AUTOIMMUNITY IN THE ENVIRONMENTALLY ILL PATIENT
Phyllis L. Saifer, M.D., M.P.H.
Autoimmunity is an often overlooked component of environmentally induced disease. Environmentally ill patients are subject to immune dysregulation, that is, abnormal "T" lymphocyte numbers and function, and upset helper/suppressor ratios.
Inappropriate response to environmental exposures is the most commonly studied aspect of their illnesses.
Inappropriate response to self-antigens may result from a genetic trait that determines individual susceptibility. Environmental factors, both internal and external, are triggers for expression of these genes.
There are at least 2 good reasons to consider autoimmune disease in the complex environmentally ill patient who does not respond adequately to thorough treatment for external triggers. Such patients should be evaluated for thyroiditis, oophoritis, diabetes mellitus, adrenalitis, (Addison's disease), and gastritis (Pernicious anemia)
First: Treatment for these diseases is well established and can be a major factor in achieving good health.
Second: Forewarned is forearmed: multiple autoimmune endocrinopathies develop in certain patients; thus, the discovery of one should create a heightened suspicion for the presence of or later development of others.
The knowledge one is dealing with such as a polyendocrinopathy patient can accelerate the establishment of an otherwise unsuspected diagnosis; for example, the insulin dependent diabetic who experiences the insidious onset of hypothyroidism, or the very commonly thyroiditic female who later develops oophoritis presenting as premenstrual syndrome.
The overlap between endocrine autoimmune disease and the collagen disorders is impressive; for example, rheumatoid arthritis is reported in patients with thyroiditis and their relatives. |
