Allergies /Asthma and PTSD

• Where messages appear by Margaret Blakely, 5/14/96
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    • Allergies/Asthma and PTSD by Anita F. Redlich, 12/14/96
      
      

The general relationship among asthma, allergies, and anxiety has been recognized for many years (Also blue eyes, but I'll try to explain that more tenous one at another time). It is one of those triads that doctors seem to like so much. The exact link between immune response, hyperimmune response, and "anxiety" remains controversial. First of all, "anxiety" can mean fear, distress, or shame (usually co-assembled with distress). In "depression," which is an even more amorphous grouping of chronic negative affect states, immune function is generally depressed, for instance the Natural Killer (NK)leukocytes decline in numbers or at least activity during depressive episodes. NK activity also declines during more transient negative affect, but the studies which have shown this have not defined the affects with enough precision. I think they have mainly measured distress-anguish, and some shame.

Just as with the affect system, the immune system has multiple feedback loops with enough complexity to occasionally get things screwed up. The hyperimmune response of the allergies may be due to deficits in negative feedback upon the response against the allergens, as much as due to any primary over-responsiveness. I have not studied allergies much for several years, so I won't even try to be more specific. In asthma, there probably are deficits in the downregulation of mast cell response. I cannot tell you the links from distress to an asthma attack, but I have certainly seen exacerbation of true asthma (as opposed to upper airway stridor, which can clearly be post-traumatic psychosomatic) correlate closely with the exacerbation of fear, distress, and shame, when PTSD is in a more intrusive phase. I have not seen asthma exacerbation particularly associated with the more "avoidant" phases, which look more like depression-shame-withdrawal to me. Obviously, an asthma attack can trigger intrusive PTSD symptoms, including dissociation via physical triggering of the affects of fear-terror, and distress-anguish. Further responses might be based upon pre-morbid (with respect to PTSD) personal scripting, such as a shame-bind of distress in the socialization of many Viet Nam draftees. In men, such socialization often intensifies the total density of stimulation; from distress which is backed up, from shame, and from the ongoing pain of any physical condition. The total density is often then enough to elicit anger, even if the childhood and wartime socialization had not produced a well practiced distress -> shame -> anger script. Usually such a script does exist, and operates so swiftly that only anger is ordinarily observed.

The genetic link is probably due to inherited traits of shame-sensitivity or other distress-sensitivity, which predispose to ANY anxiety disorders (but GAD is the closest thing to a pure culture of distress-sensitivity, and Atypical Depression the closest to shame-sensitivity; both disorders can also have clear family-of-origin non-heritable developmental components). And these affect sensitivities must be linked to immune function. During "stress," heart rate increases, and so does serum cortisol. For the temperamentally anxious, these measures increase more than for the temperamentally laid-back, which has been shown in both animal and human models. An animal model has shown heritability of the physiologic response traits. "Anxious" individuals also have lower than average heart rate variability, which indicates a balance between sympathetic and parasympathetic systems, that is tipped towards the sympathetic, or adrenergic system.

The association between psychological "stress" and asthma exacerbation is well established, and correctly a part of folk wisdom. Asthma exacerbations can be reduced with psychotherapy (Fred Womboldt, M.D. is one researcher in this field). The backed-up affect of distress-anguish may be associated with either true or pseudo-asthma attacks, in part via constriction of the rib cage due to excessive chronic muscle tension.

Enough for now. Will you please look out, over the next 9 to 10 months, for any association between asthma, allergies and migraines - and PTSD. How much more frequently is migraine seen in asthma, allergy. or anxiety patients, than in a general medical population without those problems?

E-mail: remost@execpc.com or rmost@gc.gundluth.org

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