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Stress Impact in the Immune System: Clinical Implications and Aids to Mitigate the Burden

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San Antonio, Texas, was the host city of our annual American Academy of Asthma Allergy and Immunology (AAAAI) 2023 meeting, which proved to be our specialty's traditionally exciting, novel, and comprehensive update. One of the advancements in the field of Allergy and Immunology is that the immune system does not act alone. There is a vast network of bidirectional communication between the nervous-endocrine-immune system that is there for survival reasons. There has to be a crosstalk between these systems. If an aggressor (virus, bacteria, other pathogens, injury, inflammation of any source, among other biological insults) "attacks," the neuro-endocrine immune system reacts to control such aggression in a very organized way to control and mitigate suffering and pain. In this meeting, there was one important virtual symposium (among others), which is accessible for a year to registered participants that addresses this topic. 

The symposium was: Introduction of the Psychoneuroimmunology: Understanding the Biology of the Stress  Response and its Impact on the Innate and Adaptive Immune Response

One of the two speakers in this symposium, Michael Irwin, MD, presented a fascinating video conference on The Biology of the Stress Response and its Clinical Implications in Immunology Diseases [1]. 

Dr. Irwin holds the Norman Cousins Distinguished Professorship in the Department of Psychiatry and Biobehavioral Science at the UCLA Geffen School of Medicine for his lifetime contributions to understanding the reciprocal interactions between the central nervous system, the immune system, and health. Dr. Irwin provided an excellent overview of what the field of Psychoneuroimmunology entails. He explained the neuroendocrine and autonomic pathways involved in this cross-talk between the Neuro-endocrine-immune network, its implication for stress-induced pathology, and its influence on health and disease. One physiological function that is key for this cross-talk communication is sleep. Dr. Irwin showed us how afferent signals from the immune cells promote sleep as one of the mechanisms supporting a neurally integrated immune system that may respond to infection, injuries, and other 'danger signals.' He examines this topic in a comprehensive review of sleep and inflammation. He also shared important studies from his early research on the effects of behavioral interventions in enhancing the immune system. A particular example was an enhancement of the Varicella Zoster Vaccine immune response in older adults who participated in a specific type of Asian meditation and Tai Chi. Tai Chi modulates the stress arousal pathways decreasing the sympathetic nervous system activation. In addition, he reviews other behavioral interventions such as Cognitive Behavioral Therapy (CBT), exercise, and other meditation modalities showing improvement in sleep quality and other immune outcomes. This conference covers many of his different published research in this field, providing valuable information and avenues of possible therapeutic interventions.[1] 

In this same symposium, I spoke about one of the neuropeptides that is a player in this neuroimmune crosstalk. Vasoactive Intestinal Peptide (VIP) is a neuropeptide found in the peripheral (PNS) and central (CNS) nervous systems. It controls circadian rhythms, anxiety, response to stress, schizophrenia, learning, and memory, among other functions. It has an essential regulatory role in the Immune system. I presented data on The Differential Expression and Regulation of Vasoactive Intestinal Peptide (VPAC1 and VPAC2) Receptors in T Cell Subsets and Monocytes [2]. VIP has potent effects on T cell differentiation and migration and modulates cytokine production by T helper cells. VPAC1 and VPAC 2 differential distribution in resting and activated state of T cells may serve a role in preventing uncontrolled bystander activation in the gut and airway where there is abundant innervation with VIP-secreting nerve terminals. VIP plays a role in innate and adaptive immune response via nociceptive receptors, differential distribution, and its VPAC1 and VPAC 2 receptors within mononuclear cells. VIP also acts as a co-transmitter of non-adrenergic non-cholinergic relaxation of vascular and nonvascular smooth muscles. It is a potent endogenous bronchodilator in the airways and may have a role in asthma that is still not fully elucidated.

Understanding the Neuro-endocrine-immune interactions may identify therapeutic targets of pharmacological and non-pharmacological interventions that will help to expand treatment options for patients with allergic and immunological diseases. The Psychoneuroimmunology field provides critical knowledge that is increasingly vital in the Allergy and Immunology specialty. 

[1] The Biology of the Stress Response and is Clinical Implications in Immunology Diseases. Michael Irwin, MD 

[2] The Differential Expression and Regulation of Vasoactive Intestinal Peptide (VPAC1 and VPAC2) Receptors in T Cell Subsets and Monocytes. Maria Luz Lara-Marquez MD, Ph.D., FAAAAI 

Dr. Lara-Marquez is an Allergist and Immunologist, now practicing in San Diego California in private practice. She is the Past-Chair and current member of the Integrative Medicine Committee of the AAAAI, a volunteer position. Her views are her own. Dr. Lara-Marquez has no conflicts of interest to report.

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