki.se

Summary

Background Stress can aggravate the allergic inflammation, but determinants of disturbed immune regulation are largely unknown.

Objective To determine systemic immunological, local inflammatory and functional airway responses to stress in healthy and atopic individuals.

Methods Forty-one undergraduate students, 22 with allergy of whom 16 had asthma, and 19 healthy controls, were studied in a low-stress period and in association with a large exam. Subjects completed questionnaires on stress and health behaviours, underwent lung function tests, bronchial methacholine challenge, measurements of exhaled nitric oxide and urine cortisol. Blood cells were phenotyped, and cytokines from mononuclear blood cells were analysed.

Results Perceived stress and anxiety increased in both groups during the exam period while cortisol increased only in the atopy group. Cytokine production decreased broadly in response to stress in both groups, which was paralleled by an increase in the proportion of regulatory T cells (CD4+CD45RO+CD25bright). Interestingly, atopic individuals, but not controls, reacted with a decreased T-helper type 1/T-helper type 2 (Th1/Th2) ratio and a decrease in natural killer (NK) cell numbers in response to stress. In control subjects only, exhaled nitric oxide decreased and forced expiratory volume in one second increased during stress.

Conclusion Atopic and non-atopic subjects shared some immune changes in response to stress, such as a dramatic decline in cytokines and an increase in the number of regulatory T cells in peripheral blood. However, other stress-induced immune changes were unique to atopic individuals, such as a skewed Th1/Th2 ratio and reduced NK cell numbers, indicating that some pathogenic mechanisms in atopics may be more strongly affected by stress than others.

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