Immunosuppression, possible effect

Opioids induce the release of histamine, which leads to the itching sensation associated with use and abuse of opioids. Bronchiolar constriction is possible. Opioids are also immunosuppressive, having effects on the T-helper and T-suppressor cells. 

There has been some concern about the possible effects of factor VIII formulations on the immune system. In vitro experiments with coagulation factor concentrates have shown immunosuppressive effects (16,17), such as the impairment of Fc receptor-mediated phagocytosis and intracellular bacterial killing (18). Inhibition of IL-2 production, an impaired MLR, and impairment of PHA transformation have been demonstrated (19). A fall in the number of T4 lymphocytes has also been found. Whether these findings reflect functional impairment of the immune system is still unclear. 

The Committee noted that this study did not address the possible effects of carrageenan on the gastrointestinal tract. The statistical power of the study is unlikely to have been sufficient to demonstrate an immunosuppressive effect of carrageenan. 

Immunosuppressive medications. Steroid minimization and possibly withdrawal are effective strategies for the prevention of NODAT. Also, patients with worsening blood glucose levels after transplantation who are receiving tacrolimus may benefit from conversion to cyclosporine.74... 

The anticonvulsant phenytoin, and to a lesser degree carbamazepine, can inhibit the synthesis of antibodies, and in some cases these drugs can result in lymphoproliferation [77-79]. These effects on the immune system could be viewed as a type of autoimmunity. The relationship between such effects and autoimmunity are still not clear, although the more recent observations that cytokines and anti-cytokines can cause autoimmunity support the existence of such a relationship. The previous edition of this book contained an extensive discussion of the possible relationship between immunosuppression and autoimmunity [80], Phenytoin and carbamazepine can also cause a lupus-like syndrome although the incidence is lower than with many other drugs. 

As a consequence of their immunosuppressive activity, Tregs may function as a cellular therapeutic agent that ameliorates allergies and autoimmune diseases. This has been proven in several disease models including asthma, inflammatory bowel disease, multiple sclerosis and CHS reactions. Others and we have studied the effects of in vivo applied Tregs as a possible therapeutical means to curb... 

However, selective HR2 antagonists have attracted interest because of their potential immune response-modifying activify [88]. Mosf data suggest that cimetidine has a stimulatory effect on the immune system, possibly by blocking the receptors on subsets of T lymphocytes and inhibiting HR2-induced immunosuppression. Cimetidine has also been used successfully to restore immune functions in patients with malignant disorders, hypogammaglobulinemia and AIDS-related complexes. 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

The various organs of the immune system such as spleen, lymph nodes, thymus and bone marrow containing the cells involved in the various immune responses offer the possibility to harvest these cells and perform in vitro assays for evaluation of effects on the immune system. When part of an in vivo animal study this may indicate a direct toxic effect of pharmaceuticals, that is, immunosuppression (Table 18.2). So, it is feasible to obtain cell suspensions for further evaluation such as determination of cellular subsets of T and B leukocytes by fluorescent activated cell sorter analysis (FACS analysis), and determination of natural killer (NK) cell activity of the spleen cell population. An advantage of this approach is that it may lead to identification of a biomarker to be used in clinical studies. In addition, in vitro stimulation of spleen cells with mitogens activating specific subsets may indicate potential effects on the functionality of splenic cell populations. Concanavalin A (Con A) and phytohemagglutinin (PHA) activate Tcells, while lipopolysaccharide (LPS) activates primarily B cell populations. Blood is collected for total white blood cell (WBC) determination and blood cell differential count. In addition, serum can be obtained for determination of serum immunoglobulins. 

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