Chronic Allergy Research Articles

Autoimmune and related diseases among women with endometriosis: a survey analysis

Objective: Some have hypothesized that women with endometriosis may have an altered immune system but few report the prevalence of autoimmune diseases and other conditions among women with endometriosis. We report the prevalence and association of autoimmune diseases, endocrine conditions, chronic fatigue syndrome (CFS), fibromyalgia (FM), allergies, and asthma in women with endometriosis.

Regulation of mucosal immune responses in effector sites.

In human disease and rodent models, immune responses in the intestinal mucosa can be damaging. Damage is characterised by villus atrophy, crypt hyperplasia and reduced ability to digest and absorb nutrients. In normal individuals active responses to harmless environmental antigens associated with food and commensal bacteria are controlled by the development of immunological tolerance. Similar pathological changes occur in piglets weaned early from their mothers. Active immune responses to food antigens are observed in these piglets, and we and others have hypothesised that the changes occur as a result of transient allergic immune responses to novel food or bacteria antigens. The normal mechanism for producing tolerance to food antigens may operate at induction (Peyer's patches and mesenteric lymph nodes) or at the effector stage (intestinal lamina propria). In our piglet studies immunological tolerance occurs despite the initial active response. Together with evidence from rodents, this observation suggests that active responses are likely to be controlled at the effector stage, within the intestinal lamina propria. Support for this mechanism comes from the observation that human and pig intestinal T-cells are susceptible to apoptosis, and that this process is accelerated by antigen. We suggest that the role of the normal mature intestinal lamina propria is a balance between immunological effector and regulatory function. In neonatal animals this balance develops slowly and is dependant on contact with antigen. Immunological insults such as weaning may tip the balance of the developing mucosal immune system into excessive effector or regulatory function resulting in transient or chronic allergy or disease susceptibility.

Effects of environmental and organizational factors on the health of shiftworkers of a printing company.

This study explored the effects of environmental and organizational stressors on the health of shiftworkers in a printing company (n = 124). A questionnaire was used to gather data on work history, organizational factors, psychosocial characteristics, medical history, present health, occupational and non-occupational exposures, and lifestyle factors. The perception of environmental and organizational conditions was associated (P < 0.05) with chronic back pain (odds ratio [OR], 1.29), varicose veins (OR, 1.35), allergic rhinitis (OR, 1.27), depression (OR, 1.45), and gastritis (OR, 1.15). Anxiety scores were associated with allergic rhinitis (OR, 1.14) and skin allergy (OR, 1.09). Shiftwork was a significantly risk factor for conjunctivitis (OR, 3.68), depression (OR, 0.23), cardiac arrhythmia (OR, 7.13), and gastritis (OR, 4.38). Other associations included tenure and chronic back pain (OR, 4.89), toluene exposure and skin allergy (OR, 3.76), worksite and conjunctivitis (OR, 7.0), and worksite and dermatitis (OR, 1.24 to 4.95). The number of hours of exercise per week was associated with varicose veins (OR, 4.33), and alcohol intake was associated with cardiac arrhythmia (OR, 6.74).

Why the increases in upper respiratory problems?

The incidence of ear infections has roughly tripled in the last 25 years. Sinus infections and allergies also have increased. Asthma, triggered by chronic sinus infections and allergies, has paralleled the increases of otitis. These increases began in the early 1970s when antihistamines, decongestants, and combinations thereof, became available without prescription and were heavily advertised in the growing media of television. These drugs are designed to block the immune system’s attempts to wash pollutants and irritants from the nasopharynx.The alternative is helping the immune system with this washing. I have used such a technique in my office for the past three years. Its rationale is discussed as well as my own experience.

Recognizing and Verifying Heavy Metal Toxicity: Integrative Resources

T his issue of Alternative & Complementary Therapies explores, from several different angles, chronic heavy metal and toxic chemical exposure. This article summarizes some of the clinical manifestations of heavy metal toxicity and presents resources that some practitioners have found to be helpful for identifying and confirming that patients may be carrying unusually heavy toxic metal loads. It is important to note that “chronic heavy metal toxicity” is not a clinical diagnosis nor is it a condition that has a well-defined set of symptoms. Indeed, many prac t it ioners of conventiona l medicine concede only that acute metal toxicity is a problem deserving medical attention and question whether chronic low-level toxicity can be assessed objectively or whether it is a condition that justifies medical intervention. The myriad possible effects of longterm exposure to heavy metals, and the elusive damage caused by their accumulation in the body, can make identification of chronic heavy-metal toxicity one of the most difficult challenges a practitioner might face. The particular metal (s) to which an individual has been exposed, the level and duration of exposure, and the health of the individual determine the nature and severity of symptoms. Toxic metals—most typically aluminum (Al), arsenic (As), cadmium (Cd), copper (Cu), mercury (Hg), lead (Pb) and thallium (Tl)—cause damage at the cellular and molecular levels. The mechanisms of action include alteri n g c e l l -m embr ane p e rmea b i l i t y , impairing oxidative phosphorylation, replacing critical metallic components of enzymes or their cofactors, or binding to large molecules and distorting them. Cellular and molecular level dysfunctions then manifest as a wide range of poss ib le physical symptoms that potentially can affect every organ system in the human body. A person who is carrying a heavy load of toxic metals may experience no symptoms at all or may have any combination of many possible symptoms of physiologic dysfunction. Moreover, the presenting symptoms are frequently not the primary result of metal toxicity but are secondary and even tertiary results of the disturbances associated with high titers of heavy metals. For example, a patient who is seeking relief for chronic fatigue or food allergies may be feeling the combined effects of inadequate absorption of essentia l minerals through a leaky gut, overgrowth of beneficial intestinal flora by pathogenic microbes, and impaired function of liver enzymes that remove metals and harmful chemicals from the body. The elimination of toxic metals is one of several treatment measures such a patient requires. The difficulty of recognizing heavy metal toxicity is highlighted by very facts that metals accumulate at the same time that numerous physiologic dys functions may occur and that the toxic act ions of the metals exacerbate the other physiologic problems, which, in turn, contribute further to the toxicity of the metals. In short, neither the recognition nor the treatment of heavy-metal toxicity is an isolated event . Heavymetal accumulation is a systemic problem that demands an integrative treatment plan. T a b l e 1 s umma r i z e s f r e q ue n t l y observed symptoms and signs of chronic heavy metal toxicity that the practitioner may encounter in the clinical setting. A patient who is experiencing several of these symptoms should be evaluated not only for possible heavy metal toxicity but also for nutritional deficiencies, hormonal and metabol ic imbalances, food and chemical sensitivit ies and allergies, disturbances in intestinal flora, and subclinical or asymptomatic infections. These are all conditions that may coexist and mutually reinforce an internal environment of toxicity and dysfunction. The practitioner needs to have a complete assessment of the patient’s health problems in order to draw up a treatment plan that addresses maximal restoration of health.

Desirable and Undesirable Immunotropic Effects of Antibiotics: Immunomodulating Properties of Cefaclor

The effect exerted on complex immunoregulatory functions of the immune system is an important criterion when selecting an antibiotic. When assessing the effect of an antibiotic on the immune system, one should also take into consideration the existence of functional relationships between the immune system and the nervous and hormonal systems. Among these three systems, there are common factors that modify biological processes. This makes it possible for the antibiotic not only to interact directly with the elements of the immune system, but also to exert indirect influences on potential neurotropic and endocrinotropic effects of the drug.Besides highly effective bactericidal activity, cefaclor demonstrates the ability to exert a favorable effect on some of the specific and non-specific immune responses and immunoregulation mechanisms, which may be important from a clinical point of view. Cefaclor enhances phagocytosis and bactericidal activity of granulocytes and macrophages, and favorably modifies the cooperation of monocytes and T lymphocytes. In this way, it corrects, both in vivo and in vitro, the immunoregulatory disturbances induced and aggravated by an infection. This effect is reflected by an improvement in the impaired immunoregulat-ing activity of T lymphocytes, and is manifest both as an increase in suppres-sive activity and a correction of the monokine level ratio in relation to the decrease of proinflammatory monokine IL-1 and a relative increase of anti-inflammatory IL-1ra. By normalizing the disturbed immunoregulation mechanism, cefaclor enhances the protective potential of the immune reaction while it also reduces the risk of immunogenic clinical complications such as persistent inflammatory conditions and allergic and/or autoaggressive responses. Such immunomodulating properties of cefaclor may be useful in the clinical treatment of patients with immune disorders leading to chronic inflammation and secondary allergic or autoaggressive reactions.

Immunologically mediated signaling in basophils and mast cells: finding therapeutic targets for allergic diseases in the human FcεR1 signaling pathway

The high affinity IgE receptor, FcεRI, plays key roles in an array of acute and chronic human allergic reactions including asthma, allergic rhinitis, atopic dermatitis, urticaria and anaphylaxis. In humans and rodents, this receptor is found at high levels on basophils and mast cells where its activation by IgE and multivalent antigen produces mediators and cytokines responsible for FcεRI-dependent acute inflammation. Mast cells can additionally contribute to sustained inflammatory responses by internalizing antigen bound to IgE-FcεRI complexes for processing to peptides and presentation to T cells. In humans, the FcεRI is also expressed, at lower density, on monocytes, macrophages and dendritic cells (DC) where its likely functions again include both signaling to mediator and cytokine production and antigen presentation. Our laboratories have focused on defining the earliest steps in the FcεRI signaling cascade in basophils and mast cells and on developing new routes to control allergic inflammation based on inhibiting these events. Here, we describe novel strategies to limit antigen-stimulated FcεRI signaling by: (1) sequestering the FcεRI-associated protein-tyrosine kinase, Lyn, that initiates FcεRI signaling; (2) eliminating; or (3) inactivating the protein-tyrosine kinase, Syk, that propagates FcεRI signaling; and (4) establishing inhibitory crosstalk between FcεRI and a co-expressed receptor, FcγRII, that again limits FcεRI-mediated Syk activation. These strategies may form the basis for new therapies for allergic inflammation.

Epidemiological study of 134 subjects with allergic conjunctivitis.

At times it is difficult to distinguish among the subtypes of chronic allergic conjunctivitis. A prospective study with 134 patients was carried out. Patients were diagnosed with vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC) or perennial allergic conjunctivitis (PAC). Demographic information was also collected including, age at symptom onset, sex, history of non-ocular allergy, and history of family allergy. Forty-six percent were diagnosed with VKC, 40% with AKC, 8% with PAC, and 6% were not specifically diagnosed. This distribution information as well as the demographic information collected demonstrates that there are patterns within each subgroup of chronic ocular allergy sufferers. These findings will be helpful in the diagnosing and proper classification of ocular allergic conditions.

Validation and Clinical Results of the FLQA-d, a Quality of Life Questionnaire for Patients with Chronic Skin Disease

Background: Quality of Life (QoL) has become an important outcome parameter in dermatology. Although various dermatology- specific questionnaires have been developed in the last years, many methodological questions on how to evaluate QoL in skin diseases are still unanswered. We previously published the concept of a modular QoL instrument called Freiburg Life Quality Assessment (FLQA) with variants for the use in chronic venous insufficiency, leg ulcer and allergies. Objective: To develop, validate and test a new FLQA variant for the use in chronic skin diseases that includes disease-specific as well as generic components. Methods: An open survey was performed, asking 46 patients with atopic dermatitis, psoriasis and urticaria about the most important psychosocial and physical implications of their disease. The resulting list of answers was further reduced by an expert panel and combined with generic QoL items derived from previously validated variants of the FLQA. The resulting questionnaire (FLQA-d) includes 53 items referring to 6 dimensions of QoL. This questionnaire was validated on 747 patients with chronic skin diseases at admission to hospital. Results: Clinically, patients with atopic dermatitis showed significantly greater reductions of QoL than patients with psoriasis, urticaria and other dermatoses. Regarding the FLQA-d validation, satisfactory results were found with respect to internal consistency, distribution characteristics, test-retest reliability, responsiveness, convergent (construct) validity and discriminant validity. The number of missing data was low. Conclusion: The FLQA-d is a valid and easy-to-use instrument for the evaluation of QoL in chronic dermatoses.

Foreign-body reaction to silastic burr-hole covers with seroma formation: Case report and review of the literature

Because silastic material is one of the most commonly used biomaterials in modern medicine, the biocompatibility of these implants is still a source of long standing controversy. Though several studies have established silastic material as biologically inert, numerous authors have repeatedly described characteristic pathological tissue responses to silicone and its elastomeres. We report a case of foreign-body reaction to silastic burr-hole cover with successive formation of a seroma following resection of an olfactory groove meningioma. Within 30 days postoperatively, the patient developed a marked bulge in the glabbelar region. Histopathological examination revealed a seroma-like lesion obviously caused by a chronic inflammatory allergic reaction to the silastic burr-hole cover. Although the silicone-induced tissue damage clinically shows a wide variability and a conclusive model of pathogenesis is presently not available, the histopathological findings in some patients, in the form of granulomatous lesions and inflammatory cell response, might partly be due to an immunological reaction. Such a reaction has been previously described both clinically and experimentally, as detected in our patient. In addition, a review of the literature is given.

Idiopathic maxillary painPrevalence of maxillary sinus hyperreactivity in relation to allergy, chronic mucosal inflammation, and eosinophilia

Objective. In patients with chronic orofacial pain, an underlying sinus hyperreactivity may contribute to the clinical symptoms of a diagnosis of atypical odontalgia, trigeminal neuralgia, or temporomandibular disorders. The purpose of this study was to assess the prevalence of histamine-related maxillary sinus hyperreactivity in patients manifesting signs and symptoms of idiopathic maxillary pain and to correlate the respective findings with the presence or absence of chronic maxillary sinusitis–related diagnoses such as allergy, chronic mucosal inflammation, and eosinophilia. Study Design. Fifty patients who had been assigned a diagnosis of idiopathic maxillary pain underwent skin allergy tests, maxillary sinus histamine provocation tests, and maxillary sinus mucosa biopsy. Histamine challenge to a selected area was performed during transoral sinuscopy of the maxillary sinus; a positive test result was defined as the development of a significant local mucosa response such as reddening and swelling. Results. Comparison of the data showed most patients (38%) to have an absence of chronic maxillary sinusitis–related diagnoses, whereas the most common multiple diagnosis was found to be chronic mucosal inflammation in combination with eosinophilia (22%). Regarding the prevalence rates of positive histamine provocation test outcomes, a significant difference was found between the diagnostic subgroup “absence of chronic maxillary sinusitis–related diagnoses” (36.9%) and the diagnostic subgroups “chronic mucosal inflammation” (20%; P < .05), “chronic mucosal inflammation in combination with eosinophilia” (18.2%; P < .05), and “chronic mucosal inflammation in combination with eosinophilia and allergy” (14.3%; P < .01). An analysis of the distribution of chronic maxillary sinusitis–related diagnoses revealed absence of chronic mucosal inflammation–related diagnoses to be significantly more frequently associated with positive histamine provocation test outcomes than with negative histamine provocation test outcomes (41.2% vs 19.7%; P < .01), whereas chronic maxillary sinusitis (41.0% vs 29.4%), eosinophilia (26.2% vs 17.6%), and allergy (13.1% vs 11.8%) were found to be more prevalent in patients with negative histamine provocation test outcomes. Conclusions. The findings of this study suggest patients with idiopathic maxillary pain to be associated with a low rate of sinus hyperreactivity, whereas a positive test outcome with histamine provocation may not be linked to the presence of chronic maxillary sinusitis–related diagnoses such as allergy, chronic mucosal inflammation, and eosinophilia. Further investigations using a larger sample size of patients with idiopathic maxillary pain and nonidiopathic maxillary pain are necessary to demonstrate the presence or absence of an idiopathic maxillary pain–specific prevalence of maxillary sinus hyperreactivity. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:685–90)

Comparison of sinusitis with and without allergic rhinitis: Characteristics of paranasal sinus effusion and mucosa

Purpose: The relationship between chronic sinusitis and allergy has been discussed for many years. Type I allergies are believed to be involved in chronic sinusitis. However, there is not enough evidence to allow allergic sinusitis to be distinguished as an exact entity. This study was designed to examine the role of immunoglobulin E-mediated allergic reactions in allergic sinusitis. Patients and Methods: We investigated the differences between 31 patients with allergic rhinitis and chronic sinusitis (allergic sinusitis) and 48 control subjects with nonallergic chronic sinusitis (chronic sinusitis). The pathological features of paranasal sinus effusion and mucosa were examined and compared in these two groups. Results: The number of eosinophils, activated eosinophils, and neutrophils was higher in paranasal sinus effusion from patients with allergic sinusitis. The concentration of interleukin-5 was higher in the effusion of allergic sinusitis patients. In addition, more eosinophils and activated eosinophils infiltrated into the sinus mucosa of patients with allergic sinusitis. Conclusion: The type I allergic reaction has a significant role in the pathogenesis of sinusitis arising in patients with allergic rhinitis.

Chronic diarrhoea allergy or another disease?

Chronic diarrhoea allergy or another disease?

Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents’ homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m 2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI≥20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13–3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64–3.59), allergy (OR = 1.89, 95% CI: 1.34–2.66), and Environmental Tobacco Smoke (OR = 1.54, 95% CI: 1.05–2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43–1.00) when compared with children from households where coal or gas was used for home heating.

Predisposition to acute respiratory infections among overweight preadolescent children an epidemiologic study in Poland

This cross-sectional field health survey has as its subjects 1129 preadolescent children resident in Krakow. Trained health visitors interviewed the mothers at the children's schools or at the parents’ homes in order to gather standardized information regarding the families' social background and the families' and children's respiratory health and episodes of respiratory infections. Predisposition to respiratory infections in children has been defined as frequent spells (3 or more) of acute respiratory infections experienced by a given child over the 12 months preceding the interview. Clinical examination of children consisted of anthropometric measurements and spirometric testing. Anthropometric measurements (weight and height) were used for calculation of the body mass index (kg/m2). A child whose BMI was 20 or higher was defined as overweight (90th percentile). Susceptibility to acute respiratory infections was related significantly to body mass index. The children with BMI≥20 experienced twice as high a risk for acute respiratory infections than children with low BMI (OR = 2.02, 95% CI: 1.13–3.59). Out of other potential factors possibly involved in the occurrence of respiratory infections only the presence of chronic respiratory symptoms (OR = 2.43, 95% CI: 1.64–3.59), allergy (OR = 1.89, 95% CI: 1.34–2.66), and Environmental Tobacco Smoke (OR = 1.54, 95% CI: 1.05–2.25) increased the susceptibility of children to acute respiratory infections. Central heating in the household was shown to have a protective effect (OR = 0.65, 95% CI: 0.43–1.00) when compared with children from households where coal or gas was used for home heating.

Clinical features and characteristics of paranasal sinus effusion in allergic sinusitis

Plain paranasal sinus radiographs including occipitofrontal and occipitomental views often show abnormal shadows in patients with allergic rhinitis. For that reason, the relationship between chronic sinusitis and allergy has been discussed for many years. Type I allergy is thought to be involved in the sinusitis which is called allergic sinusitis. However, there is not enough information pertaining to this disorder. In order to determine the clinical feature and the characteristics of paranasal sinus effusion in allergic sinusitis, we investigated the differences between 20 patients with allergic sinusitis and 20 with non-allergic chronic sinusitis used as controls. Clinical symptoms (nasal discharge, nasal obstruction, headache, postnasal discharge) and anterior rhinoscopic findings (nasal discharge, nasal edema), clinical examinations (type of x ray maxillary sinus shadow, bacteriology of nasal discharge), and pathological features of the paranasal sinus effusion were examined and compared in the two kind of sinusitis. Pathological findings of the effusion sampled from 14 patients with allergic sinusitis and 15 with non-allergic sinusitis included the number of eosinophils, activated eosinophils and neutrophils, concentrations of interleukin (IL)-1 beta, IL-4, IL-5, IL-8, and concentrations of leukotriene C4/D4/E4 and prostaglandin E2. The incidence and degree of postnasal discharge as a symptom and a nasal finding were lower in allergic sinusitis patients than in the controls. Microorganisms were detected less frequently in the allergic group. The number of eosinophils, activated eosinophils and neutrophils was higher in the paranasal sinus effusion of the patients with allergic sinusitis. The concentrations (ng/mg of protein) of IL-1 beta and IL-8 showed no difference between the two groups, but IL-4, and IL-5 were more prevalent per mg of protein in the effusion of allergic sinusitis patients. These findings suggest that the clinical features of allergic sinusitis include a low incidence and degree of postnasal discharge and a low rate of detection of bacteria, and that the sinus effusion is characterized by the presence of more eosinophils, activated eosinophils, and IL-5 than in those of chronic sinusitis.

An Unusual Case of Elastofibroma Oculi

A 22-year-old female college student from the southwestern United States was first seen with progressive fluffy white growths over both corneas nasally and a history of chronic allergies and extensive sun, wind, and chlorine exposure as a competitive swimmer. The lesions were superficial, elevated, crescent-shaped, vascularized, and extended from the limbal conjunctiva onto the peripheral cornea nasally. The lesions were composed of an unencapsulated thick fibrovascular pannus with numerous fibrocytes, chronic inflammatory cells and mast cells, and abundant linear and wavy elastinophilic profiles, but no adipose tissue. Ultrastructurally, the elastinophilic structures were immature elastic fibers arranged in globules and bundles within a thick collagenous matrix. No mature elastic fibers were found. A few areas of elastotic degeneration were also found. This lesion resembled elastofibromas that have been reported more commonly in the subcapsular region and only once in the ocular region. Previous reports debated whether the elastic material in elastofibromas is derived from excessive production of elastic fibers by activated fibrocytes or from elastotic degeneration of collagen. In our case, both processes occur and are presumed to result from excessive ultraviolet radiation, wind and chlorine exposure, and perhaps, chronic inflammation; features that have been ascribed to the pathogenesis of pingueculae and pterygia.

The immune effects of neuropeptides

Current evidence indicates that the neuroendocrine system is the highest regulator of immune/inflammatory reactions. Prolactin and growth hormone stimulate the production of leukocytes, including lymphocytes, and maintain immunocompetence. The hypothalamus-pituitary-adrenal axis constitutes the most powerful circuit regulating the immune system. The neuropeptides constituting this axis, namely corticotrophin releasing factor, adrenocorticotrophic hormone, alpha-melanocyte stimulating hormone, and beta-endorphin are powerful immunoregulators, which have a direct regulatory effect on lymphoid cells, regulating immune reactions by the stimulation of immunoregulatory hormones (glucocorticoids) and also by acting on the central nervous system which in turn generates immunoregulatory nerve impulses. Peptidergic nerves are major regulators of the inflammatory response. Substance P and calcitonin gene-related peptide are pro-inflammatory mediators and somatostatin is anti-inflammatory. The neuroendocrine regulation of the inflammatory response is of major significance from the point of view of immune homeostasis. Malfunction of this circuit leads to disease and often is life-threatening. The immune system emits signals towards the neuroendocrine system by cytokine mediators which reach significant blood levels (cytokine-hormones) during systemic immune/inflammatory reactions. Interleukin-1, -6, and TNF-alpha are the major cytokine hormones mediating the acute phase response. These cytokines induce profound neuroendocrine and metabolic changes by interacting with the central nervous system and with many other organs and tissues in the body. Corticotrophin releasing factor functions under these conditions as a major co-ordinator of the response and is responsible for activating the ACTH-adrenal axis for regulating fever and for other CNS effects leading to a sympathetic outflow. Increased ACTH secretion leads to glucocorticoid production. alpha-melanocyte stimulating hormone functions under these conditions as a cytokine antagonist and an anti-pyretic hormone. The sympathetic outflow, in conjunction with increased adrenal activity. leads to the elevation of catecholamines in the bloodstream and in tissues. Current evidence suggests that neuroimmune mechanisms are essential in normal physiology, such as tissue turnover, involution, atrophy, intestinal function, and reproduction. Host defence against infection, trauma and shock relies heavily on the neuroimmunoregulatory network. Moreover, abnormalities of neuroimmunoregulation contribute to the aetiology of autoimmune disease, chronic inflammatory disease, immunodeficiency, allergy, and asthma. Finally, neuroimmune mechanisms play an important role in regeneration and healing.

The immune effects of neuropeptides

Current evidence indicates that the neuroendocrine system is the highest regulator of immune/inflammatory reactions. Prolactin and growth hormone stimulate the production of leukocytes, including lymphocytes, and maintain immunocompetence. The hypothalamus-pituitary-adrenal axis constitutes the most powerful circuit regulating the immune system. The neuropeptides constituting this axis, namely corticotrophin releasing factor, adrenocorticotrophic hormone, α-melanocyte stimulating hormone, and β-endorphin are powerful immunoregulators, which have a direct regulatory effect on lymphoid cells, regulating immune reactions by the stimulation of immunoregulatory hormones (glucocorticoids) and also by acting on the central nervous system which in turn generates immunoregulatory nerve impulses. Peptidergic nerves are major regulators of the inflammatory response.Substance P and calcitonin gene-related peptide are pro-inflammatory mediators and somatostatin is anti-inflammatory. The neuroendocrine regulation of the inflammatory response is of major significance from the point of view of immune homeostasis. Malfunction of this circuit leads to disease and often is life-threatening. The immune system emits signals towards the neuroendocrine system by cytokine mediators which reach significant blood levels (cytokine-hormones) during systemic immune/inflammatory reactions. Interleukin-1, -6, and TNF-α are the major cytokine hormones mediating the acute phase response. These cytokines induce profound neuroendocrine and metabolic changes by interacting with the central nervous system and with many other organs and tissues in the body. Corticotrophin releasing factor functions under these conditions as a major co-ordinator of the response and is responsible for activating the ACTH-adrenal axis for regulating fever and for other CNS effects leading to a sympathetic outflow. Increased ACTH secretion leads to glucocorticoid production. α-melanocyte stimulating hormone functions under these conditions as a cytokine antagonist and an anti-pyretic hormone. The sympathetic outflow, in conjunction with increased adrenal activity, leads to the elevation of catecholamines in the bloodstream and in tissues. Current evidence suggests that neuroimmune mechanisms are essentialin normal physiology, such as tissue turnover, involution, atrophy, intestinal function, and reproduction. Host defence against infection, trauma and shock relies heavily on the neuroimmunoregulatory network. Moreover, abnormalities of neuroimmunoregulation contribute to the aetiology of autoimmune disease, chronic inflammatory disease, immunodeficiency, allergy, and asthma. Finally, neuroimmune mechanisms play an important role in regeneration and healing.

Sick buildings: definition, diagnosis and mitigation

Chapter 1. Defining the Issues Building-Related Illness Sick Building Syndrome Tight Buildings Sick Buildings/Problem Buildings Multiple Chemical Sensitivity Recapitulation References Chapter 2. People-Related Risk Factors Personal Characteristics Psychosocial Phenomenon Tobacco Smoking Recapitulation References Chapter 3. Environmental Conditions/Environmental Systems Environmental Conditions Environmental Systems Recapitulation References Chapter 4. Office Materials, Equipment, and Furnishings Office Materials and Equipment Floor Covering Recapitulation References Chapter 5. Gas/Vapor- and Particulate-Phase Contaminants Bioeffluents Formaldehyde Volatile Organic Compounds Dust Recapitulation References Chapter 6. Contaminants of Biological Origin Hypersensitivity Diseases Legionnaires' Disease Asthma Chronic Allergic Rhinitis Allergy and Allergens as Risk Factors for SBS Symptoms Other Biological Contaminant-Related Health Concerns Recapitulation References Chapter 7. Diagnosing Problem Buildings Role of Public and Private Groups Role of Industrial Hygiene Problem Building Investigation Features of Investigative Protocols Procedures for Evaluating Problems with HVAC Systems Recapitulation Appendices References Chapter 8. Measurement of Indoor Air Contaminants Contaminant Measurement Considerations Procedures for Commonly Measured Chemical/Physical Contaminants Sampling Biological Aerosols Recapitulation References Chapter 9. Source Control Chemical Contaminants Biological Contaminants Surface Dusts Recapitulation References Chapter 10. Contaminant Control General Dilution Ventilation Local Exhaust Ventilation Entrainment/Re-Entry/Cross-Examination Air Cleaning Recapitulation References Index