Vol. 16, No. 5, 2009
Issue release date: June 2009
Free Access
Neuroimmunomodulation 2009;16:300–317
Add to my selection

Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection and Immunopathology

Dhabhar F.S.
Department of Psychiatry & Behavioral Sciences, and Stanford Institute for Immunity, Transplantation, & Infection, Stanford University, Stanford, Calif., USA
email Corresponding Author

 goto top of outline Key Words

  • Acute stress-induced enhancement
  • Fight-or-flight stress
  • Immune cell distribution
  • Immune function, effects of stress
  • Immune function, enhancing vs. suppressive effects
  • Immunoprotection vs. immunopathology
  • Innate/primary immune responses
  • Leukocyte trafficking
  • Adaptive/secondary immune responses

 goto top of outline Abstract

Stress is known to suppress immune function and increase susceptibility to infections and cancer. Paradoxically, stress is also known to exacerbate asthma, and allergic, autoimmune and inflammatory diseases, although such diseases should be ameliorated by immunosuppression. Moreover, the short-term fight-or-flight stress response is one of nature’s fundamental defense mechanisms that enables the cardiovascular and musculoskeletal systems to promote survival, and it is unlikely that this response would suppress immune function at a time when it is most required for survival (e.g. in response to wounding and infection by a predator or aggressor). These observations suggest that stress may suppress immune function under some conditions while enhancing it under others. The effects of stress are likely to be beneficial or harmful depending on the type (immunoprotective, immunoregulatory/inhibitory, or immunopathological) of immune response that is affected. Studies have shown that several critical factors influence the direction (enhancing vs. suppressive) of the effects of stress or stress hormones on immune function: (1) Duration (acute vs. chronic) of stress: Acute or short-term stress experienced at the time of immune activation can enhance innate and adaptive immune responses. Chronic or long-term stress can suppress immunity by decreasing immune cell numbers and function and/or increasing active immunosuppressive mechanisms (e.g. regulatory T cells). Chronic stress can also dysregulate immune function by promoting proinflammatory and type-2 cytokine-driven responses. (2) Effects of stress on leukocyte distribution: Compartments that are enriched with immune cells during acute stress show immunoenhancement, while those that are depleted of leukocytes, show immunosuppression. (3) The differential effects of physiologic versus pharmacologic concentrations of glucocorticoids, and the differential effects of endogenous versus synthetic glucocorticoids: Endogenous hormones in physiological concentrations can have immunoenhancing effects. Endogenous hormones at pharmacologic concentrations, and synthetic hormones, are immunosuppressive. (4) The timing of stressor or stress hormone exposure relative to the time of activation and time course of the immune response: Immunoenhancement is observed when acute stress is experienced at early stages of immune activation, while immunosuppression may be observed at late stages of the immune response. We propose that it is important to study and, if possible, to clinically harness the immunoenhancing effects of the acute stress response, that evolution has finely sculpted as a survival mechanism, just as we study its maladaptive ramifications (chronic stress) that evolution has yet to resolve. In view of the ubiquitous nature of stress and its significant effects on immunoprotection as well as immunopathology, it is important to further elucidate the mechanisms mediating stress-immune interactions and to meaningfully translate findings from bench to bedside.

Copyright © 2009 S. Karger AG, Basel

 goto top of outline References
  1. McEwen BS: Protective and damaging effects of stress mediators: allostasis and allostatic load. N Engl J Med 1998;338:171–179.
  2. Ader R: Psychoneuroimmunology, ed 4. San Diego, Academic Press, 2006.
  3. Dhabhar FS, Miller AH, McEwen BS, Spencer RL: Effects of stress on immune cell distribution – dynamics and hormonal mechanisms. J Immunol 1995;154:5511–5527.
  4. Dhabhar FS, McEwen BS: Bidirectional effects of stress and glucocorticoid hormones on immune function: possible explanations for paradoxical observations; in Ader R, Felten DL, Cohen N (eds): Psychoneuroimmunology, ed 3. San Diego, Academic Press, 2001, pp 301–338.
  5. Glaser R, Kiecolt-Glaser JK: Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 2005;5:243–251.
  6. Chrousos GP, Kino T: Glucocorticoid action networks and complex psychiatric and/or somatic disorders. Stress 2007;10:213–219.
  7. Glaser R, MacCallum RC, Laskowski BF, Malarkey WB, Sheridan JF, Kiecolt-Glaser JK: Evidence for a shift in the Th1 to Th2 cytokine response associated with chronic stress and aging. J Gerontol A Biol Sci Med Sci 2001;56:M477–M482.
  8. Epel E, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM: Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA 2004;101:17312–17315.
  9. Dhabhar FS, McEwen BS: Acute stress enhances while chronic stress suppresses immune function in vivo: a potential role for leukocyte trafficking. Brain Behav Immun 1997;11:286–306.
  10. Saul AN, Oberyszyn TM, Daugherty C, Kusewitt D, Jones S, Jewell S, Malarkey WB, Lehman A, Lemeshow S, Dhabhar FS: Chronic stress and susceptibility to skin cancer. J Nat Cancer Inst 2005;97:1760–1767.
  11. Goldstein DS, McEwen B: Allostasis, homeostats, and the nature of stress. Stress 2002;5:55–58.
  12. McEwen BS: The End of Stress as We Know It. Washington, Dana Press, 2002.
  13. Sapolsky RM: The influence of social hierarchy on primate health. Science 2005;308:648–652.
  14. Altemus M, Rao B, Dhabhar FS, Ding W, Granstein R: Stress-induced changes in skin barrier function in healthy women. J Invest Dermatol 2001;117:309–317.
  15. Irwin M, Patterson T, Smith TL, Caldwell C, Brown SA, Gillin CJ, Grant I: Reduction of immune function in life stress and depression. Biol Psychiatry 1990;27:22–30.
  16. Dhabhar FS, Viswanathan K: Short-term stress experienced at the time of immunization induces a long-lasting increase in immunological memory. Am J Physiol 2005;289:R738–R744.
  17. Dhabhar FS, McEwen BS: Bidirectional effects of stress on immune function: possible explanations for salubrious as well as harmful effects; in Ader R (ed): Psychoneuroimmunology, ed 4. San Diego, Elsevier, 2007, pp 723–760.
  18. Sephton S, Spiegel D: Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun 2003;17:321–328.
  19. Gunnar M, Quevedo K: The neurobiology of stress and development. Annu Rev Psychol 2007;58:145–173.
  20. Dhabhar FS, McEwen BS, Spencer RL: Stress response, adrenal steroid receptor levels, and corticosteroid-binding globulin levels – a comparison between Sprague-Dawley, Fischer 344, and Lewis rats. Brain Res 1993;616:89–98.
  21. Sternberg EM, Hill JM, Chrousos GP, Kamilaris T, Listwak SJ, Gold PW, Wilder RL: Inflammatory mediator-induced hypothalamic-pituitary-adrenal axis activation is defective in streptococcal cell wall arthritis-susceptible Lewis rats. Proc Natl Acad Sci USA 1989;86:2374–2378.
  22. Dhabhar FS, McEwen BS, Spencer RL: Adaptation to prolonged or repeated stress – comparison between rat strains showing intrinsic differences in reactivity to acute stress. Neuroendocrinology 1997;65:360–368.
  23. Dhabhar FS, Miller AH, McEwen BS, Spencer RL: Differential activation of adrenal steroid receptors in neural and immune tissues of Sprague-Dawley, Fischer 344, and Lewis rats. J Neuroimmunol 1995;56:77–90.
  24. Gomez-Serrano M, Tonelli L, Listwak S, Sternberg E, Riley AL: Effects of cross-fostering on open-field behavior, acoustic startle, lipopolysaccharide-induced corticosterone release, and body weight in Lewis and Fischer rats. Behav Genet 2001;31:427–436.
  25. Schwab CL, Fan R, Zheng Q, Myers LP, Hebert P, Pruett SB: Modeling and predicting stress-induced immunosuppression in mice using blood parameters. Toxicol Sci 2005;83:101–113.
  26. Benschop RJ, Rodriguez-Feuerhahn M, Schedlowski M: Catecholamine-induced leukocytosis: early observations, current research, and future directions. Brain Behav Immun 1996;10:77–91.
  27. Van Gaal LF, Mertens IL, De Block CE: Mechanisms linking obesity with cardiovascular disease. Nature 2006;444:875–880.
  28. Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW: From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci 2008;9:46–56.
  29. Maes MA: A review on the acute phase response in major depression. Rev Neurosci 1993;4:407–416.
  30. Bluestone JA, Tang Q: How do CD4+CD25+ regulatory T cells control autoimmunity? Curr Opin Immunol 2005;17:638–642.
  31. Finn OJ: Cancer immunology. N Engl J Med 2008;358:2704–2715.
  32. Sprent J, Tough DF: Lymphocyte lifespan and memory. Science 1994;265:1395–1400.
  33. Hoagland H, Elmadjian F, Pincus G: Stressful psychomotor performance and adrenal cortical function as indicated by the lymphocyte response. J Clin Endocrinol 1946;6:301–311.

    External Resources

  34. Fauci AS, Dale DC: The effect of in vivo hydrocortisone on subpopulations of human lymphocytes. J Clin Invest 1974;53:240–246.
  35. Dhabhar FS, Miller AH, McEwen BS, Spencer RL: Stress-induced changes in blood leukocyte distribution – role of adrenal steroid hormones. J Immunol 1996;157:1638–1644.
  36. Bilbo SD, Dhabhar FS, Viswanathan K, Saul A, Yellon SM, Nelson RJ: Short day lengths augment stress-induced leukocyte trafficking and stress-induced enhancement of skin immune function. Proc Natl Acad Sci USA 2002;99:4067–4072.
  37. Dhabhar FS, Miller AH, Stein M, McEwen BS, Spencer RL: Diurnal and stress-induced changes in distribution of peripheral blood leukocyte subpopulations. Brain Behav Immun 1994;8:66–79.
  38. Morrow-Tesch JL, McGlone JJ, Norman RL: Consequences of restraint stress on natural killer cell activity, behavior, and hormone levels in rhesus macaques (Macaca mulatta). Psychoneuroendocrinology 1993;18:383–395.
  39. Schedlowski M, Jacobs R, Stratman G, Richter S, Hädike A, Tewes U, Wagner TOF, Schmidt RE: Changes of natural killer cells during acute psychological stress. J Clin Immunol 1993;13:119–126.
  40. Redwine L, Mills PJ, Sada M, Dimsdale J, Patterson T, Grant I: Differential immune cell chemotaxis responses to acute psychological stress in Alzheimer caregivers compared to non-caregiver controls. Psychosom Med 2004;66:770–775.
  41. Naliboff BD, Benton D, Solomon GF, Morley JE, Fahey JL, Bloom ET, Makinodan T, Gilmore SL: Immunological changes in young and old adults during brief laboratory stress. Psychosom Med 1991;53:121–132.
  42. Mills PJ, Berry CC, Dimsdale JE, Ziegler MG, Nelesen RA, Kennedy BP: Lymphocyte subset redistribution in response to acute experimental stress: effects of gender, ethnicity, hypertension, and the sympathetic nervous system. Brain Behav Immun 1995;9:61–69.
  43. Rinner I, Schauenstein K, Mangge H, Porta S, Kvetnansky R: Opposite effects of mild and severe stress on in vitro activation of rat peripheral blood lymphocytes. Brain Behav Immun 1992;6:130–140.
  44. Manuck SB, Cohen S, Rabin BS, Muldoon MF, Bachen EA: Individual differences in cellular immune response to stress. Psychol Science 1991;2:111–115.

    External Resources

  45. Dhabhar FS, McEwen BS: Stress-induced enhancement of antigen-specific cell-mediated immunity. J Immunol 1996;156:2608–2615.
  46. Dhabhar FS, McEwen BS: Enhancing versus suppressive effects of stress hormones on skin immune function. Proc Natl Acad Sci USA 1999;96:1059–1064.
  47. Dhabhar FS, Satoskar AR, Bluethmann H, David JR, McEwen BS: Stress-induced enhancement of skin immune function: a role for IFN-γ. Proc Natl Acad Sci USA 2000;97:2846–2851.
  48. Cunnick JE, Lysle DT, Kucinski BJ, Rabin BS: Evidence that shock-induced immune suppression is mediated by adrenal hormones and peripheral β-adrenergic receptors. Pharmacol Biochem Behav 1990;36:645–651.
  49. Zalcman S, Anisman H: Acute and chronic stressor effects on the antibody response to sheep red blood cells. Pharmacol Biochem Behav 1993;46:445–452.
  50. Dhabhar FS: Stress-induced enhancement of cell-mediated immunity. Ann NY Acad Sci 1998;840:359–372.
  51. Monjan AA, Collector MI: Stress-induced modulation of the immune response. Science 1977;196:307–308.
  52. Miller AH, Spencer RL, Hasset J, Kim C, Rhee R, Cira D, Dhabhar FS, McEwen BS, Stein M: Effects of selective type I and type II adrenal steroid receptor agonists on immune cell distribution. Endocrinology 1994;135:1934–1944.
  53. Viswanathan K, Dhabhar FS: Stress-induced enhancement of leukocyte trafficking into sites of surgery or immune activation. Proc Natl Acad Sci USA 2005;102:5808–5813.
  54. Saint-Mezard P, Chavagnac C, Bosset S, Ionescu M, Peyron E, Kaiserlian D, Nicolas JF, Berard F: Psychological stress exerts an adjuvant effect on skin dendritic cell functions in vivo. J Immunol 2003;171:4073–4080.
  55. Blecha F, Barry RA, Kelley KW: Stress-induced alterations in delayed-type hypersensitivity to SRBC and contact sensitivity to DNFB in mice. Proc Soc Exp Biol Med 1982;169:239–246.
  56. Coe CL, Lubach G, Ershler WB: Immunological consequences of maternal separation in infant primates; in Lewis M, Worobey J (eds): Infant Stress and Coping. New York, Jossey-Bass, 1989, vol 45.
  57. Wood PG, Karol MH, Kusnecov AW, Rabin BS: Enhancement of antigen-specific humoral and cell-mediated immunity by electric footshock stress in rats. Brain Behav Immun 1993;7:121–134.
  58. Cocke R, Moynihan JA, Cohen N, Grota LJ, Ader R: Exposure to conspecific alarm chemosignals alters immune responses in Balb/c mice. Brain Behav Immun 1993;7:36–46.
  59. Viswanathan K, Daugherty C, Dhabhar FS: Stress as an endogenous adjuvant: augmentation of the immunization phase of cell-mediated immunity. Int Immunol 2005;17:1059–1069.
  60. Flint MS, Miller DB, Tinkle SS: Restraint-induced modulation of allergic and irritant contact dermatitis in male and female B6.129 mice. Brain Behav Immun 2000;14:256–269.
  61. Edwards KM, Burns VE, Reynolds T, Carroll D, Drayson M, Ring C: Acute stress exposure prior to influenza vaccination enhances antibody response in women. Brain Behav Immun 2006;20:159–168.
  62. Edwards KM, Burns VE, Adkins AE, Carroll D, Drayson M, Ring C: Meningococcal A vaccination response is enhanced by acute stress in men. Psychosom Med 2008;70:147–151.
  63. Smith A, Vollmer-Conna U, Bennett B, Wakefield D, Hickie I, Lloyd A: The relationship between distress and the development of a primary immune response to a novel antigen. Brain Behav Immun 2004;18:65–75.
  64. Kripke ML: Ultraviolet radiation and immunology: something new under the sun – presidential address. Cancer Res 1994;54:6102–6105.
  65. Granstein RD, Matsui MS: UV radiation-induced immunosuppression and skin cancer. Cutis 2004;74:4–9.
  66. Bonneau RH, Sheridan JF, Feng N, Glaser R: Stress-induced effects on cell-mediated innate and adaptive memory components of the murine immune response to herpes simplex virus infection. Brain Behav Immun 1991;5:274–295.
  67. Elenkov IJ: Glucocorticoids and the Th1/Th2 balance. Ann NY Acad Sci 2004;1024:138–146.
  68. Wilckens T, DeRijk R: Glucocorticoids and immune function: unknown dimensions and new frontiers. Immunol Today 1997;18:418–424.
  69. Dhabhar FS: Enhancing versus suppressive effects of stress on immune function: implications for immunoprotection versus immunopathology. Allergy Asthma Clin Immunol 2008;4:2–11.
  70. Halliday WJ, Garvey JS: Some factors affecting the secondary immune response in tissue cultures containing hydrocortisone. J Immunol 1964;93:757–762.

    External Resources

  71. Danes RA, Araneo BA: Contrasting effects of glucocorticoids on the capacity of T cells to produce the growth factors interleukin-2 and interleukin-4. Eur J Immunol 1989;19:2319–2325.
  72. Mosmann TR, Coffman RL: Th1 and Th2 cells: different patterns of lymphokine secretion lead to different functional properties. Ann Rev Immunol 1989;7:145–173.
  73. Mason D: Genetic variation in the stress response: susceptibility to experimental allergic encephalomyelitis and implications for human inflammatory disease. Immunol Today 1991;12:57–60.
  74. Grayson J, Dooley NJ, Koski IR, Blaese RM: Immunoglobulin production induced in vitro by glucocorticoid hormones: T-cell-dependent stimulation of immunoglobulin production without B-cell proliferation in cultures of human peripheral blood lymphocytes. J Clin Invest 1981;68:1539–1547.
  75. Plaut M: Lymphocyte hormone receptors. Annu Rev Immunol 1987;5:621–669.
  76. Wiegers GJ, Labeur MS, Stec IE, Klinkert WE, Holsboe RF, Reul JM: Glucocorticoids accelerate anti-T-cell receptor-induced T-cell growth. J Immunol 1995;155:1893–1902.
  77. Wiegers GJ, Reul JMHM, Holsboer F, De Kloet ER: Enhancement of rat splenic lymphocyte mitogenesis after short-term exposure to corticosteroids in vitro. Endocrinology 1994;135:2351–2357.
  78. Wiegers GJ, Stec IE, Klinkert WE, Linthorst AC, Reul JM: Bidirectional effects of corticosterone on splenic T-cell activation: critical role of cell density and culture time. Neuroendocrinology 2001;73:139–148.
  79. Mekaouche M, Givalois L, Barbanel G, Siaud P, Maurel D, Malaval F, Bristow AF, Boissin J, Assenmacher I, Ixart G: Chronic restraint enhances interleukin-1β release in the basal state and after endotoxin challenge, independently of adrenocorticotropin and corticosterone release. Neuroimmunomodulation 1994;1:292–299.
  80. Takaki A, Huang QH, Somogyvari-Vigh A, Arimura A: Immobilization stress may increase plasma interleukin-6 via central and peripheral catecholamines. Neuroimmunomodulation 1994;1:335–342.
  81. Calandra T, Bernhagen J, Metz CN, Spiegel LA, Bacher M, Donnelley T, Cerami A, Bucala R: MIF as a glucocorticoid-induced modulator of cytokine production. Nature 1995;377:68–71.
  82. Baumann H, Gauldie J: The acute phase response. Immunol Today 1994;15:74–80.
  83. Wiegers GJ, Reul JMHM: Induction of cytokine receptors by glucocorticoids: functional and pathological significance. Trends Pharmacol Sci 1998;19:317–321.
  84. Esparza EM, Arch RH: Glucocorticoid-induced TNF receptor functions as a costimulatory receptor that promotes survival in early phases of T-cell activation. J Immunol 2005;174:7869–7874.
  85. Tone M, Tone Y, Adams E, Yates SF, Frewin MR, Cobbold SP, Waldmann H: Mouse glucocorticoid-induced tumor necrosis factor receptor ligand is costimulatory for T cells. Proc Natl Acad Sci USA 2003;100:15059–15064.
  86. Akahoshi T, Oppenheim JJ, Matsushima K: Induction of high-affinity interleukin-1 receptor on human peripheral blood lymphocytes by glucocorticoid hormones. J Exp Med 1988;167:924–936.
  87. Girard MT, Hjaltadottir S, Fejes-Toth AN, Guyre PM: Glucocorticoids enhance the γ-interferon augmentation of human monocyte IGG Fc receptor expression. J Immunol 1987;138:3235–3241.
  88. Kizaki T, Oh-Ishi S, Ookawara T, Yamamoto M, Izawa T, Ohno H: Glucocorticoid-mediated generation of suppressor macrophages with high density FcγRII during acute cold stress. Endocrinology 1996;137:4260–4267.
  89. Reed J, Abidi A, Alpers J, Hoover R, Robb R, Nowell P: Effect of cyclosporin A and dexamethasone on interleukin-2 receptor gene expression. J Immunol 1986;137:150–154.
  90. Boumpas DT, Paliogianni F, Anastassiou ED, Balow JE: Glucocorticosteroid action on the immune system: molecular and cellular aspects. Clin Exp Rheum 1991;9:413–423.
  91. Lamas M, Sanz E, Martin-Parras L, Espel E, Sperisen P, Collins M, Silva AG: Glucocorticoid hormones upregulate interleukin-2 receptor a gene expression. Cell Immunol 1993;151:437–450.
  92. Munck A, Guyre PM, Holbrook NJ: Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev 1984;5:25–44.
  93. Schleimer RP, Claman HN, Oronsky A (eds): Anti-inflammatory steroid action: basic and clinical aspects, ed 1. San Diego, Academic Press, 1989, pp 1–564.
  94. Marx J: How the glucocorticoids suppress immunity. Science 1995;270:232–233.
  95. Sternberg EM, Wilder RL: The role of the hypothalamic-pituitary-adrenal axis in an experimental model of arthritis. Prog Neuroendocrinol Immunol 1989;2:102–108.
  96. Webster JI, Tonelli L, Sternberg EM: Neuroendocrine regulation of immunity. Annu Rev Immunol 2002;20:125–163.
  97. Dougherty TF: Role of the adrenal gland in the protection against anaphylactic shock. Anat Rec 1949;103:24.
  98. Kroemer G, Brezinschek HP, Faessler R, Schauenstein K, Wick G: Physiology and pathology of an immunoendocrine feeback loop. Immunol Today 1988;9:163–165.
  99. Besedovsky H, Del Ray A, Sorkin E, Dinarello CA: Immunoregulatory feedback between interleukin-1 and glucocorticoid hormones. Science 1986;233:652–655.
  100. Sternberg EM, Young WS, Bernadini R, Calogero AE, Chrousos GP, Gold PW, Wilder RL: A central nervous system defect in biosynthesis of corticotropin-releasing hormone is associated with susceptibility to streptococcal cell wall-induced arthritis in Lewis rats. Proc Natl Acad Sci USA 1989;86:4771–4775.
  101. Sternberg EM, Glowa J, Smith M, Calogero AE, Listwak SJ, Aksentijevich S, Chrousos GP, Wilder RL, Gold PW: Corticotropin-releasing hormone-related behavioural and neuroendocrine responses to stress in Lewis and Fischer rats. Brain Res 1992;570:54–60.
  102. Wick G, Sgonc R, Lechner O: Neuroendocrine-immune disturbances in animal models with spontaneous autoimmune diseases. Ann NY Acad Sci 1998;840:591–598.
  103. MacKenzie FJ, Leonard JP, Cuzner ML: Changes in lymphocyte β-adrenergic receptor density and noradrenaline content of the spleen are early indicators of immune reactivity in acute experimental allergic encephalomyelitis in the Lewis rat. J Neuroimmunol 1989;23:93–100.
  104. Del Rey A, Klusman I, Besedovsky HO: Cytokines mediate protective stimulation of glucocorticoid output during autoimmunity: involvement of IL-1. Am J Physiol 1998;275:R1146–R1151.
  105. Buske-Kirschbaum A, Hellhammer DH: Endocrine and immune responses to stress in chronic inflammatory skin disorders. Ann NY Acad Sci 2003;992:231–240.
  106. Torpy DJ, Chrousos GP: The three-way interactions between the hypothalamic-pituitary-adrenal and gonadal axes and the immune system. Baillieres Clin Rheumatol 1996;10:181–198.
  107. Buske-Kirschbaum A, Geiben A, Hellhammer D: Psychobiological aspects of atopic dermatitis: an overview. Psychother Psychosom 2001;70:6–16.
  108. Buske-Kirschbaum A, von Auer K, Krieger S, Weis S, Rauh W, Hellhammer D: Blunted cortisol responses to psychosocial stress in asthmatic children: a general feature of atopic disease? Psychosom Med 2003;65:806–810.
  109. Priftis KN, Papadimitriou A, Nicolaidou P, Chrousos GP: The hypothalamic-pituitary-adrenal axis in asthmatic children. Trends Endocrinol Metab 2008;19:32–38.
  110. Kavelaars A, de Jong-de Vos van Steenwijk T, Kuis W, Heijnen CJ: The reactivity of the cardiovascular system and immunomodulation by catecholamines in juvenile chronic arthritis. Ann NY Acad Sci 1998;840:698–704.
  111. Chrousos GP: Stress, chronic inflammation, and emotional and physical well-being: concurrent effects and chronic sequelae. J Allergy Clin Immunol 2000;106:S275–S291.

 goto top of outline Author Contacts

Firdaus S. Dhabhar
Department of Psychiatry & Behavioral Sciences, and
Stanford Institute for Immunity, Transplantation, & Infection, Stanford University
300 Pasteur Drive, MC 5135, Stanford, CA 94305-5135 (USA)
E-Mail dhabhar@gmail.com

 goto top of outline Article Information

Published online: June 29, 2009
Number of Print Pages : 18
Number of Figures : 2, Number of Tables : 0, Number of References : 111

 goto top of outline Publication Details


Vol. 16, No. 5, Year 2009 (Cover Date: June 2009)

Journal Editor: Savino W. (Rio de Janeiro)
ISSN: 1021-7401 (Print), eISSN: 1423-0216 (Online)

For additional information: http://www.karger.com/NIM

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.