May 26, 2014 Puzzle Piece
The Relationship of Cortisol Levels to Allergies
This week's Puzzle Piece
comes from Labrix Laboratories, who is my favorite on salivary testing
for hormone levels. They also have webinars and seminars to further our
education.
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For many of us, the increased sunshine, longer daylight
hours, birds chirping, bees buzzing and flowers blooming that come with
onset of spring are most welcome after cold, gray winter days. However,
for the allergy sufferer, these can be the signal of just another season
of frustrating runny noses and itchy, watery eyes. While most of us
remember to test cortisol in our fatigued or chronically stressed
patients, it can also be quite useful to test cortisol levels in those
suffering from chronic allergies.
Conventional approaches to treating allergic symptoms
have often involved the use of a topical or inhaled corticosteroid. The
corticosteroid, while effective at reducing the inflammation, does not
address the underlying question of "Why can't this patient tolerate
seemingly benign environmental factors such as grass or pollen?"
What we know about the role of the
hypothalamic-pituitary-adrenal axis (HPA) and allergies is complex.
Research shows that even in early life, infants who have an atopic
disposition have an aberrant cortisol response. Initially, in infancy,
when a stressor is incurred, the infant with an atopic disposition
produces a higher level of cortisol than his or her non-atopic
counterparts. However, in atopic adults, we see an attenuated response
of the HPA to a stressor. What is unclear is whether this reduced
responsiveness represents a genetically determined predisposition or
whether a hyporeactive HPA is a consequence of chronic inflammatory
markers increasing negative feedback effects on the HPA over time.
Another interesting study shows that the hyporeactivity
of the HPA in adult atopy may be related to disease severity. This
suggests that adults with increased allergic or atopic symptoms may have
increased hyporeactivity of their HPA than other atopic adults. Also,
increased stress, in the form of anxiety, has been shown to heighten the
magnitude of allergic symptoms. For clinicians, this makes sense as we
often see an increase in atopic and allergic symptoms in our patients
who are undergoing stressful life events.
Ultimately what this information gives us is an
understanding that cortisol production in the atopic patient is
irregular. In the very young infant or child, it can be quite elevated
before the onset of disease or clinical manifestations. In the toddler,
child or adult who has atopic symptoms, we can see depressed cortisol
levels indicating hyporesponsiveness of the HPA and, often, the severity
of the depression of cortisol levels can be correlated with the
severity of symptoms. This information gives us great incentive for
monitoring our atopic patients more closely with salivary cortisol
levels in order to support their compromised HPA and help to
holistically manage their symptoms.
References:
* Buske-Kirschbaum A, Fischbach S, Rauh W, Hanker J,
Hellhammer D. (2004). Increased responsiveness of the
hypothalamic-pituitary-adrenal (HPA) axis to stress in newborns with
atopic disposition. Psychoneuroendocrinology, 29(6), 705-11.
* Buske-Kirschbaum A, Ebrecht M, Hellhammer DH.
(2010). Blunted HPA axis responsiveness to stress in atopic patients is
associated with the acuity and severeness of allergic inflammation.
Brain, Behavior and Immunity, 24(8), 1347-53.
* Kiecolt-Glaser JK, Heffner KL, Glaser R, Malarkey
WB, Porter K, Atkinson C, Laskowski B, Lemeshow S, Marshall GD. (2009).
How stress and anxiety can alter immediate and late phase skin test
responses in allergic rhinitis. Psychoneuroendocrinology, 34(5), 670-80.
* Mizawa M, Yamaguchi M, Ueda C, Makino T, Shimizu T.
(2013). Stress evaluation in adult patients with atopic dermatitis using
salivary cortisol. Biomedical Research International, 2013:138027.
* Stenius F, Borres M, Bottai M, Lilja G, Lindblad F,
Pershagen G, Scheynius A, Swartz J, Theorell T, Alm J. (2011). Salivary
cortisol levels and allergy in children: The ALADDIN birth cohort.
Journal of Allergy and Clinical Immunology, 128(6), 1335-9.
http://clicks.aweber.com/y/ct/?l=BJ7fV&m=JeVtjGgL34OlUD&b=lX8yZiPO0JsKg1nw75DZJQ
REGISTRATION IS OPEN!
Labrix Founder and Medical Director Dr. Jay Mead, CEO and
Associate Medical Director Dr. Erin Lommen, and Staff Physicians Dr.
Robyn Kutka, Dr. Lylen Ferris, and Dr. Sara Wood present the
fundamentals of hormone balancing, broken down into simple core concepts
and related in a single day of engaging presentations and discussions.
This event is designed for the provider who is new to the field of
hormone balancing or is looking to brush up on the basics.
Join Labrix for this 8-hour training and leave with the tools and knowledge necessary to:
* Identify patients who would benefit from hormone balancing
* Understand the roles of major sex and adrenal hormones in men and women
* Appreciate the relationships between the various hormones and the entire endocrine system
* Recognize the role that sex and adrenal hormones play in several prominent disease processes
* Treat hormone imbalances with nutritional supplements, botanical medicines and BHRT
This event will be held on Saturday, August 2nd, 2014 at the Hilton Portland & Executive Tower.
This event is a non-CME event.
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Thanks to Dr. Jay Mead and
his staff or this excellent information, webinars and seminars to keep
us up to speed with the most up to date information. MaX Hypothalamus/Pituitary is a great modulator for the HPA. MaX Adrenal, MaX Iodine and MaX Thyroid
should be considered in helping bring patients to optimal function of
the HPA. HistDAO can be an incredible nutraceutical for allergies with
histamine as part of the puzzle.
Yours in Health and Wellness,
John W. Brimhall, BA, BS, DC, FIAMA, DIBAK