Social stress and asthma: the role of corticosteroid insensitivity

J Allergy Clin Immunol. 2010 Mar;125(3):550-8. doi: 10.1016/j.jaci.2009.11.005. Epub 2010 Feb 11.

Abstract

Psychosocial stress alters susceptibility to infectious and systemic illnesses and may enhance airway inflammation in asthma by modulating immune cell function through neural and hormonal pathways. Stress activates the hypothalamic-pituitary-adrenal axis. Release of endogenous glucocorticoids, as a consequence, may play a prominent role in altering the airway immune homeostasis. Despite substantial corticosteroid and catecholamine plasma levels, chronic psychosocial stress evokes asthma exacerbations. Animal studies suggest that social stress induces corticosteroid insensitivity that in part may be a result of impaired glucocorticoid receptor expression and/or function. Such mechanisms likely promote and amplify airway inflammation in response to infections, allergen, or irritant exposure. This review discusses evidence of an altered corticosteroid responsive state as a consequence of chronic psychosocial stress. Elucidation of the mechanisms of stress-induced impairment of glucocorticoid responsiveness and immune homeostasis may identify novel therapeutic targets that could improve asthma management.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / immunology
  • Adrenal Cortex Hormones / therapeutic use
  • Animals
  • Anti-Asthmatic Agents / immunology
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy
  • Asthma / immunology
  • Asthma / psychology*
  • Glucocorticoids / immunology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Hypothalamo-Hypophyseal System / immunology
  • Immunity, Innate / immunology*
  • Neuroimmunomodulation / immunology*
  • Pituitary-Adrenal System / immunology
  • Receptors, Glucocorticoid / immunology
  • Stress, Psychological / immunology*

Substances

  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Glucocorticoids
  • Receptors, Glucocorticoid