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Cited by 288Asthma and respiratory diseasesAllergic Rhinitis and SensitizationOccupational exposure and asthma

School examinations enhance airway inflammation to antigen challenge

Liu, Lin Ying, Coe, Christopher L., Swenson, Cheri A., Kelly, Elizabeth A., Kita, Hirohito, Busse, William W.·2002·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/ajrccm.165.8.2109065
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Abstract

Psychological stress can lead to asthma exacerbations in some patients. It is our hypothesis that the stress effect can occur through an enhancement of allergic inflammatory response. To investigate this possibility, airway antigen challenge was evaluated in 20 college students with mild asthma during both a low-stress phase (midsemester or two weeks postfinal examination) and a stress phase (final examination week). Subjects completed questionnaires to assess psychological state and underwent inhaled antigen challenge. Sputum samples were collected before challenge, and six and 24 hours and seven days postchallenge. Leukocytes were counted and eosinophil-derived neurotoxin (EDN) was measured in sputum supernates. Sputum cells were cultured and stimulated ex vivo with phytohemagglutinin (10 microg/ml), and culture supernates were assayed for interleukin-5 (IL-5) and interferon-gamma by enzyme-linked immunosorbent assay. Sputum eosinophils and EDN levels significantly increased at six and 24 hours postchallenge and were enhanced during the stress phase (p < 0.01). IL-5 generation by sputum cells was also increased at 24 hours during stress and correlated with airway eosinophils (r(s) = 0.65, p < 0.05). Students' anxiety and depression scores were significantly higher during the examination period. Our findings suggest that stress associated with final examinations can act as a cofactor to increase eosinophilic airway inflammation to antigen challenge and thus may enhance asthma severity.

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Crossref · 10.1164/ajrccm.165.8.2109065

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  • In human studies, stress induces measurable changes in biology, such as in the magnitude of inflammatory cytokines and in functional changes within relevant end-organs.

    “In human studies, stress induces measurable changes in biology, such as in the magnitude of inflammatory cytokines and in functional changes within relevant end-organs, such as in pulmonary function in the case of allergic inflammation (Liu et al., 2002).”

    From Origin and function of stress-induced IL-6 in murine models (2020) · cites this paper as Liu et al., 2002

  • Psychosocial stress worsens most inflammatory diseases, including allergic diseases, autoimmune diseases, and cancers.

    “Indeed, psychosocial stress worsens most inflammatory diseases, including allergic diseases, autoimmune diseases, and cancers (Batty et al., 2017; Liu et al., 2002; Mohr et al., 2004; Roussou et al., 2013).”

    From Origin and function of stress-induced IL-6 in murine models (2020) · cites this paper as Liu et al., 2002

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Authors
Liu, L. Y., Coe, C. L., Swenson, C. A., Kelly, E. A., Kita, H., & Busse, W. W.
Affiliations
Mayo Clinic (US)
ORCID
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2002-04
Volume
165
Issue
8
Pages
1062-1067
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/ajrccm.165.8.2109065
OpenAlex
W1965298978
Cited by
288
References
37
Citations by year
2026: 3 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 12 · 2018: 10 · 2017: 11 · 2016: 12 · 2015: 12 · 2014: 12 · 2013: 12 · 2012: 19
FWCI
8.21
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (HL-56396, P50HL056396)
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Keywords
psychological stress, asthma exacerbations, school examinations, eosinophilic airway inflammation, eosinophil-derived neurotoxin, IL-5, interferon-gamma, sputum eosinophils, allergic airway inflammation, anxiety, depression, university students
MeSH terms
Administration, Inhalation, Adolescent, Adult, Allergens, Anxiety, Asthma, Depression, Eosinophils, Female, Forced Expiratory Volume, Humans, Hydrocortisone, Interferon-gamma, Leukocytes, Male, Ribonucleases, Sputum, Stress, Psychological, Interleukin-5, Cytokines, Cross-Over Studies, Eosinophil-Derived Neurotoxin

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