The human immune system contains complex and powerful machinery capable of keeping us healthy under most circumstances, by attacking a myriad of active and potential pathogens simultaneously. On occasion, as seen with autoimmune disease and other conditions, this system malfunctions, yielding various disturbances in these immunological mechanisms. Here we discuss the possibility of autoimmune disease affecting the body’s normal immune function, hindering it from doing its job effectively.
If I have an autoimmune condition (or multiple conditions), what does that mean in terms of my immune system’s ability to attack outside disease?
For example, am I more likely to catch an infection and/or have trouble fighting outside viruses or bacteria because my immune system is so busy attacking itself?
Our immune system is an extremely powerful tool that aids us in the safe navigation of a world filled with viruses, bacteria, fungi and other bugs. Unfortunately, sometimes this formidable ally partially devotes itself to more nefarious purposes, attacking the body’s own tissues and resulting in autoimmune conditions. Luckily, the immune system is so robust and potent that in terms of autoimmune disease limiting its ability to perform its normal duties, the vast majority of patients can fight off most infections without a problem, despite the disrupted autoimmune process occurring simultaneously.
Naturally, there are sometimes exceptions, but except perhaps in very special scenarios, there should not be an issue regarding the interaction of normal and dysfunctional immune processes. If anything, the supercharged immune system may indeed make normal immune responses more vigorous, especially if certain antibodies experience cross reactions between outside and internal real and perceived pathogens. However, this is merely educated supposition and not material fact.
Additionally, it has been proposed that infection-fighting proteins may be involved in development of autoimmune diseases, suggesting that while not normally influential in altering the body’s ability to fight infections, autoimmune disease may in fact partially be the result of such infectious triggers, according to a University of Michigan study and a Johns Hopkins study.
Alternatively, others believe in something called the hygiene hypothesis, which suggests that the rising incidence of autoimmunity around the world may be the result of actually being “too clean”, so to speak. This notion states that our lack of encountering as many pathogens as our ancestors has possibly turned our immune systems looking inward, by virtue of no longer having to battle as many outside invaders. Clearly, our understanding of autoimmune conditions and its causes are still at a very rudimentary stage.
It should be noted that there is a major difference between autoimmunity and immunodeficiency, which despite completely different mechanisms, are often confused by members of the lay public.
In contrast to autoimmune disease, someone with an immunodeficiency (also known as immunocompromised) has one or more defects that render the body incapable of performing its standard duties protecting against foreign invasion, resulting in a host of possible common and opportunistic infections. The most well-known form of immunodeficiency is probably AIDS, secondary to HIV inoculation, where the virus prevents the immune system from doing its job. Fortunately, advances in understanding and treatment of the disease have changed this once terminal illness into a usually manageable chronic disease.
And of course as autoimmunity sufferers know all too well, immunosuppressive drugs used to combat their disorder(s), such as steroids and methotrexate, may very well have undesirable effects on the ability to stave off microbial invasion. But this is a result of the treatments rather than the disease itself.
On the other hand, there are instances in which the two dysfunctional processes (autoimmunity and immunodeficiency) occur together, in which case the patient would clearly experience the manifestations of both illnesses, for example in this study from the University of Florida College of Medicine, which looked at associations between the two. Such cases would fall under the heading of very special scenarios mentioned above. Interestingly, though it doesn’t seem well understood, it appears that most cases involve people who have been diagnosed with some sort of immunodeficiency subsequently developing or being diagnosed with autoimmune condition(s). What this association or the order of appearance means is uncertain.
With an overactive immune system causing autoimmune disease, should I take precaution with putting stress on my immune system, i.e., stay away from flu and other vaccines?
Although as noted above it appears that infection may be among the initial triggers of autoimmune disease, it does not seem that the reverse is true; i.e. autoimmune conditions, in and of themselves, do not particularly predispose someone to more infections and successful foreign invasion. Still, while the evidence for such a phenomenon in the literature is lacking, there are some patients on forums that believe this to be the case, or at least suspect it as a possibility.
Having said this, it should be mentioned that anytime one has issues with his or her immune system, whether it be overactive or underactive, he or she should absolutely do whatever possible to minimize generalized stress on a daily basis. As anyone who has been under substantial stress and then developed a cold or other infection can testify, there is certainly something to the notion of such anxiety lowering the barrier to invasion, though the way this occurs is unknown. Also, undergoing significant stress while dealing with autoimmune conditions may provoke a flare or symptoms, offering another reason for autoimmune patients to try as much as possible to manage stress and anxiety.
In terms of the “stress” put on an immune system during vaccination, this is not normally a problem for autoimmune patients, and should certainly not be a reason on its own, in most cases, for avoidance of immunizations. However, since many patients with autoimmune conditions may be on some sort of immunosuppressive regimen, such therapy may require (but often still doesn’t) an adjustment or outright avoidance of some vaccines. Two articles from the CDC and Euro PubMed Central give opinions on the topic. This decision will also likely depend on the type and formulation (live vs. dead, for example) of the specific vaccine in question. For these reasons, as always, it is best to check with your doctor regarding these situations and whether or not to abstain from certain injections or other vaccinations.
Questions for your doctor:
- Do you believe that autoimmunity can impact the body’s ability to fight infection? What is the evidence for/against this possibility?
- Given my specific condition(s), which immunizations, if any, should I not receive?
- Can you recommend a good source for more information on the topic of autoimmune and immunodeficient interactions?
- Which immunosuppressants make it most likely I will experience infections and/or be required to avoid certain vaccines?
- Is it possible that my autoimmune condition can actually help in fighting some infections because of the hyperimmune state it results in?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].