Blunted HPA axis responsiveness to stress in atopic patients is associated with the acuity and severeness of allergic inflammation
Abstract
Previously we could demonstrate attenuated responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis to stress in patients with chronic allergic inflammatory disease (i.e., atopic dermatitis, allergic asthma). The present study was designed to investigate HPA axis function in an acute manifestation of allergy. Patients with seasonal allergic rhinitis (SAR; n = 20) and non-atopic controls (n = 20) were exposed to a standardized laboratory stressor ('Trier Social Stress Test'; TSST). Cortisol responses to the TSST and cortisol awakening responses (CAR) were measured in SAR subjects while suffering from acute symptoms of SAR (pollen season), and during a non-active state of their disease (pollen-free season). To assess the acuity and severity of SAR, eosinophil and basophil numbers and SAR symptomatology were determined. Non-allergic control subjects were examined at identical times during the year. To control for possible sequence effects, a cross-over design was used. SAR patients showed significantly increased symptom severity (t = 9.4; p<.001) as well as eosinophil (F(1,31) = 9.8; p<.01) and basophil (F(1,38) = 6.4; p<.05) numbers during the pollen season when compared to a pollen-free period. When exposed to the TSST, significantly attenuated cortisol responses were found in SAR subjects during acute manifestation of the disease (pollen season) when compared to the pollen-free season (F(16,456) = 1.65; p<.05). In SAR patients, there was a significant negative correlation between symptom severity and the cortisol response to the stressor (r = .53; p<.05). No significant between-group or between-condition differences with respect to the CAR could be determined (all p>.05). These findings support previous data of attenuated HPA axis responsiveness to stress in atopic conditions and further, suggest that HPA axis hyporesponsiveness in atopy may be linked to the severity of the allergic inflammatory process.
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Atopic dermatitis patients show a blunted stress response with lower cortisol production than normal controls.
“Atopic patients demonstrate a blunted response to stress (decreased production of cortisol) compared to normal controls [175].”
From Steroidogenesis in the skin: Implications for local immune functions (2013) · cites this paper as [175]
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Dickerson, S. S., & Kemeny, M. E. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.3.355 · Cited by 5,881 · see citing works
Kirschbaum, C., Kudielka, B. M., Gaab, J., Schommer, N. C., & Hellhammer, D. H. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00006 · Cited by 1,890 · cited 1× · see citing works
“Since it has been shown that the menstrual cycle, the use of contraceptives and smoking are relevant factors influencing HPA axis activity (Kirschbaum et al., 1999; Rohleder and Kirschbaum, 2006), only male, non-smoking SAR patients were recruited.”
Self-citationStress Hormones, Proinflammatory and Antiinflammatory Cytokines, and Autoimmunity
ELENKOV, I. J., & CHROUSOS, G. P. (2002) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2002.tb04229.x · Cited by 983 · see citing works
The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004) · Stress · doi:10.1080/10253890410001667205 · Cited by 856 · see citing works
Opp, M. R., Smith, E. M., & Hughes, T. K. (1995) · Journal of Neuroimmunology · doi:10.1016/0165-5728(95)00066-b · Cited by 145 · see citing works
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Steroidogenesis in the skin: Implications for local immune functions
Slominski, A., Zbytek, B., Nikolakis, G., Manna, P. R., Skobowiat, C., Zmijewski, M., Li, W., Janjetovic, Z., Postlethwaite, A., Zouboulis, C. C., et al. (2013) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2013.02.006 · Cited by 369 · see citing works
Association between Stress and the HPA Axis in the Atopic Dermatitis
Lin, T.-K., Zhong, L., & Santiago, J. (2017) · International Journal of Molecular Sciences · doi:10.3390/ijms18102131 · Cited by 127 · see citing works
“HPA dysfunction is present in AD patients, showing a decreased response of serum GCs after being exposed to stressors when compared with unaffected persons [27,28].”
BackgroundThe role of environmental factors in allergy: A critical reappraisal
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The relationship between cortisol responses to laboratory stress and cortisol profiles in daily life
Kidd, T., Carvalho, L. A., & Steptoe, A. (2014) · Biological Psychology · doi:10.1016/j.biopsycho.2014.02.010 · Cited by 88 · see citing works
Skin steroidogenesis in health and disease
Nikolakis, G., Stratakis, C. A., Kanaki, T., Slominski, A., & Zouboulis, C. C. (2016) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-016-9390-z · Cited by 76 · see citing works
Wieck, A., Grassi-Oliveira, R., do Prado, C. H., Rizzo, L. B., de Oliveira, A. S., Kommers-Molina, J., Viola, T. W., Teixeira, A. L., & Bauer, M. E. (2013) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2013.07.005 · Cited by 63 · see citing works
- Authors
- Buske-Kirschbaum, A., Ebrecht, M., & Hellhammer, D. H.
- Affiliations
- Technische Universität Dresden (DE)
- Bristol-Myers Squibb (Germany) (DE)
- Universität Trier (DE)
- Corresponding author
- Buske-Kirschbaum, A.
- ORCID
- Hellhammer, D.H.
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 24
- Issue
- 8
- Pages
- 1347-1353
- ISSN
- 0889-1591 (ISSN-L)
- OpenAlex
- W2077017826
- Cited by
- 96
- References
- 5
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 8 · 2017: 8 · 2016: 8 · 2015: 6 · 2014: 9 · 2013: 7 · 2012: 13
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Keywords
- hypothalamic-pituitary-adrenal axis, stress response, allergic rhinitis, atopy, cortisol, cortisol awakening response, Trier Social Stress Test, pollen season, eosinophils, basophils, allergic inflammation, symptom severity
- MeSH terms
- Adult, Female, Rhinitis, Allergic, Seasonal, Humans, Hydrocortisone, Hypersensitivity, Immediate, Hypothalamo-Hypophyseal System, Immunoglobulin E, Inflammation, Leukocyte Count, Leukocytes, Male, Pituitary-Adrenal System, Pollen, Social Environment, Stress, Psychological
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