social stress and asthma:The role of corticosteroid insensitivity

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Haczku,J allergy clinical Immunol,vol125,number3,pgs550-558.

Stress profoundly affects the course of airway inflammation.In asthma

evidence now suggests that social stress prolongs allergen-induced inflammatory

changes,increases asthma exacerbations,and contributes to asthma morbidity and

mortality.

Recent studies highlighted the role of altered corticosteroid responsivenerss

of T cells,dendritic cells,and airway epithelial cells in stress-induced

enhancement of inflammation .Central to this process is the shift in the balance

of the mutual transrepression of the GR (glucocorticoid receptor)and NF-kB

(nuclear factor-kB) that results in steroid insensitivity and an increase in

immune cell activation.

Concievably ,repeated exposure to social stress skews the immune response to

the Th2 phenotype in the airways,including a persistant and amplified

inflammation after allergen challenge.Such changes ,in part,may a result of

endogenous corticosteroid insensitivity,mediated by decreased function and

expression of the GR.

Another reason why oral prednisone might not always work so well. Wayne