Dysregulation of the stress response in asthmatic children

• Published in: Allergy Vol. 64; no. 1; pp. 18 - 31
• Main Authors: Priftis, K.N, Papadimitriou, A, Nicolaidou, P, Chrousos, G.P
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford, UK : Blackwell Publishing Ltd 2009; Blackwell Publishing Ltd; Blackwell
• Subjects: Adrenal Cortex Hormones - therapeutic use; adrenals; allergy; Animals; Asthma; Asthma - drug therapy; Asthma - etiology; Asthma - pathology; Biological and medical sciences; Child; Childrens health; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; hypersensitivity; hypothalamic-pituitary-adrenal axis; Hypothalamo-Hypophyseal System; Inflammation; Medical sciences; Pituitary-Adrenal System; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Stress; Stress, Physiological; Human; Lung disease; Allergy; Immunopathology; Adrenal glands; Hypothalamohypophysoadrenal axis; Respiratory disease; Dermatology; Stress; Asthma; Immunology; Bronchus disease; Obstructive pulmonary disease; adrenals; Child; hypothalamic- pituitary-adrenal axis
• ISSN: 0105-4538; 1398-9995; 0108-1675
• DOI: 10.1111/j.1398-9995.2008.01948.x

The stress system co-ordinates the adaptive responses of the organism to stressors of any kind. Inappropriate responsiveness may account for increased susceptibility to a variety of disorders, including asthma. Accumulated evidence from animal models suggests that exogenously applied stress enhances airway reactivity and increases allergen-induced airway inflammation. This is in agreement with the clinical observation that stressful life events increase the risk of a new asthma attack. Activation of the hypothalamic-pituitary-adrenal (HPA) axis by specific cytokines increases the release of cortisol, which in turn feeds back and suppresses the immune reaction. Data from animal models suggest that inability to increase glucocorticoid production in response to stress is associated with increased airway inflammation with mechanical dysfunction of the lungs. Recently, a growing body of evidence shows that asthmatic subjects who are not treated with inhaled corticosteroids (ICS) are likely to have an attenuated activity and/or responsiveness of their HPA axis. In line with this concept, most asthmatic children demonstrate improved HPA axis responsiveness on conventional doses of ICS, as their airway inflammation subsides. Few patients may experience further deterioration of adrenal function, a phenomenon which may be genetically determined.