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Ryklief Z, Suliman S, Hemmings SMJ, van den Heuvel LL, Seedat S. Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls. J Psychosom Res 2022; 158:110938. [PMID: 35580455 DOI: 10.1016/j.jpsychores.2022.110938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/25/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017. METHODS Self-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma. RESULTS Rates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD. CONCLUSIONS Rates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.
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Affiliation(s)
- Zulfa Ryklief
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa; South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Fregoso DR, Hadian Y, Gallegos AC, Degovics D, Maaga J, Keogh CE, Kletenik I, Gareau MG, Isseroff RR. Skin-brain axis signaling mediates behavioral changes after skin wounding. Brain Behav Immun Health 2021; 15:100279. [PMID: 34589779 PMCID: PMC8474598 DOI: 10.1016/j.bbih.2021.100279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Patients with chronic wounds often have associated cognitive dysfunction and depression with an as yet unknown mechanism for this association. To address the possible causality of skin wounding inducing these changes, behavior and cognitive functions of female C57BL/6 mice with an excisional skin wound were compared to unwounded animals. At six days post wounding, animals exhibited anxiety-like behaviors, impaired recognition memory, and impaired coping behavior. Wounded animals also had concomitant increased hippocampal expression of Tnfa, the pattern recognition receptor (PRR) Nod2, the glucocorticoid receptors GR/Nr3c1 and Nr3c2. Prefrontal cortex serotonin and dopamine turnover were increased on day six post-wounding. In contrast to the central nervous system (CNS) findings, day six post -wounding serum catecholamines did not differ between wounded and unwounded animals, nor did levels of the stress hormone corticosterone, TNFα, or TGFβ. Serum IL6 levels were, however elevated in the wounded animals. These findings provide evidence of skin-to-brain signaling, mediated either by elevated serum IL6 or a direct neuronal signaling from the periphery to the CNS, independent of systemic mediators. Wounding in the periphery is associated with an altered expression of inflammatory mediators and PRR genes in the hippocampus, which may be responsible for the observed behavioral deficits.
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Affiliation(s)
- Daniel R. Fregoso
- University of California, School of Medicine, Department of Dermatology, Davis, United States
| | - Yasmin Hadian
- University of California, School of Medicine, Department of Dermatology, Davis, United States
| | - Anthony C. Gallegos
- University of California, School of Medicine, Department of Dermatology, Davis, United States
| | - Doniz Degovics
- University of California, School of Medicine, Department of Dermatology, Davis, United States
| | - John Maaga
- University of California, School of Medicine, Department of Dermatology, Davis, United States
| | - Ciara E. Keogh
- University of California, School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, Davis, United States
| | - Isaiah Kletenik
- Harvard Medical School, Department of Neurology, And Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Department of Neurology, United States
| | - Melanie G. Gareau
- University of California, School of Veterinary Medicine, Department of Anatomy, Physiology and Cell Biology, Davis, United States
| | - R. Rivkah Isseroff
- University of California, School of Medicine, Department of Dermatology, Davis, United States
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Kwon CW, Fried RG, Nousari Y, Ritchlin C, Tausk F. Psoriasis: Psychosomatic, somatopsychic, or both? Clin Dermatol 2018; 36:698-703. [DOI: 10.1016/j.clindermatol.2018.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lin TK, Zhong L, Santiago JL. Association between Stress and the HPA Axis in the Atopic Dermatitis. Int J Mol Sci 2017; 18:ijms18102131. [PMID: 29023418 PMCID: PMC5666813 DOI: 10.3390/ijms18102131] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
The hypothalamic–pituitary–adrenal (HPA) axis is one of the body’s neuroendocrine networks that responds to psychological stress (PS). In the skin, there exists a peripheral HPA axis similar to the central axis. Glucocorticoids (GCs) are key effector molecules of the HPA axis and are essential for cutaneous homeostasis. Atopic dermatitis (AD) is a condition typically characterized by a chronic relapsing course that often results in PS. HPA dysfunction is present in AD patients by the decreased response of GCs elevation to stress as compared to those unaffected by AD. Nevertheless, in skin, acute PS activates several metabolic responses that are of immediate benefit to the host. During the acute phase of PS, increased endogenous GCs have been shown to provide benefit rather than by aggravating cutaneous inflammatory dermatoses. However, a chronic T helper cell type 2 (Th2) predominant cytokine profile acts as a negative feedback loop to blunt the HPA axis response in AD. In this article, we reviewed the role of CRF, pro-opiomelanocortin (POMC)-derived peptides, GCs of the HPA, and 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) in AD, with a discussion of the pathogenetic mechanisms of inflammation and skin barrier functions, including antimicrobial defense, and their association with PS.
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Affiliation(s)
- Tzu-Kai Lin
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Lily Zhong
- Citrus Valley Medical Center, West Covina, CA 91790, USA.
| | - Juan Luis Santiago
- Dermatology Service & Translational Research Unit (UIT), Hospital General Universitario de Ciudad Real, Ciudad Real 13005, Spain.
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Trikojat K, Luksch H, Rösen-Wolff A, Plessow F, Schmitt J, Buske-Kirschbaum A. "Allergic mood" - Depressive and anxiety symptoms in patients with seasonal allergic rhinitis (SAR) and their association to inflammatory, endocrine, and allergic markers. Brain Behav Immun 2017; 65:202-209. [PMID: 28495610 DOI: 10.1016/j.bbi.2017.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/06/2017] [Accepted: 05/06/2017] [Indexed: 12/21/2022] Open
Abstract
A growing number of studies show an association between seasonal allergic rhinitis (SAR) with depression and anxiety. The underlying mechanisms of a link between SAR and affect, however, are still unclear. The objective of the present study was to investigate depressive symptoms and anxiety in SAR patients and their association to inflammatory and endocrine parameters. SAR patients (n=41) and non-allergic, healthy controls (n=42) were assessed during (pollen season) and out of symptomatic periods (non-pollen season). Inflammatory cytokine profile (Interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, IL-17, IFN-γ, TNF-α), Immunoglobulin-E (IgE), hair cortisol concentrations (HCC), as well as sleep quality were measured. The present data show that during acute allergic inflammation SAR patients experienced a significant increase in Beck Depression Inventory (BDI-) II scores when (a) compared to the asymptomatic period and (b) when compared to the non-allergic controls, while no differences in anxiety were observed. Increased BDI-II scores in SAR patients were significantly associated with levels of IL-6 as well as IL-6/IL-10 and IFN-γ/IL-10 ratios and further, to an early age at manifestation of SAR and poor sleep quality. These findings support a close relationship between acute allergic processes and affective states, with inflammatory cytokines, sleep, and age of manifestation as potentially relevant mediators.
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Affiliation(s)
- Katharina Trikojat
- Department of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Hella Luksch
- Department of Pediatrics, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Angela Rösen-Wolff
- Department of Pediatrics, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jochen Schmitt
- Centre for Evidence-Based Health Care, Technische Universität Dresden, Dresden, Germany; University Allergy Center, University Hospital Carl Gustav Carus, Dresden, Germany
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Wetherell MA, Craw O, Smith K, Smith MA. Psychobiological responses to critically evaluated multitasking. Neurobiol Stress 2017; 7:68-73. [PMID: 28540348 PMCID: PMC5432679 DOI: 10.1016/j.ynstr.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/06/2017] [Accepted: 05/10/2017] [Indexed: 11/02/2022] Open
Abstract
In order to understand psychobiological responses to stress it is necessary to observe how people react to controlled stressors. A range of stressors exist for this purpose; however, laboratory stressors that are representative of real life situations provide more ecologically valid opportunities for assessing stress responding. The current study assessed psychobiological responses to an ecologically valid laboratory stressor involving multitasking and critical evaluation. The stressor elicited significant increases in psychological and cardiovascular stress reactivity; however, no cortisol reactivity was observed. Other socially evaluative laboratory stressors that lead to cortisol reactivity typically require a participant to perform tasks that involve verbal responses, whilst standing in front of evaluative others. The current protocol contained critical evaluation of cognitive performance; however, this was delivered from behind a seated participant. The salience of social evaluation may therefore be related to the response format of the task and the method of evaluation. That is, the current protocol did not involve the additional vulnerability associated with in person, face-to-face contact, and verbal delivery. Critical evaluation of multitasking provides an ecologically valid technique for inducing laboratory stress and provides an alternative tool for assessing psychological and cardiovascular reactivity. Future studies could additionally use this paradigm to investigate those components of social evaluation necessary for eliciting a cortisol response.
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Affiliation(s)
- Mark A Wetherell
- Psychobiology Research Group, Department of Psychology, Northumbria University Newcastle, UK
| | - Olivia Craw
- Psychobiology Research Group, Department of Psychology, Northumbria University Newcastle, UK
| | - Kenny Smith
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, UK
| | - Michael A Smith
- Psychobiology Research Group, Department of Psychology, Northumbria University Newcastle, UK.,Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
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Blunted cortisol response to psychosocial stress in atopic patients is associated with decrease in salivary alpha-amylase and aldosterone: Focus on sex and menstrual cycle phase. Psychoneuroendocrinology 2017; 78:31-38. [PMID: 28152431 DOI: 10.1016/j.psyneuen.2017.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/30/2016] [Accepted: 01/05/2017] [Indexed: 12/22/2022]
Abstract
A decreased responsiveness of the hypothalamic-pituitary-adrenocortical axis to stress stimuli in patients with atopy is well documented. The aim of this study was to investigate personality traits, salivary alpha-amylase activity and the aldosterone response to psychosocial stress procedure based on public speech in atopic patients with respect to sex and the menstrual cycle (MC) phase. The study was performed in 106 subjects of both sexes, 53 atopic patients suffering from allergic rhinitis, allergic asthma or atopic dermatitis and 53 age-, sex-, the MC phase- and BMI- matched healthy controls. Substantially attenuated activity of alpha-amylase and reduced secretion of aldosterone during the psychosocial stress were observed in the whole sample of patients with atopy. Higher activity of alpha-amylase observed in the follicular compared to the luteal phase in healthy women was not present in atopic patients. In both males and females, atopy was associated with blunted cortisol response but no changes in the heart rate. Psychological characterization revealed a significantly higher trait anxiety and higher preference for avoidance-oriented coping strategy in female but not male atopic patients. These findings provide evidence that patients with atopy exhibit insufficient alpha-amylase and aldosterone responsiveness to psychosocial stress, thus suggesting decreased sympathetic activity. Potential disturbances in sex hormone status during the MC in female patients with atopy have to be considered in future research. Changes in personality traits were demonstrated in female atopic patients, but not in male patients.
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Trueba AF, Ritz T, Trueba G. The Role of the Microbiome in the Relationship of Asthma and Affective Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 874:263-88. [PMID: 26589224 DOI: 10.1007/978-3-319-20215-0_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The effect of stress, anxiety and other affective states on inflammatory conditions such as asthma is well documented. Although several immune pathway mechanisms have been proposed and studied, they cannot fully explain the relationship. In this chapter we present a new perspective on asthma development and exacerbation that integrates findings on the role of psychological factors in asthma with the microbiome and the hygiene hypothesis in asthma development.
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Affiliation(s)
- Ana F Trueba
- Universidad San Francisco de Quito, Quito, Ecuador.
| | - Thomas Ritz
- Southern Methodist University, Dallas, TX, USA.
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9
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Cortisol response to acute stress in asthma: Moderation by depressive mood. Physiol Behav 2016; 159:20-6. [PMID: 26965527 DOI: 10.1016/j.physbeh.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 01/08/2023]
Abstract
Both individuals with asthma and depression show signs of a dysregulated hypothalamus-pituitary-adrenal axis. However, little is known about the cortisol response to stress in the context of co-occurring asthma and depressive mood. Thirty-nine individuals with asthma and 41 healthy controls underwent a combined speech and mental arithmetic stressor. During the course of the laboratory session, salivary cortisol was collected 5 times, with 1 sample at 0min before the stressor and 4 samples at 0, 15, 30 and 45min after the stressor. Depressive mood in the past week was assessed with the Hospital Anxiety and Depression Scale at the beginning of the session. Depressive symptoms moderated cortisol response to the acute stressor, but only among asthmatic patients. Higher depressive mood was associated with a significant increase in cortisol, whereas low depressive mood was associated with no cortisol response. In healthy participants, depressive mood had no substantial effect on cortisol response to the stressor. These findings suggest that depressive mood and chronic inflammatory diseases such as asthma can interact to augment cortisol response to stress.
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10
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Laugero KD. Response to the Letter by Grace F. M., et al. J Clin Endocrinol Metab 2015; 100:L58-9. [PMID: 26151403 DOI: 10.1210/jc.2015-2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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11
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Kong L, Wu J, Lin Y, Wang G, Wang J, Liu J, Chen M, Du X, Sun J, Lin J, Dong J. BuShenYiQi granule inhibits atopic dermatitis via improving central and skin Hypothalamic-Pituitary-Adrenal axis function. PLoS One 2015; 10:e0116427. [PMID: 25658752 PMCID: PMC4319736 DOI: 10.1371/journal.pone.0116427] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/05/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dysfunction of central and skin Hypothalamic-Pituitary-Adrenal (HPA) axis play important roles in pathogenesis of atopic dermatitis (AD). Our previous studies showed that several Chinese herbs could improve HPA axis function. In this study, we evaluated the anti-inflammatory effects of BuShenYiQi granule (BSYQ), a Chinese herbs formula, in AD mice and explored the effective mechanism from regulation of HPA axis. METHODS The ovalbumin (OVA) induced AD mice model were established and treated with BSYQ. We evaluated dermatitis score and histology analysis of dorsal skin lesions, meanwhile, serum corticosterone (CORT), adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH) and inflammatory cytokines were determined by ELISA. The changes of CRH/proopiomelanocortin(POMC) axis elements, corresponding functional receptors and crucial genes of glucocorticosteroidogenesis in the skin were measured by quantitative real-time PCR and western blot, respectively. RESULTS The symptoms and pathological changes in skin of AD mice were significantly improved and several markers of inflammation and allergy descended obviously after BSYQ treatment. We found that AD mice had insufficient central HPA tone, but these conditions were markedly improved after BSYQ treatment. The AD mice also showed a disturbed expression of skin HPA. In lesion skin of AD mice, the mRNA and protein expressions of CRH decreased significantly, on the contrary, POMC and cytochrome P450 side-chain cleavage enzyme (CYP11A1) increased markedly, meanwhile, NR3C1 (mouse GR), CRHR2 and 11-hydroxylase type 1(CYP11B1) were reduced locally. Most of these tested indexes were improved after BSYQ treatment. CONCLUSIONS AD mice displayed the differential expression pattern of central and skin HPA axis and BSYQ treatment significantly alleviated the symptoms of AD mice and presented anti-inflammatory and anti-allergic effects via regulating the expression of central and skin HPA axis.
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Affiliation(s)
- Lingwen Kong
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jingfeng Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yanhua Lin
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Genfa Wang
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jia Wang
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jiaqi Liu
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Meixia Chen
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Xin Du
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jing Sun
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jinpei Lin
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
| | - Jingcheng Dong
- Department of integrated traditional Chinese and western medicine, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of integrated traditional Chinese and western medicine of Fudan University, Shanghai, PR China
- * E-mail:
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12
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Osman OT, Mufaddel A, Almugaddam F, Augusterfer EF. The psychiatric aspects of skin disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.11.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mufaddel A, Abdelgani AE. Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojpsych.2014.43022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Simon DM, Corbett BA. Examining associations between anxiety and cortisol in high functioning male children with autism. J Neurodev Disord 2013; 5:32. [PMID: 24216056 PMCID: PMC3827503 DOI: 10.1186/1866-1955-5-32] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 10/29/2013] [Indexed: 12/28/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is characterized by deficits in communication and social ability, as well as restricted interests and repetitive behavior. Anxiety is a persistent anticipation or apprehension about one or more situations to which a person is exposed, and affects many people, including children with ASD. Stress, by contrast, is a response to situations that are threatening, uncontrollable, or unexpected. Indices of anxiety are often measured through informants, with parents and teachers serving as the primary sources of reported anxiety in children. However, self-report measures exist, allowing current (state) and persistent (trait) anxiety to be assessed. The current study was designed to evaluate whether children with autism could identify their own levels of anxiety and the degree to which these levels were associated with symptom profile and physiological arousal. Methods Self-reported state and trait anxiety were collected during exposure to different stress paradigms for 40 children (21 typically developing, 19 with autistic disorder) and compared to parent reported social ability (Social Responsiveness Scale) and stress responsivity (cortisol). Results Significant differences were found between typically developing and children with autism for both state and trait anxiety across all conditions. Associations were identified between severity of parent-reported social impairment and both types of self-report anxiety. No relationship was found between stress (salivary cortisol) and anxiety in children with autism. Conclusions Children with autism are able to consistently report their persistent level of anxiety symptoms in stressful situations of benign character. Therefore, the inclusion of such measures may be useful in identifying and tracking symptoms in children with autism under appropriate circumstances.
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Affiliation(s)
| | - Blythe A Corbett
- Department of Psychiatry, Vanderbilt University, 230 Appleton Way, 37203 Nashville, TN, USA.
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Hiramoto K, Kobayashi H, Sekiyama A, F Sato E, Tsuruta D, Ishii M. Mild exercise suppresses exacerbation of dermatitis by increasing cleavage of the β-endorphin from proopiomelanocortin in NC/Nga mice. J Clin Biochem Nutr 2013. [PMID: 23341699 DOI: 10.3164/jcbn.12.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the mechanism by which the strength and weakness of exercise stress affects the skin symptoms of atopic dermatitis (AD). Specific pathogen-free (SPF) and conventional NC/Nga mice were used. Conventional mice, but not the SPF, spontaneously develop dermal symptoms similar to that of patients with AD. There were two types of stress, mild (20 m/min for 60 min) or strong exercise (25 m/min for 90 min), using a treadmill four times per day. The symptom of the conventional group were strongly exacerbated by strong exercise but ameliorated by mild exercise. The plasma concentrations of α-melanocyte stimulating hormone (α-MSH) and the expression of melanocortin receptor-1 in skin elevated after strong exercise but decreased after mild exercise. The plasma levels of β-endorphin and the expression of µ-opioid receptor in skin were increased by mild exercise. In addition, the expression of prohormone convertase (PC) 1/3, PC2 and carboxypeptidase E (CPE) in pituitary gland were higher in the conventional group than in the SPF group. The level of PC2 was suppressed by mild exercise in the conventional groups, and elevated further by strong exercise. The level of PC1/3 becomes higher with the increase of the exercise load. On the other hand, the expression of the CPE was further increase by mild exercise but suppressed by strong exercise. These observations suggested that exercise-induced stress significantly affect the symptoms of AD in a pivotal manner depending on the levels of α-MSH and β-endorphin, and the expression of pituitary PC2 and CPE.
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Affiliation(s)
- Keiichi Hiramoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan ; Brain Science Institute, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan
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Rosenkranz MA, Davidson RJ, Maccoon DG, Sheridan JF, Kalin NH, Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun 2013; 27:174-84. [PMID: 23092711 PMCID: PMC3518553 DOI: 10.1016/j.bbi.2012.10.013] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/11/2012] [Accepted: 10/12/2012] [Indexed: 12/27/2022] Open
Abstract
Psychological stress is a major provocative factor of symptoms in chronic inflammatory conditions. In recent years, interest in addressing stress responsivity through meditation training in health-related domains has increased astoundingly, despite a paucity of evidence that reported benefits are specific to meditation practice. We designed the present study to rigorously compare an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention to a well-matched active control intervention, the Health Enhancement Program (HEP) in ability to reduce psychological stress and experimentally-induced inflammation. The Trier Social Stress Test (TSST) was used to induce psychological stress and inflammation was produced using topical application of capsaicin cream to forearm skin. Immune and endocrine measures of inflammation and stress were collected both before and after MBSR training. Results show those randomized to MBSR and HEP training had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms. However, MBSR training resulted in a significantly smaller post-stress inflammatory response compared to HEP, despite equivalent levels of stress hormones. These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions. Moreover, mindfulness practice, in particular, may be more efficacious in symptom relief than the well-being promoting activities cultivated in the HEP program.
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Affiliation(s)
- Melissa A Rosenkranz
- Waisman Laboratory for Brain Imaging & Behavior and Center for Investigating Healthy Minds, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, United States.
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Hiramoto K, Kobayashi H, Sekiyama A, F Sato E, Tsuruta D, Ishii M. Mild exercise suppresses exacerbation of dermatitis by increasing cleavage of the β-endorphin from proopiomelanocortin in NC/Nga mice. J Clin Biochem Nutr 2012; 52:58-63. [PMID: 23341699 PMCID: PMC3541420 DOI: 10.3164/jcbn.12-51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/17/2012] [Indexed: 12/16/2022] Open
Abstract
This study investigated the mechanism by which the strength and weakness of exercise stress affects the skin symptoms of atopic dermatitis (AD). Specific pathogen-free (SPF) and conventional NC/Nga mice were used. Conventional mice, but not the SPF, spontaneously develop dermal symptoms similar to that of patients with AD. There were two types of stress, mild (20 m/min for 60 min) or strong exercise (25 m/min for 90 min), using a treadmill four times per day. The symptom of the conventional group were strongly exacerbated by strong exercise but ameliorated by mild exercise. The plasma concentrations of α-melanocyte stimulating hormone (α-MSH) and the expression of melanocortin receptor-1 in skin elevated after strong exercise but decreased after mild exercise. The plasma levels of β-endorphin and the expression of µ-opioid receptor in skin were increased by mild exercise. In addition, the expression of prohormone convertase (PC) 1/3, PC2 and carboxypeptidase E (CPE) in pituitary gland were higher in the conventional group than in the SPF group. The level of PC2 was suppressed by mild exercise in the conventional groups, and elevated further by strong exercise. The level of PC1/3 becomes higher with the increase of the exercise load. On the other hand, the expression of the CPE was further increase by mild exercise but suppressed by strong exercise. These observations suggested that exercise-induced stress significantly affect the symptoms of AD in a pivotal manner depending on the levels of α-MSH and β-endorphin, and the expression of pituitary PC2 and CPE.
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Affiliation(s)
- Keiichi Hiramoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan ; Brain Science Institute, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585, Japan
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Corbett BA, Schupp CW, Lanni KE. Comparing biobehavioral profiles across two social stress paradigms in children with and without autism spectrum disorders. Mol Autism 2012; 3:13. [PMID: 23158965 PMCID: PMC3533919 DOI: 10.1186/2040-2392-3-13] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/30/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Autism spectrum disorders (ASD) are defined by impairment in reciprocal social interaction and flexible adaptation to the environment. This study compared physiological stress in children with and without ASD exposed to two social stress protocols. We hypothesized that the ASD group would show heightened initial and enduring cortisol levels to the social stressors, which would be moderated by age and intelligence. METHODS Twenty-seven children with ASD and 32 with typical development (TYP) completed a standardized social-evaluative performance task and a validated paradigm of social play with peers. Physiological stress was measured by salivary cortisol at nine time points. Statistical approaches included repeated-measures linear mixed models and correlation analyses. RESULTS The average cortisol level of both groups during initial exposure to social situations was significantly greater than baseline levels (ASD, P = 0.018; TYP, P = 0.006). Stress responsivity was significantly different between the groups; the TYP group showed a significant reduction in cortisol over time (P = 0.023), whereas the ASD group maintained an elevated cortisol level (P >0.05). The ASD group evidenced greater variability in between-group, within-group and intra-individual analyses. Age was a positive moderator of stress for the ASD group (P = 0.047), whereas IQ was a negative moderator for the TYP group (P = 0.061). CONCLUSIONS Initial stress to novel social scenarios is idiosyncratic and predictive of subsequent exposure. Amidst significant variability in cortisol, children with ASD show enhanced and sustained social stress that increases with age. Developmental and cognitive factors differentially moderate stress in children with ASD and TYP, respectively. A model of neuroendocrine reactivity is proposed.
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Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry, Vanderbilt University, Vanderbilt Kennedy Center, PMB 40, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Clayton W Schupp
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA
| | - Kimberly E Lanni
- Veterans Affairs Northern California Healthcare System, 10535 Hospital Way, Building 649, Mather, CA, 95655, USA
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Peters EM, Liezmann C, Klapp BF, Kruse J. The neuroimmune connection interferes with tissue regeneration and chronic inflammatory disease in the skin. Ann N Y Acad Sci 2012; 1262:118-26. [DOI: 10.1111/j.1749-6632.2012.06647.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Okan G, Muhammedrezai S, Vural P. Angio-oedema after trans-sphenoidal surgery in a patient with Cushing's disease. Allergol Immunopathol (Madr) 2011; 39:52-3. [PMID: 20655139 DOI: 10.1016/j.aller.2010.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/06/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
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Pavlovic S, Liezmann C, Blois SM, Joachim R, Kruse J, Romani N, Klapp BF, Peters EMJ. Substance P Is a Key Mediator of Stress-Induced Protection from Allergic Sensitization via Modified Antigen Presentation. THE JOURNAL OF IMMUNOLOGY 2010; 186:848-55. [DOI: 10.4049/jimmunol.0903878] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Loerbroks A, Gadinger MC, Bosch JA, Stürmer T, Amelang M. Work-related stress, inability to relax after work and risk of adult asthma: a population-based cohort study. Allergy 2010; 65:1298-305. [PMID: 20456315 DOI: 10.1111/j.1398-9995.2010.02375.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an extensive literature linking stressful work conditions to adverse health outcomes. Notwithstanding, the relationship with asthma has not been examined, although various other measures of psychological stress have been associated with asthma. Therefore, we aimed to investigate the relation between work stress and asthma prevalence and incidence. METHODS We used data from a population-based cohort study (n = 5114 at baseline in 1992-1995 and n = 4010 at follow-up in 2002/2003). Asthma was measured by self-reports. Two scales that assessed psychologically adverse work conditions were extracted from a list of work-condition items by factor analysis (these scales were termed 'work stress' and 'inability to relax after work'). For each scale, the derived score was employed both as continuous z-score and as categorized variable in analyses. Associations with asthma were estimated by prevalence ratios (PRs) and risk ratios (RRs) using Poisson regression with a log-link function adjusting for demographics, health-related lifestyles, body mass index and family history of asthma. Analyses were restricted to those in employment (n = 3341). RESULTS Work stress and inability to relax z-scores were positively associated with asthma prevalence (PR = 1.15, 95%CI = 0.97, 1.36 and PR = 1.43, 95%CI = 1.12, 1.83, respectively). Prospective analyses using z-scores showed that for each 1 standard deviation increase in work stress and inability to relax, the risk of asthma increased by approximately 40% (RR for work stress = 1.46, 95%CI = 1.06, 2.00; RR for inability to relax = 1.39, 95%CI = 1.01, 1.91). Similar patterns of associations were observed in analyses of categorized exposures. CONCLUSIONS This is the first study to show a cross-sectional and longitudinal association of work stress with asthma.
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Affiliation(s)
- A Loerbroks
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Orita K, Hiramoto K, Inoue R, Sato EF, Kobayashi H, Ishii M, Inoue M. Strong exercise stress exacerbates dermatitis in atopic model mice, NC/Nga mice, while proper exercise reduces it. Exp Dermatol 2010; 19:1067-72. [PMID: 21087324 DOI: 10.1111/j.1600-0625.2010.01130.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopic dermatitis is well known to exacerbate by stress. How the influence of exercise stress on the skin symptoms in patients with atopic dermatitis has not been clarified. The purpose of our research is to investigate how different strength of exercise stress acts on atopic dermatitis. Specific pathogen-free (SPF) and conventional NC/Nga male mice were used for the experiments. Conventional mice but not SPF group spontaneously develop dermal symptom similar to that of patients with atopic dermatitis at their age of 7 weeks. They were given two types of stress, mild (20 m/min for 60 min) or strong exercise (25 m/min for 90 min), using a treadmill four times per day. The dermal symptom of the conventional group was strongly exacerbated by strong exercise but ameliorated by mild exercise. Under the standard experimental conditions, plasma concentrations of α-melanocyte-stimulating hormone (α-MSH), transforming growth factor-β (TGF-β) and substance P in conventional mice increased markedly with concomitant exacerbation of the symptom. The plasma concentrations of these proteins elevated after strong exercise but decreased after mild exercise. Under the conventional conditions, plasma levels of β-endorphin increased with time by some mechanisms enhanced by the mild exercise. These observations suggested that exercise-induced stress significantly affect the symptom of atopic dermatitis in a pivotal manner depending on the plasma levels of TGF-β, α-MSH, substance P and β-endorphin.
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Affiliation(s)
- Kumi Orita
- Department of Biochemistry and Molecular Pathology, Osaka City University Medical School, Abeno, Osaka, Japan
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Kudielka BM, Wüst S. Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity. Stress 2010; 13:1-14. [PMID: 20105052 DOI: 10.3109/10253890902874913] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stress is one of the most significant health problems in modern societies and the 21st century. This explains a pressing need for investigations into the biological pathways linking stress and health. Besides the locus coeruleus-noradrenaline/autonomic (sympathetic) nervous system ( Chrousos and Gold 1992 ), the hypothalamus-pituitary-adrenal (HPA) axis is the major physiological stress response system in the body. Since alterations in HPA axis regulation under basal conditions and in response to acute stress appear to be a close correlate or even a determining factor of the onset of different diseases or disease progression ( Holsboer 1989 ; Chrousos and Gold 1992 ; Tsigos and Chrousos 1994, 2002 ; Stratakis and Chrousos 1995 ; McEwen 1998 ; Heim et al. 2000a ; Raison and Miller 2003 ), the characterization of an individual's HPA axis activity as well as reactivity pattern to psychosocial stress appears to be of major interest. It is obvious that such a research agenda substantially depends on the availability of appropriate measures. However, since the HPA axis is a highly adaptive system which is characterized by marked inter- and intraindividual variability ( Mason 1968 ; Hellhammer et al. 2009 ), the development of such markers of HPA axis regulation in humans was-and still is-a rather challenging task. In this brief review, we focus on findings on two HPA axis measures, namely the cortisol-awakening response (CAR) to assess HPA axis basal activity and the Trier social stress test (TSST) to investigate HPA axis stress reactivity.
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Affiliation(s)
- Brigitte M Kudielka
- Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.
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Afsar FS, Isleten F, Sonmez N. Children with Atopic Dermatitis Do Not Have More Anxiety or Different Cortisol Levels Compared with Normal Children. J Cutan Med Surg 2010; 14:13-8. [DOI: 10.2310/7750.2010.09021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The hypothalamic-pituitary-adrenal axis has an important immunoregulatory role under stress, and stressmediated anxiety has been reported to be associated with alterations in immune functions and attenuated cortisol levels in atopic dermatitis (AD) patients. Objective: We investigated serum basal cortisol and anxiety levels in pediatric AD patients and compared them with those of controls. Methods: Basal serum cortisol levels were measured in 36 pediatric AD patients (aged 9–16 years) and 36 control subjects (aged 9–15 years). Anxiety was assessed by the trait anxiety subscale (TAI-C) of the State-Trait Anxiety Inventory for Children. The severity of AD was assessed by the objective severity scoring of AD (SCORing Atopic Dermatitis [SCORAD]). Results: Data analysis showed no statistical difference for the basal serum cortisol levels ( p = .383) and the TAI-C ( p = .730) between the two groups. No significant correlation was found between the basal cortisol values and the TAI-C scores in the AD group ( p = .290). The SCORAD index was correlated with the TAI-C scores ( p < .05) but not correlated with the basal serum cortisol values in AD patients ( p = .06). Conclusion: Children with AD do not have more anxiety or different cortisol levels when compared with normal children, but the severe symptomatology of AD itself may cause anxiety levels to increase in children with AD.
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Affiliation(s)
- F. Sule Afsar
- From the Departments of Dermatology and Biochemistry, Dr. Behcet Uz Children's Hospital, Izmir, Turkey, and Department of Psychiatry, Tepecik Teaching Hospital, Izmir, Turkey
| | - Figen Isleten
- From the Departments of Dermatology and Biochemistry, Dr. Behcet Uz Children's Hospital, Izmir, Turkey, and Department of Psychiatry, Tepecik Teaching Hospital, Izmir, Turkey
| | - Nihal Sonmez
- From the Departments of Dermatology and Biochemistry, Dr. Behcet Uz Children's Hospital, Izmir, Turkey, and Department of Psychiatry, Tepecik Teaching Hospital, Izmir, Turkey
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Dhabhar FS. A hassle a day may keep the pathogens away: The fight-or-flight stress response and the augmentation of immune function. Integr Comp Biol 2009; 49:215-36. [PMID: 21665815 DOI: 10.1093/icb/icp045] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Stress is known to suppress or dysregulate immune function and increase susceptibility to disease. Paradoxically, the short-term fight-or-flight stress response is one of nature's fundamental defense mechanisms that galvanizes the neuroendocrine, cardiovascular, and musculoskeletal systems into action to enable survival. Therefore, it is unlikely that short-term stress would suppress immune function at a time when it may be critically required for survival (e.g., in response to wounding and infection by a predator or aggressor). In fact, studies have shown that stress can enhance immune function under certain conditions. Several factors influence the direction (enhancing versus suppressive) of the effects of stress on immune function: (1) DURATION: acute or short-term stress experienced at the time of activation of an immune response enhances innate and adaptive immune responses. Chronic or long-term stress can suppress or dysregulate immune function. (2) Leukocyte distribution: compartments (e.g., skin), that are enriched with immune cells during acute stress show immuno-enhancement, while those that are depleted of leukocytes (e.g., blood), show immuno-suppression. (3) The differential effects of physiologic versus pharmacologic stress hormones: Endogenous hormones in physiological concentrations can have immuno-enhancing effects. Endogenous hormones at pharmacologic concentrations, and synthetic hormones, are immuno-suppressive. (4) Timing: immuno-enhancement is observed when acute stress is experienced during the early stages of an immune response while immuno-suppression may be observed at late stages. The type of immune response (protective, regulatory/inhibitory, or pathological) that is affected determines whether the effects of stress are ultimately beneficial or harmful for the organism. Arguments based on conservation of energy have been invoked to explain potential adaptive benefits of stress-induced immuno-suppression, but generally do not hold true because most mechanisms for immuno-suppression expend, rather than conserve, energy. We propose that it is important to study, and if possible, to clinically harness, the immuno-enhancing effects of the acute stress response that evolution has finely sculpted as a survival mechanism, just as we study its maladaptive ramifications (chronic stress) that evolution has yet to resolve.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences and Stanford Institute for Immunity, Transplantation, & Infection, Stanford University, Stanford, CA 94305-5135, USA.
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Dhabhar FS. Enhancing versus suppressive effects of stress on immune function: implications for immunoprotection and immunopathology. Neuroimmunomodulation 2009; 16:300-17. [PMID: 19571591 PMCID: PMC2790771 DOI: 10.1159/000216188] [Citation(s) in RCA: 518] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Stress is known to suppress immune function and increase susceptibility to infections and cancer. Paradoxically, stress is also known to exacerbate asthma, and allergic, autoimmune and inflammatory diseases, although such diseases should be ameliorated by immunosuppression. Moreover, the short-term fight-or-flight stress response is one of nature's fundamental defense mechanisms that enables the cardiovascular and musculoskeletal systems to promote survival, and it is unlikely that this response would suppress immune function at a time when it is most required for survival (e.g. in response to wounding and infection by a predator or aggressor). These observations suggest that stress may suppress immune function under some conditions while enhancing it under others. The effects of stress are likely to be beneficial or harmful depending on the type (immunoprotective, immunoregulatory/inhibitory, or immunopathological) of immune response that is affected. Studies have shown that several critical factors influence the direction (enhancing vs. suppressive) of the effects of stress or stress hormones on immune function: (1) Duration (acute vs. chronic) of stress: Acute or short-term stress experienced at the time of immune activation can enhance innate and adaptive immune responses. Chronic or long-term stress can suppress immunity by decreasing immune cell numbers and function and/or increasing active immunosuppressive mechanisms (e.g. regulatory T cells). Chronic stress can also dysregulate immune function by promoting proinflammatory and type-2 cytokine-driven responses. (2) Effects of stress on leukocyte distribution: Compartments that are enriched with immune cells during acute stress show immunoenhancement, while those that are depleted of leukocytes, show immunosuppression. (3) The differential effects of physiologic versus pharmacologic concentrations of glucocorticoids, and the differential effects of endogenous versus synthetic glucocorticoids: Endogenous hormones in physiological concentrations can have immunoenhancing effects. Endogenous hormones at pharmacologic concentrations, and synthetic hormones, are immunosuppressive. (4) The timing of stressor or stress hormone exposure relative to the time of activation and time course of the immune response: Immunoenhancement is observed when acute stress is experienced at early stages of immune activation, while immunosuppression may be observed at late stages of the immune response. We propose that it is important to study and, if possible, to clinically harness the immunoenhancing effects of the acute stress response, that evolution has finely sculpted as a survival mechanism, just as we study its maladaptive ramifications (chronic stress) that evolution has yet to resolve. In view of the ubiquitous nature of stress and its significant effects on immunoprotection as well as immunopathology, it is important to further elucidate the mechanisms mediating stress-immune interactions and to meaningfully translate findings from bench to bedside.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, and Stanford Institute for Immunity, Transplantation, & Infection, Stanford University, Stanford, CA 94305-5135, USA.
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Kudielka BM, Hellhammer DH, Wüst S. Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology 2009; 34:2-18. [PMID: 19041187 DOI: 10.1016/j.psyneuen.2008.10.004] [Citation(s) in RCA: 632] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Revised: 10/01/2008] [Accepted: 10/08/2008] [Indexed: 11/30/2022]
Abstract
Stress and stress-related health impairments are major problems in human life and elucidating the biological pathways linking stress and disease is of substantial importance. However, the identification of mechanisms underlying a dysregulation of major components of the stress response system is, particularly in humans, a very challenging task. Salivary cortisol responses to diverse acute challenge paradigms show large intra- and interindividual variability. In order to uncover mechanisms mediating stress-related disorders and to potentially develop new therapeutic strategies, an extensive phenotyping of HPA axis stress responses is essential. Such a research agenda depends on substantial knowledge of moderating and intervening variables that affect cortisol responses to different stressors and stimuli. The aim of this report is, therefore, to provide a comprehensive summary of important determinants of, in particular, human salivary cortisol responses to different kinds of laboratory stimuli including acute psychosocial stress as well as pharmacological provocation procedures. This overview demonstrates the role of age and gender, endogenous and exogenous sex steroid levels, pregnancy, lactation and breast-feeding, smoking, coffee and alcohol consumption as well as dietary energy supply in salivary cortisol responses to acute stress. Furthermore, it briefly summarizes current knowledge of the role of genetic factors and methodological issues in terms of habituation to repeated psychosocial stress exposures and time of testing as well as psychological factors, that have been shown to be associated with salivary cortisol responses like early life experiences, social factors, psychological interventions, personality as well as acute subjective-psychological stress responses and finally states of chronic stress and psychopathology.
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Affiliation(s)
- Brigitte M Kudielka
- Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany.
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Boettger MK, Bär KJ, Dohrmann A, Müller H, Mertins L, Brockmeyer NH, Agelink MW. Increased vagal modulation in atopic dermatitis. J Dermatol Sci 2008; 53:55-9. [PMID: 18790607 DOI: 10.1016/j.jdermsci.2008.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 07/18/2008] [Accepted: 08/01/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atopic dermatitis has been shown to be associated with neurogenic and psychosocial factors. In related atopic diseases such as rhinitis or asthma, a shift in autonomic balance towards a parasympathetic modulation has been described. On the other hand, the psychiatric symptoms known for atopic dermatitis are often associated with decreased vagal modulation. Furthermore, an increased parasympathetic activity has been shown to exhibit anti-inflammatory effects, thus rather alleviating dermatitis symptoms. OBJECTIVE In order to address these intriguing discrepancies, we aimed to assess the autonomic state in patients suffering from atopic dermatitis. METHODS Heart rate variability assessment was performed in 30 patients and data were compared to those obtained from matched controls. Furthermore, questionnaires for disease activity and psychosocial stressors were employed. RESULTS Patients showed higher values for parasympathetic modulation than controls. This was mainly reflected by an increase in the root mean square of successive differences (RMSSD). This parameter further correlated with dermatological symptoms and the time since the last severe exacerbation of the disease. In addition, subgroups of patients with dyshidrosis or photophobia showed significant differences in autonomic modulation under deep respiration. Moreover, cardiac autonomic modulation was hardly altered upon postural change, indicating that autonomic reactivity is only mildly influenced in these patients. CONCLUSION Patients with atopic dermatitis showed an autonomic dysbalance which is comparable to other diseases related to atopy or allergy. Our findings point to the question whether these alterations are disease-inherent or counter-regulatory, which should be addressed in future studies.
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Amano H, Akiyama H, Bienenstock J. Differential corticosterone responses to stress in the lung in two strains of Flinders rats. Clin Exp Allergy 2008; 38:659-66. [PMID: 18167122 DOI: 10.1111/j.1365-2222.2007.02909.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute stress affects a variety of organs and cellular systems. These include the hypothalamic-pituitary-adrenal (HPA) axis, corticotropin-releasing factor (CRF), mast cells and nerves. Flinders-sensitive (FSL) rat strains have hypercholinergic responses and are more sensitive than Flinders-resistant rats (FRL) to anaphylaxis. OBJECTIVE To investigate the effects of acute water avoidance stress (1 h) on FSL and FRL tracheal epithelial tissue. METHODS We measured short circuit current (I(sc)) as a measure of tracheal response, and the effect of substance P (SP) on tracheal epithelium in Ussing chambers. Electron microscopy was performed to assess mast cell activation. RESULTS Both strains showed increased I(sc) responses to stress, inhibited by prior injection of the CRF receptor 1 and 2 antagonist, alpha-helical CRF-(9-41). No increases in conductance were seen. Stress responses were accompanied by electron microscopic morphologic evidence for mast cell degranulation, which was not completely inhibited by alpha-helical CRF-(9-41) pre-treatment. Stress primed the epithelium for an enhanced response to SP in FSL, but this again was not inhibited by alpha-helical CRF-(9-41). FRL had 2.5 times the corticosterone response of FSL. CONCLUSION Acute stress affects the tracheal epithelium, not accompanied by changes in ion permeability, but associated with mast cell degranulation. Because blunted HPA axis responses are associated with vulnerability to inflammation, this may partially explain the findings. These stress effects on the lung have a genetic basis associated with relative corticosterone responses, are complex and only in part mediated by CRF.
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Affiliation(s)
- H Amano
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Pavlovic S, Daniltchenko M, Tobin DJ, Hagen E, Hunt SP, Klapp BF, Arck PC, Peters EMJ. Further exploring the brain-skin connection: stress worsens dermatitis via substance P-dependent neurogenic inflammation in mice. J Invest Dermatol 2007; 128:434-46. [PMID: 17914449 DOI: 10.1038/sj.jid.5701079] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A neurogenic component in atopy and allergy is evident and potentially of great pathogenic relevance. Stress was recently shown to activate elements of this component and is vividly discussed as a cause of exacerbation. However, to date, scientific proof of stress-induced neuronal plasticity and neuro-immune interaction in atopy or allergy remains lacking. Here we show early evidence that exposure to sound stress and atopic dermatitis-like allergic dermatitis (AD) equipotently raise the number of cutaneous nerve fibers containing the prototypic stress neuropeptide substance P (SP) in mice. Stress increases AD readout parameters by at least 30% (eosinophil infiltration, vascular cell adhesion molecule-positive blood vessels, epidermal thickness). This dramatic pathologic exacerbation is associated with increased neurogenic inflammation (degranulated mast cells; interstitial neuropeptidergic dense core granules, mast cell apoptosis, endothelial gaping). Key features of AD exacerbation could not be induced in mice lacking the neurokinin-1 SP receptor (NK1). Interestingly, stress had no significant additional effect on CD4+ cell number, but shifted the cytokine profile toward TH2 in skin. Thus, we conclude that stress primarily exacerbates AD via SP-dependent cutaneous neurogenic inflammation and subsequent local cytokine shifting and should be considered as a therapeutic target, while it offers a convincing pathogenic explanation to affected patients and their frustrated physicians alike.
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Affiliation(s)
- Sanja Pavlovic
- Psycho-Neuro-Immunology, Center for Internal Medicine and Dermatology, Neuroscience Research Center, Charité-University Medicine, Campus Mitte, Berlin, Germany
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Sharp LK, Kimmel LG, Kee R, Saltoun C, Chang CH. Assessing the Perceived Stress Scale for African American adults with asthma and low literacy. J Asthma 2007; 44:311-6. [PMID: 17530531 DOI: 10.1080/02770900701344165] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Perceived Stress Scale (PSS) is a widely used measure of stress that has not been validated in asthma patients. The psychometric properties of the PSS were explored using confirmatory factor analysis and item response theory. Study 1 involved 312 ambulatory care patients with asthma who completed the PSS during a routine visit. Study 2 involved 247 community-dwelling adults with asthma who completed the PSS as a part of a larger asthma study. Four items showed acceptable psychometric performance across ethnic groups and literacy. The short PSS is a rapid, valid measure of subjective stress in diverse asthma populations.
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Affiliation(s)
- Lisa K Sharp
- Department of Medicine, Section of Health Promotion Research, University of Illinois at Chicago, Chicago, IL 60608, USA.
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Höglund CO, Axén J, Kemi C, Jernelöv S, Grunewald J, Müller-Suur C, Smith Y, Grönneberg R, Eklund A, Stierna P, Lekander M. Changes in immune regulation in response to examination stress in atopic and healthy individuals. Clin Exp Allergy 2007; 36:982-92. [PMID: 16911354 DOI: 10.1111/j.1365-2222.2006.02529.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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(+)CD25(bright)). 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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Affiliation(s)
- C Olgart Höglund
- Department of Medicine Solna, Division of Respiratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Theoharides TC, Kempuraj D, Tagen M, Vasiadi M, Cetrulo CL. Human umbilical cord blood-derived mast cells: a unique model for the study of neuro-immuno-endocrine interactions. ACTA ACUST UNITED AC 2007; 2:143-54. [PMID: 17237553 DOI: 10.1007/s12015-006-0021-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/24/2022]
Abstract
Findings obtained using animal models have often failed to reflect the processes involved in human disease. Moreover, human cultured cells do not necessarily function as their actual tissue counterparts. Therefore, there is great demand for sources of human progenitor cells that may be directed to acquire specific tissue characteristics and be available in sufficient quantities to carry out functional and pharmacological studies. Acase in point is the mast cell, well known for its involvement in allergic reactions, but also implicated in inflammatory diseases. Mast cells can be activated by allergens, anaphylatoxins, immunoglobulin-free light chains, superantigens, neuropeptides, and cytokines, leading to selective release of mediators. These could be involved in many inflammatory diseases, such as asthma and atopic dermatitis, which worsen by stress, through activation by local release of corticotropin-releasing hormone or related peptides. Umbilical cord blood and cord matrix-derived mast cell progenitors can be separated magnetically and grown in the presence of stem cell factor, interleukin-6, interleukin-4, and other cytokines to yield distinct mast cell populations. The recent use of live cell array, with its ability to study such interactions rapidly at the single-cell level, provides unique new opportunities for fast output screening of mast cell triggers and inhibitors.
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Affiliation(s)
- T C Theoharides
- Department of Laboratory of Molecular Immunopharmacology and Drug Discovery, Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA, USA.
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Theoharides TC, Kalogeromitros D. The critical role of mast cells in allergy and inflammation. Ann N Y Acad Sci 2007; 1088:78-99. [PMID: 17192558 DOI: 10.1196/annals.1366.025] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Mast cells are well known for their involvement in allergic and anaphylactic reactions, but recent findings implicate them in a variety of inflammatory diseases affecting different organs, including the heart, joints, lungs, and skin. In these cases, mast cells appear to be activated by triggers other than aggregation of their IgE receptors (FcepsilonRI), such as anaphylatoxins, immunoglobulin-free light chains, superantigens, neuropeptides, and cytokines leading to selective release of mediators without degranulation. These findings could explain inflammatory diseases, such as asthma, atopic dermatitis, coronary inflammation, and inflammatory arthritis, all of which worsen by stress. It is proposed that the pathogenesis of these diseases involve mast cell activation by local release of corticotropin-releasing hormone (CRH) or related peptides. Combination of CRH receptor antagonists and mast cell inhibitors may present novel therapeutic interventions.
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Affiliation(s)
- Theoharis C Theoharides
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA 02111, USA.
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Klokk M, Götestam KG, Mykletun A. There are no association between IgE levels and symptoms of anxiety and depression in the adult female general population. The Hordaland Health Study (HUSK). Nord J Psychiatry 2007; 61:410-7. [PMID: 18236306 DOI: 10.1080/08039480701788715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There are multiple reports of increased prevalence of anxiety and depression in patients with asthma, eczema and rhinitis. Suggested biological mechanisms underlying these associations most commonly involve IgE. However, the association between anxiety/depression and IgE has hardly been studied, and the aim of the present study will therefore be to examine the hypothesized association between anxiety/depression and IgE in a general adult female population. A sub-sample of 374 female participants in a population-based general health study in Norway (the Hordaland Health Study) with participation rate 70% was screened for total and allergen-specific IgE. Anxiety and depression were measured employing the Hospital Anxiety and Depression Scale (HADS). This design ensured adequate statistical power, and the population-approach ensured satisfactory variance in both IgE and anxiety/depression. No association between case level or symptom load of anxiety/depression and total or allergen-specific IgE was found. Non-significant tendencies were both positive and negative. This finding was robust across continuous and categorical statistical approaches. Our finding does not question the commonly reported associations between anxiety/depression and asthma, rhinitis and eczema. We do, however, question the relevance of IgE as an aetiological factor in the biological chain underlying these associations.
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Affiliation(s)
- Marianne Klokk
- Department of Psychiatry, Aalesund Hospital, Aalesund, Helse-Sunnmøre HF, Norway.
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Buske-Kirschbaum A, Ebrecht M, Kern S, Hellhammer DH. Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)--do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology 2006; 31:439-46. [PMID: 16359823 DOI: 10.1016/j.psyneuen.2005.10.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 10/17/2005] [Accepted: 10/21/2005] [Indexed: 11/30/2022]
Abstract
In previous research we reported attenuated responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis and further, an increased reactivity of the sympathetic adrenomedullary (SAM) system to stress in patients suffering from atopic dermatitis (AD). AD is a chronic inflammatory skin disease mainly triggered by TH(2)-dependent inflammatory processes. The specific goal of the present study was to investigate whether altered HPA axis and SAM system responsiveness to stress can also be found in TH(1)-mediated inflammatory conditions. Patients with psoriasis (PSO; n=23), a TH(1)-mediated inflammatory (autoimmune) skin disease and healthy controls (n=25) were exposed to a standardized laboratory stressor (TSST) which mainly consists of a free speech and a mental arithmetic task in front of an audience. To investigate HPA axis and SAM system responsiveness, cortisol, ACTH, and catecholamines were determined before and after the stress test. In addition, cortisol levels after awakening and cortisol levels during the day (short diurnal profile) were determined. In order to test feedback sensitivity of the HPA axis, a dexamethasone (DEX) suppression test (0.5 mg) was performed. Analysis of cortisol and ACTH levels after the stress test yielded no significant differences between PSO subjects and controls indicating no altered HPA axis function in this patient group. Further, no between-group differences were found in cortisol levels after awakening or during the day (short diurnal profile). Additionally, no difference between PSO and healthy subjects in the feedback sensitivity of the system could be found (DEX test). However, PSO patients showed elevated epinephrine (F(3,102)=4.7; p<0.005) and norepinephrine (F(3,135)=2.7; p<0.05) levels in response to the stress test when compared to the controls. These findings suggest no altered HPA axis responsiveness, but increased reactivity of the SAM system in TH(1)-mediated chronic inflammatory skin disease.
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Affiliation(s)
- A Buske-Kirschbaum
- Department of Biopsychology, University of Dresden, D-01026 Dresden, Germany.
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Yang PC, Jury J, Söderholm JD, Sherman PM, McKay DM, Perdue MH. Chronic psychological stress in rats induces intestinal sensitization to luminal antigens. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 168:104-14; quiz 363. [PMID: 16400013 PMCID: PMC1592661 DOI: 10.2353/ajpath.2006.050575] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is increasing evidence that stress plays a role in the pathophysiology of chronic intestinal disorders, but the mechanisms remain unclear. Previous studies in rats have revealed that stress decreases gut barrier function and allows excessive uptake of luminal material. Here, we investigated whether chronic psychological stress acts to induce sensitization of intestinal tissues to oral antigens. Rats were subjected to 1 hour per day of water avoidance stress or sham stress daily for 10 days, and horseradish peroxidase (HRP) was delivered by gavage on day 5. Studies to determine sensitization were conducted on day 20. All stressed rats developed HRP-specific IgE antibodies, antigen-induced intestinal secretion, and increased numbers of inflammatory cells in gut mucosa. Luminal HRP was absorbed more readily by enterocytes of stressed animals. In addition, stressed rats had increased expression of interleukin-4 and decreased expression of interferon-gamma in gut mucosa, a cytokine profile that is typical of allergic conditions. Treatment of stressed rats with an antagonist to corticotropin-releasing hormone (previously shown to inhibit stress-enhanced gut permeability) eliminated the manifestations of intestinal hypersensitivity. Our results indicate that the presence of oral antigen during chronic psychological stress alters the immune response (to sensitization rather than oral tolerance) and causes subsequent antigen-induced gut pathophysiology.
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Affiliation(s)
- Ping-Chang Yang
- Department of Pathology and Molecular Medicine, Intestinal Disease Research Program, McMaster University, Hamilton, Ontario, Canada
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41
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Koblenzer CS. The Emotional Impact of Chronic and Disabling Skin Disease: A Psychoanalytic Perspective. Dermatol Clin 2005; 23:619-27. [PMID: 16112437 DOI: 10.1016/j.det.2005.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article discusses some major early factors that influence the evolving psychologic development, which in turn helps determine the emotional impact that chronic or disabling skin disease may have on patients' lives. If the emotional environment, encompassed by the infant-caretaker relationship, is less than optimal, the stability of the body image may be compromised, self-esteem diminished, and affect less well handled and the somatic expression of emotional content may ensue. Each of these is important in dermatology, as is the nature of the disease and the capacity of families and of society to adapt. Psoriasis, atopic dermatitis, and acne are used as examples.
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Abstract
Many studies have established the routes by which the immune and central nervous (CNS) systems communicate. This network of connections permits the CNS to regulate the immune system through both neuroendocrine and neuronal pathways. In turn, the immune system signals the CNS through neuronal and humoral routes, via immune mediators and cytokines. This regulatory system between the immune system and CNS plays an important role in susceptibility and resistance to autoimmune, inflammatory, infectious and allergic diseases. This review focuses on the regulation of the immune system via the neuroendocrine system, and underlines the link between neuroendocrine dysregulation and development of major depressive disorders, autoimmune diseases and osteoporosis.
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Affiliation(s)
- A Marques-Deak
- Section on Neuroendocrine Immunology and Behavior, Integrative Neural Immune Program, National Institute of Mental Health, NIH, Bethesda, MD 20892, USA
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43
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Affiliation(s)
- L Misery
- Service de Dermatologie, CHU Morvan, 5, avenue Foch, 29200 Brest.
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44
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Marshall GD. Neuroendocrine mechanisms of immune dysregulation: applications to allergy and asthma. Ann Allergy Asthma Immunol 2004; 93:S11-7. [PMID: 15330008 DOI: 10.1016/s1081-1206(10)61482-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the current information and hypotheses related to the underlying mechanisms that link psychological stress and asthma activity via a neuroimmune network dysfunction that may manifest as increased morbidity of immune diseases, such as asthma. DATA SOURCES Literature searches of MEDLINE for published human and animal studies and review articles published in English-language periodicals. Keywords searched included individual and various combinations of psychoneuroimmunology, neuroimmune, neuroimmunology, stress, immunity, allergy, asthma, and inflammation. Both review articles and specific hypothesis-driven articles that focused on immune effects of stress were included. Manuscripts that focused on animal studies were excluded from this review. STUDY SELECTION Representative studies that reflect the consensus of the field based on the expert opinion of the author. RESULTS This article demonstrates the established relationships between the neuroendocrine and immune systems and the impact of both acute and chronic psychological stress on neuroendocrine and immune network function. The adverse impact of stress appears to occur more on immune dysregulation rather than immune suppression. CONCLUSION Psychological stress, allergy and asthma morbidity, and allergy and asthma incidence are all steadily increasing in our society. Establishing a firm relationship can provide a possible new therapeutic direction for evaluation and management of difficult-to-treat patients and possible prophylactic strategies in susceptible populations.
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Affiliation(s)
- Gailen D Marshall
- Division of Allergy and Clinical Immunology, The University of Texas Medical School at Houston, Houston, Texas 77030-1501, USA.
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Sari DK, Kuwahara S, Tsukamoto Y, Hori H, Kunugita N, Arashidani K, Fujimaki H, Sasaki F. Effect of prolonged exposure to low concentrations of formaldehyde on the corticotropin releasing hormone neurons in the hypothalamus and adrenocorticotropic hormone cells in the pituitary gland in female mice. Brain Res 2004; 1013:107-16. [PMID: 15196973 DOI: 10.1016/j.brainres.2004.03.070] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2004] [Indexed: 11/21/2022]
Abstract
We examine the effect on the hypothalamus-pituitary-adrenal gland (HPA) axis of prolonged exposure to low levels of formaldehyde in female C3H/He mice, using immunocytochemical and RT-PCR methods. Two groups of female mice were exposed to differing concentrations (0, 80, 400, 2000 ppb) of formaldehyde inhalation for 16 h/day, 5 days/week, for 12 weeks. The corticotropin releasing hormone (CRH)-immunoreactive (ir) neurons in the hypothalamus were then examined, together with the adrenocorticotropin hormone (ACTH)-ir cells and ACTH mRNA in the pituitary. One group comprised sham control mice. The other group was made allergic by injection of ovalbumin (OVA) and alum prior to exposure to formaldehyde, since most sick building syndrome (SBS) sufferers are women with allergic disease. These animals were further exposed to aerosolized OVA as a booster four times during the exposure period. Our results showed a dose-dependent increase in the number of CRH-ir neurons in the non-allergy (NAG) group. A similar pattern was found in ACTH-ir cells and ACTH mRNA. The allergy (AG) model group showed an increase in basal levels of all markers of HPA activity. Moreover, the AG mice appeared to respond to the lowest concentration of formaldehyde, and all indices of HPA activity were reduced at the highest concentrations of formaldehyde. These results relate to an important clinical issue and also have implications in the broader area of HPA regulation. We conclude that our experimental system may be a suitable animal model for SBS and/or multiple chemical sensitivity (MCS).
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Affiliation(s)
- Dwi Kesuma Sari
- Laboratory of Veterinary Anatomy, Graduate School of Agriculture and Biological Sciences, Osaka Prefecture University, Gakuen-cho 1-1, Sakai, Osaka, 599-8531 Japan
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Webster JI, Moayeri M, Sternberg EM. Novel repression of the glucocorticoid receptor by anthrax lethal toxin. Ann N Y Acad Sci 2004; 1024:9-23. [PMID: 15265771 DOI: 10.1196/annals.1321.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Death from anthrax has been reported to occur from systemic shock. The lethal toxin (LeTx) is the major effector of anthrax mortality. Although the mechanism of entry of this toxin into cells is well understood, its actions once inside the cell are not as well understood. LeTx is known to cleave and inactivate MAPKKs. We have recently shown that LeTx represses the glucocorticoid receptor (GR) both in vitro and in vivo. This repression is partial and specific, repressing the glucocorticoid, progesterone, and estrogen receptor alpha, but not the mineralocorticoid or estrogen receptor beta. This toxin does not affect GR ligand or DNA binding, and we have suggested that it may function by removing/inactivating one or more of the many cofactors involved in nuclear hormone receptor signaling. Although the precise involvement of this nuclear hormone receptor repression in LeTx toxicity is unknown, examples of blunted HPA axis and glucocorticoid signaling in numerous autoimmune/inflammatory diseases suggest that such repression of critically important receptors could have deleterious effects on health.
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Affiliation(s)
- Jeanette I Webster
- Section on Neuroendocrine Immunology and Behavior, National Institute of Mental Health, NIH, Bethesda, MD 20892-4020, USA
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Park MB, Ko E, Ahn C, Choi H, Rho S, Shin MK, Hong MC, Min BI, Bae H. Suppression of IgE production and modulation of Th1/Th2 cell response by electroacupuncture in DNP-KLH immunized mice. J Neuroimmunol 2004; 151:40-4. [PMID: 15145602 DOI: 10.1016/j.jneuroim.2004.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 02/11/2004] [Accepted: 02/11/2004] [Indexed: 11/23/2022]
Abstract
Effects of electroacupuncture (EA) on Th1/Th2 cell response were investigated in BALB/c mice immunized intraperitoneally with 2,4-dinitrophenylated keyhole limpet protein (DNP-KLH). Successive electroacupuncture stimulation on the ST36 acupoint was performed just after immunization. Serum levels of antigen-specific IgE and total IgE were significantly decreased compared with non-acupunctured controls. Production of the Th2-specific cytokines IL-4 and IL-13 in the anti-CD3 mAb-activated splenocytes was significantly suppressed in ST36 electroacupunctured mice compared with non-acupunctured mice. These results imply that successive electroacupuncture on ST36 can decrease the serum level of antigen-specific IgE and total IgE by suppression of the Th2 lineage development.
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Affiliation(s)
- Moon-Baik Park
- Chungnoi Clinical Research Center, and Department of Physiology, College of Oriental Medicine, Kyunghee University, Seoul, South Korea
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48
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Theoharides TC, Cochrane DE. Critical role of mast cells in inflammatory diseases and the effect of acute stress. J Neuroimmunol 2004; 146:1-12. [PMID: 14698841 DOI: 10.1016/j.jneuroim.2003.10.041] [Citation(s) in RCA: 284] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mast cells are not only necessary for allergic reactions, but recent findings indicate that they are also involved in a variety of neuroinflammatory diseases, especially those worsened by stress. In these cases, mast cells appear to be activated through their Fc receptors by immunoglobulins other than IgE, as well as by anaphylatoxins, neuropeptides and cytokines to secrete mediators selectively without overt degranulation. These facts can help us better understand a variety of sterile inflammatory conditions, such as multiple sclerosis (MS), migraines, inflammatory arthritis, atopic dermatitis, coronary inflammation, interstitial cystitis and irritable bowel syndrome, in which mast cells are activated without allergic degranulation.
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Affiliation(s)
- Theoharis C Theoharides
- Department of Pharmacology and Experimental Therapeutics, Tufts-New England Medical Center, Boston, MA, USA.
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