Atopy refers to a genetic predisposition to developing allergic diseases, while atopic march is the […]
Hormones are chemicals that are produced by the endocrine system of the body to maintain the body’s equilibrium known as homeostasis. Hormone levels can fluctuate either physiologically (natural biologically) or due to external factors, such as infection, environmental factors, drugs etc. Interestingly, our hormone levels can affect allergies or predispose a person to allergic symptoms.
In this article, we explore the effects of common hormones, such as sex hormones, thyroid hormones, stress hormones and insulin on common allergies like eczema, allergic rhinitis and asthma.
Sex hormones fluctuate physiologically throughout our reproductive age of life. We may notice our allergy symptoms becoming more prominent or worsen during certain times of our life. Here, we discuss the role of common sex hormones, such as oestrogen, progesterone and testosterone, in affecting a person’s allergy symptoms.
In asthma, oestrogen can bind with oestrogen-receptors on the lung tissues, stimulating inflammation and activation of immune cells in the lungs. Oestrogen regulates chemical protein (chemokine) production, causing mast cells (a type of allergy cell) to degranulate (breakdown), leading to airway cells and airway muscles to be inflamed and becoming overreacting towards allergens. Progesterone hormone prevents mucus clearance from the airway.
In atopic dermatitis (eczema), one is more susceptible to the sex hormones in comparison to those without atopic dermatitis. Oestrogen generally has a positive effect on the skin barrier, reducing the risk of eczema flare ups. Contrarily, both progesterone and testosterone can be detrimental in maintaining a good physical skin barrier, leading to more predisposition of flare up of skin condition under the influence of both hormones.
In allergic rhinitis, the nose tissues and secretory glands can interact with sex hormones, such as estrogen. This, in turn, leads to blood vessels growth, tissue swelling, inflammation and an increased response to allergies and mast cells degranulation. This cascade of activities within the body result in the clinical manifestation of upper respiratory allergy symptoms of rhinitis.
Allergic Asthma | Atopic Dermatitis | Allergic Rhinitis | |
Effects of Sex Hormones on allergies | Due to the influence of oestrogen and progesterone, asthma can be exacerbated during peri-menstrual period, pregnancy phase and the exacerbation decline after menopause. Testosterone has an anti-inflammatory effect in asthma conditions. | Due to physiological fluctuation of sex hormone levels during the menstrual cycle, one may notice exacerbation of skin condition just before period or during pregnancy. | Symptoms of allergic rhinitis can be worsened during ovulatory period or during pregnancy period. |
Cortisol, our body’s stress hormone, is produced by a pair of adrenal glands that reside on the tip of both kidneys. The stress hormone is controlled by the brain — hypothalamus and the pituitary.
Stress can result in worsening of allergic symptoms. Generally, stress causes general inflammation of the body. In asthma, stress is responsible for causing lung inflammation and dysregulation of the immune system, leading to susceptibility to allergens and asthma exacerbation. Interestingly, mood disorders such as depression, anxiety and attention deficit hyperactivity disorders are associated with worsening of allergic rhinitis or atopic dermatitis symptoms — hence termed ‘allergic mood’.
Due to the physiological day-night fluctuation of stress/ neuro-hormones, one with atopic dermatitis may notice worsening itch at night.
The thyroid gland is a symmetrical, butterfly-shaped gland situated in front of a person’s neck. The thyroid gland produces thyroid hormones that play essential roles in a person’s overall metabolism. The thyroid levels can fluctuate due to physiological causes, stress, infection, and even autoimmune or brain/pituitary disorders. When the thyroid levels are too high, it is termed “hyperthyroidism”. Conversely, “hypothyroidism” is used to describe thyroid levels that are too low.
Imbalance of the thyroid hormones can exacerbate asthma symptoms. An overproduction of thyroid hormones can cause inflammation, leading to high levels of immune cells and asthma exacerbation. In hypothyroidism, due to slower overall metabolism, there is reduced oxygen usage in the lungs, and slower lung tissue/muscle clearance of air/allergens leading to predisposition of asthma symptoms. Managing thyroid levels back to normal levels can alleviate and aid the overall management of asthma treatment.
Low thyroid level is associated with allergic rhinitis due to reduced mucous/nose tissue clearance of infection/ allergy particles, increased predisposition to various sinus infections and allergies.
While thyroid disorders do not have a direct relationship with atopic dermatitis, low thyroid levels can worsen existing dermatitis as hypothyroidism can cause itching and skin dryness.
Diabetes Mellitus is a chronic endocrine disorder due to dysregulation of the glucose in the body resulting from insufficient or ineffective insulin in the body to process the blood glucose. We discussed the relationship of type 2 diabetes mellitus and allergies.
Type 2 diabetes mellitus is the result of ineffective insulin to break down blood glucose due to insulin resistance over time. Frequently, type 2 diabetes mellitus can be associated with other metabolic disorders such as obesity, which both conditions impair lung function leading to exacerbation of asthma. A good control of type 2 diabetes mellitus can improve a person’s overall asthma symptoms.
The relationship between type 2 diabetes and atopic dermatitis/allergic rhinitis remains much to be elucidated, and clinical literature remains contradictory.
While the association between hormones in our body and allergic symptoms remains an area not commonly discussed, understanding the link between them can potentially ameliorate and manage allergies more effectively resulting in better quality of life.
Importantly, learning the association between hormone fluctuations and allergy symptoms allow both patient and physician to strive towards a more personalised, holistic health management plan to control allergies.
References:
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