George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.
www.asthma-drsprecace.com


ALLERGY / IMMUNOLOGY:  THE BIGGER PICTURE

See also,
WAZZUP?! - New and Notable

See also,
"Immunology in Health and Disease: An Outline for the Layman"

See also,
"Plants That Allergy Sufferers Should Avoid", The New York Times, Sunday, July 7, 2002, Cuttings, in Sports (Sec 8), p13.

This web site contains discussions regarding the more common allergic disorders and their consequences.   However, our Immune System - that collection of cells, tissues and organs including various types of white blood cells, thymus, lymph nodes, intestinal Peyer’s patches and spleen, is the seat of many other functions in health and disease.  Thus, in addition to its role in defense against infections, the Immune System is deeply involved in  autoimmune disorders,  transplantation, cancer, the aging process and  in both normal pregnancy and in infertility.  In fact, human life is not possible without a normally functioning Immune Sustem.

1)  Autoimmune Disorders:

     It is vital to our survival that our Immune System recognizes the difference between “self” and “non-self”.  Otherwise, this system would destroy itself and its host during fetal life.  It is now understood that we all harbor a small number of B and T lymphocytes that can react against self,  and that their number and activity are controlled partly by hormones and partly by genetic predisposition.
     When a sufficient number of self-attacking cells develop, the result is a group of diseases called “autoimmune diseases”.  The type and consequences of the disease produced  depend upon the type of body tissue attacked.  When the skin is attacked, autoimmune bullous (blister)  diseases result.  When the kidney is attacked, nephritis (like Goodpasteur’s Syndrome) results.  When joint tissue is attacked, various types of arthritis result.   When many different tissues are attacked, including the blood system itself, “Lupus” (Systemic Lupus Erythematosis) results.  These diseases are more common in women, and at least some tend to run in families.  Treatment involves supprression of the destructive immune reaction while maintaining the normal immune responses - a tricky challenge.

2)  Transplantation:

     Medical science can now transplant several different foreign (donor) tissues into recipient (host) bodies: lung, liver, kidney, pancreas, skin, cornea....In such cases, however, the medical team must overcome the natural tendency of the recipient immune system to reject the foreign donor tissue.  The closer the genetic match, the easier the task.  In the case of identical twins, there is no problem whatsoever.  But in all other cases, immunosuppressive drugs must be used.  The most important of these are steroids - cortisone, but there are many others. The problem is in giving enough to protect the transplanted tissue, but  not enough to knock out the host  defenses, which are always at least partly suppressed by these agents.  In fact, long-term use of immunosuppressive agents - as is necessary for long-term  protection of transplants, leads to an increased susceptibility to infections, and to cancers, as discussed below.  There is even a special problem wherein the transplanted tissue itself contains too many competent immune cells from the donor.  In that case, a “graft versus host” reaction can result, as the transplant attacks the recipient host.  Not healthy.
     Even in the best of circumstances, the results are only partial.  For example, the average 10 year survival of kidney transplants (except between identical twins) is about 40 %.  However, medical science is getting progressively better at modulating these immune reactions so as to enable more and safer transplantations to be performed.

3)  Cancer:

     Our Immune System is vital in tumor surveillance, and in the removal of pre-malignant cells from our bodies - on a daily basis.  Thus, in  primary or in secondary immunodeficiency diseases, there is an increased incidence of cancers.  The most well-known example of this, unfortunately, is AIDS, whose virus (HIV) attacks normal lymphocytes.  Among the many consequences are Kaposi’s Sarcoma, Non-Hodgkin’s Lymphoma, and cervical cancer.  On a more global scale, the immune system is affected by psychological states including anxiety, stress, and especially resentment, all of which suppress the immune system.  There is a message here for all of us.

4)  The Aging Process:

     Aging itself  is associated with - and may indeed be partly caused by “immune senescence”, wherein our lymphocytes gradually die off in a pre-programmed process called “apoptosis”, or “programmed cell death”.   The speed of the process is genetically controlled, but it proceeds in all of us.
     Can we do anything about this process to delay it?  The only manipulation found - in mice - to delay the aging process is substantial reduction in caloric intake while maintaining nutrition.  Vitamin supplementation has been suggested in the form of Vitamin A, C, D, E, B6, B12, and also iron and zinc, although there is no clear evidence concerning the effectiveness of these agents for this purpose.  Thymic (remember that?) extract is also being tested.
     In any case, something must be happening to the  process of aging in humans.  In the 1600’s, the average life expectance was in the 20’s.  In 1900 it was age 47.  Now the average life expectance is nearly 80 years.  In fact, of all the people who have EVER  lived on Earth since Adam and Eve and who have reached the age of 65, more than half are alive today!  Maybe there is a chance to beat the grim reaper...if not the tax collector.

5)  Fertility and Infertility:

     Not only is our immune system responsible for our health - and for some of our miseries.  It is also vital to whether we enter the world at all, and to whether we reproduce.  For normal pregnancy to be successful, maternal immunosuppression is necessary in order to tolerate the “foreign” (partly  paternal) graft represented in the fetus.  Conversely, some of the problems of persistent infertility and of ”recurrent pregnancy loss” which are increasing in our young population have their origin in the Immune System.
     The well-known general problems include age of female partner, sexually transmitted diseases, chromosomal abnormalities in utero, environmental toxins and co-existing diseases.  Less well-identified issues include a global (but not geographic) reduction in the quality of  sperm, the increasing finding of anti-sperm antibodies in the female partner (possibily due to delay in permitting conception in the face of prolonged sexual contacts - a process of sensitization), and increasing types and duration of stressors in modern life.  These latter issues all have immunologic implications, in addition to the issue of anti-cardiolipin antibodies found in the blood of some women with auto-immune diseases.

So Allergy / Immunology involves not only “sneeze and wheeze”.  It may actually be as close to the “Meaning of Life” as we get - short of “Love thy God...and Love thy neighbor as thyself”.

GS


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