title: Changes in immune regulation in response to examination stress in atopic and healthy individuals.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine Solna, Division of Respiratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. Caroline.Olgart@ki.se
authors.forename: C Olgart
authors.initials: CO
authors.lastname: Höglund
authors.forename: J
authors.initials: J
authors.lastname: Axén
authors.forename: C
authors.initials: C
authors.lastname: Kemi
authors.forename: S
authors.initials: S
authors.lastname: Jernelöv
authors.forename: J
authors.initials: J
authors.lastname: Grunewald
authors.forename: C
authors.initials: C
authors.lastname: Müller-Suur
authors.forename: Y
authors.initials: Y
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Grönneberg
authors.forename: A
authors.initials: A
authors.lastname: Eklund
authors.forename: P
authors.initials: P
authors.lastname: Stierna
authors.forename: M
authors.initials: M
authors.lastname: Lekander
mesh_terms: D000328:Adult; D001944:Breath Tests; D016022:Case-Control Studies; D004521:Educational Measurement; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000503:physiopathology / Q000523:psychology*; D007371:Interferon-gamma / Q000097:blood; D007378:Interleukins / Q000097:blood; D007694:Killer Cells, Natural / Q000276:immunology; D008168:Lung / Q000503:physiopathology; D018655:Lymphocyte Count; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology
chemical_list: D007378:Interleukins; D009569:Nitric Oxide; D007371:Interferon-gamma