Everything you need to know about Immunosuppression

There appears to have been a rise in the incidence of some autoimmune disorders in recent years. A study by The Lancet found that autoimmune disorders now affect about one in ten individuals in the UK and on average affect more women than men. There are over 80 identified autoimmune diseases. The causes of autoimmune conditions are poorly understood and there is no cure. Many scientists believe that autoimmune diseases are mainly due to environmental factors, including stress. 

What is immunosuppression?

Immunosuppression is the process of suppressing the immune system. Your immune system is your body’s defence against infections. It protects your body from harmful substances, germs and cell changes that could make you unwell. 

Your immune system includes:

• Your skin – this helps to keep germs out of your body.
• Bone marrow – this helps to produce immune cells.
• Lymphatic system – this is a network of tiny vessels. These allow immune cells to travel throughout the bloodstream.
• The thymus – this is a gland in your upper chest where some of your immune cells mature.
• Lymph nodes – these are found in your groin, armpits and neck and contain body tissue. When your body has an immune response, they can swell.
• Mucous membranes – such as the lining of the inside of your mouth and nose which then trap germs and allow your immune cells to attack them.
• The spleen – this is an organ underneath your ribs on your left side. It processes information from your blood.

Your immune system recognises viruses, bacteria, fungi and abnormal cell growth like cancer cells and helps the body to remain healthy by fighting anything that should not be there. There are many different immune conditions which are sometimes related to under activity or over activity of the immune system. An underactive or overactive immune system can cause health problems. When harmful germs enter your body, your body produces white blood cells in order to fight the infection. The white blood cells identify the germ and produce antibodies in order to fight it. When your body is exposed to the same germ in the future, your immune system should remember this and therefore be better equipped to fight it.

Immunosuppression is when your immune system is not functioning as well as it should do or is necessary to keep you healthy. Immunosuppression can be caused by certain illnesses but it can also be induced by medications that work to purposely suppress the immune system. These are called immunosuppressant medications. 

Sometimes your immune system attacks healthy cells and tissue by mistake, and so immunosuppressants in this case work by slowing or stopping this. Immunosuppressant medication is often used to treat autoimmune diseases. 

What are the causes of immunosuppression?

There are various things that can cause immunosuppression. These can include:

• Autoimmune diseases – autoimmune diseases happen when your immune system is overactive which can cause it to attack its own tissues. This usually requires immunosuppressive medications in order to control the immune system and stop it from overreacting.
• Other health conditions – illnesses like kidney disease or diabetes can affect the functioning of the immune system.
• Medical treatments – this includes things such as cancer treatments and organ transplants.
• Infections – this could be due to chronic infections or those caused by certain viruses, for example HIV infection.
• Age – as your body ages, your immune system naturally becomes weaker.
• Stress – the relationship between stress and autoimmune diseases is complex and not properly understood; however, chronic stress has been linked to triggering or exacerbating some autoimmune conditions.
• Certain medications – immunosuppressive medications work by directly suppressing the immune system. The goal of immunosuppressive medication is to prevent or reduce the activity of the immune system.
• Genetic factors – some genetic conditions may cause immunosuppression in some cases.
• Hormonal changes – fluctuations in hormones, particularly in women, are associated with an increased risk of autoimmune diseases. A large number of autoimmune diseases are more common in women than in men.
• Environmental factors – certain pollutants and toxins can, over time, impact the functioning of the immune system. Exposure to certain chemicals or substances in the environment may contribute to the development of autoimmune diseases.

Autoimmune disease means that your immune system stops working as it should. Usually your immune system creates antibodies which work to protect you against harmful substances like viruses, cancer cells and toxins. With autoimmune disorders, your immune system is unable to tell the difference between these invaders and healthy cells. Your immune system may stop protecting your body from harmful germs, bacteria and viruses and may start to actually attack healthy tissue and cells. It is not clear exactly what causes or triggers autoimmune diseases. Autoimmune disease also affects more women than men and the reason for this is also unclear. One theory is that higher levels of hormones in women could make them more prone to autoimmune diseases; however, this has not been proven.

Immunosuppressant medication in these cases can help to stop your immune response and work to reduce your symptoms. Autoimmune diseases can vary widely in terms of their symptoms and severity. Examples of some autoimmune diseases include:

• Type 1 diabetes.
• Rheumatoid arthritis.
• Graves’ disease.
• Celiac disease.
• Multiple Sclerosis (MS).
• Inflammatory Bowel Disease. This includes Crohn’s disease and Ulcerative Colitis.
• Psoriasis.

If you need a bone marrow transplant, you may also be given immunosuppressant medication in this case. These types of transplants use donated stem cells to replace unhealthy stem cells so that your body can begin building a new immune system. The new immune system in some cases can view your body as being a foreign object and may begin attacking it. Immunosuppressant medication can prevent this from happening. The medication may be used long term if this is needed.

Immunosuppressant medication may also be used in the case of an organ transplant. This is where an organ is transplanted from one person to another. This is usually done when an organ is damaged or failing. Immunosuppressant medication can reduce the risk that your body will reject the transplanted organ. This can happen because your immune system will know that the organ is new to your body and may think that it needs to be attacked. 

What are the signs and symptoms of immunosuppression?

The signs and symptoms of immunosuppression can vary between people and depending on what the reason is for your immune system being suppressed. Some signs and symptoms associated with immunosuppression include:

• Fatigue – this is usually chronic fatigue which is unexplained.
• Frequent infections – this is because if your immune system is not working as it should, you will be more likely to experience frequent infections.
• Slow healing wounds – this is because your immune system is not working as it should in order to heal cuts and wounds.
• High temperature – you may experience high temperature more frequently and for longer than you would expect.
• Respiratory symptoms – this could include shortness of breath, a persistent cough or chest infections.
• Weight loss – if there is unexplained weight loss, this could be a symptom of immunosuppression.
• Gastrointestinal issues – this could include digestive issues or stomach pain or discomfort.
• Skin issues – this could be unexplained marks on the skin or skin infections or unexplained rashes.

People who are immunosuppressed may also have an increased risk of certain types of cancers.

How is immunosuppression diagnosed?

Diagnosing immunosuppression usually involves your healthcare professional initially taking a detailed medical history and performing a physical examination. Blood tests can also show if you have enough infection-fighting proteins. It can also measure the level of blood cells and immune system cells. Blood tests can also check if your immune system is responding as it should to bacteria and viruses. 

There is also such a thing as prenatal testing; if you have a child who has an autoimmune disease this can be done by testing the amniotic fluid in a future pregnancy. 

How is immunosuppression treated?

Immunosuppression can be treated according to the symptoms you are experiencing or to treat the condition itself. This can include:

• Managing infections – this can include treating and preventing infections. Infections may require treatment with antibiotics. More serious infections may require hospitalisation and intravenous antibiotics. Long-term antibiotics may be needed in order to prevent infections from reoccurring.
• Immunoglobulin therapy – this is sometimes injected into a vein or put under the skin and contains antibody proteins needed for the immune system to be able to fight infections.
• A stem cell transplant – this is where normal stem cells are transferred to the person with the immunodeficiency which should make the immune system function normally. The stem cell donor is usually a close relative of the patient. After a stem cell transplant, you may need to take immunosuppressant medication for months or years until your new immune system settles down.

If you need to take an immunosuppressant medication, you may take this as a pill, liquid, injection or intravenously. You may need to take immunosuppressant medication for a few months or longer term depending upon your condition and how severe your symptoms are. 

The most common immunosuppressant medication is:

• Corticosteroids – these are usually just referred to as steroids. Steroids work by decreasing inflammation in the body and reducing the response of the immune system. Inflammation happens when the body’s white blood cells work to protect against infection and foreign substances. It is a protection mechanism for the body; however, if your immune system doesn’t work properly, it may cause inflammation unnecessarily, potentially causing damage to the organs and tissue.
• Calcineurin inhibitors – these work by blocking an enzyme that stimulates white blood cells which is what fights infection. Someone with an autoimmune disease may produce too many white blood cells.
• Inosine monophosphate dehydrogenase inhibitors – these work to affect cell growth.
• Mechanistic target of rapamycin inhibitors – these work by stopping cells from growing and multiplying.

Immunosuppressant medication is usually powerful and can cause side effects which can include:

• Fatigue.
• Hair loss.
• Acne.
• Diabetes.
• High blood pressure.
• Headaches.
• Tremors.
• Thinning of the bones.
• Stomach problems.
• Indigestion.
• Mouth sores.

There may also be more serious side effects including:

• Increased risk of infection – this is because if you are taking immunosuppressant medication, your immune system is likely to not work as well in recognising and attacking foreign invaders as it should. This can include things like skin infections, respiratory infections and blood infections including sepsis which can be very serious. Sepsis is a potentially life-threatening condition which occurs when the body’s response to an infection overwhelms the body, damaging its own tissues and organs. In serious cases, and if not treated quickly, it can lead to organ failure and even death.

If you are taking immunosuppressive medication, the use of these medications is usually carefully monitored, and healthcare providers will adjust dosages and the type of medication used based on individual patient needs and responses to the medication. Regular monitoring is crucial in order to balance the benefits of immune suppression with the risks of infections and other complications that can come from using immunosuppressive medication.

Immunosuppressive medication works by:

• Suppression of white blood cells.
• Inhibition of cytokine production.
• Preventing antibody production.
• Disrupting DNA synthesis.

If you are immunosuppressed for any reason, it is important to take extra precautions which can help protect you from illnesses and infections which you will be more vulnerable to. You should work with your healthcare provider to ensure that you understand your condition and any medication you are prescribed and any specific precautions you should take. Some other general things you can do are: 

• Ensure good hand hygiene – wash your hands regularly and thoroughly with warm soapy water. This is especially important before you eat something.
• Ensure good levels of general hygiene – this includes bathing regularly and wearing clean clothes.
• Avoid people that you know are unwell – as your immune system is compromised, avoiding anyone that you know is sick will help to protect you.
• Wear a protective mask when in busy public places – this will offer you some level of protection from the bugs and germs that are around, particularly in the winter months.
• Have regular check-ups with your healthcare provider – this will help to make sure that any issues are picked up quickly and your health can be generally monitored. Your medication can also be adjusted if needed.
• Make healthy lifestyle choices – this includes being as active as possible for your own personal circumstances and abilities, eating a healthy balanced diet and getting enough good quality sleep to help keep you as healthy as possible.
• Keep your environment clean – whether this is at work or home, ensure that your personal environment is as clean and germ free as possible.
• Take medication as directed – this also includes letting your healthcare professional know of any side effects and how your medication is affecting your symptoms.

The Wren Project offers support and advice to anyone living with an autoimmune disease.