CASE 49
LG is an 18-year-old girl in your practice with a history of seasonal allergies and, she says, multiple “bad responses” to many medications with rashes, wheezing, and general malaise. She has a known allergy to animal dander, including cats and dogs as well as rabbits (she had had one as a pet as a young child but was forced to give it up).
QUESTIONS FOR GROUP DISCUSSION
3. In general terms, describe the experimental protocol and results of the guinea pig study regarding abrupt and not abrupt isolation stress on histamine release to a conditioned stimulus. How would you extrapolate that to human experiences?
4. Consider ischemic conditioning (see Case 43) and how you might extrapolate this to the results of question 3 and childhood experiences in general?
5. Describe the conditioning studies using epinephrine, a neutral sherbet, and NK cell activity. On the basis of this study, what activity of NK cells would you predict in acute stress responses?
6. Provide a rationale for the selection of IL-2 and IFNγ as dependent measures in the conditioned studies using cyclosporine. How could the results of this study be used to design studies to offset drug toxicity?
7. Explain why it is oversimplistic to suggest that inhibition of the hypothalamic-pituitary-adrenal (HPA) axis is the only explanation for conditioned immunosuppression.
8. Describe conditioning studies that indicate that β-adrenergic receptor activity is not required for the establishment of conditioned morphine-induced changes in immune status.
9. Describe conditioning studies that support the concept that endogenous opioid activity is involved in conditioned-stimulus–induced alterations of immune function.
RECOMMENDED APPROACH
Implications/Analysis of Laboratory Studies
Whereas laboratory studies and/or allergen skin testing can identify the allergens to which this child is responding, these tests cannot possibly identify the objects that serve as conditioned stimuli.
