Table of ContentsView AllTable of ContentsWhat Is Immunosuppression?MedicationsHealth ConditionsMedical Procedures
Table of ContentsView All
View All
Table of Contents
What Is Immunosuppression?
Medications
Health Conditions
Medical Procedures
The immune system is made up of cells, tissues, and organs that help the body stave offinfection. Without an intact immune system, infections that might otherwise be controlled can become serious and even fatal.
This article explains what happens when someone is immunosuppressed and discusses some of the causes of immunosuppression.
Caiaimage / Sam Edwards / Getty Images
Immunosuppression means that the immune system is either temporarily or permanently impaired. Thespleenand other organs, as well aswhite blood cells, can’t respond as well to infection and inflammation.
People who are immunosuppressed may get sick more often, or they may have life-threatening symptoms or longer recoveries when compared with other people.
Autoimmune disorders likediabetesorlupuscan cause your own body to threaten the immune system, but there are many other causes including medications and infections.
What Are Autoimmune Diseases?
Medications That Cause Immunosuppression
Immunosuppressants are used for treating a wide variety of inflammatory andautoimmune diseases, as well as to prevent the rejection of tissues inorgan transplant recipients.
Corticosteroids
Corticosteroids, also known simply as steroids, are oral, topical, inhaled, and intravenous drugs used to temper the immune response.
Because steroids reduce inflammation, they are prescribed to treat a wide range of disorders, including:
Immunosuppression is typically related to the use of high-dose corticosteroids. For instance, steroid-induced immunosuppression will often manifest withcandidiasis(oral thrush) in people who useinhaled steroids.
Long-term users of prednisone, one of the most commonly prescribed steroids, are at an increased risk of bacterial, viral, and fungal infections.
Even when prescribed at doses of 5 milligrams (mg), oral prednisone can increase the risk of infection from 18% after one year to 76% after 10 years of use.
Prednisone Side Effects: Everything You Need to Know
Chemotherapy Drugs
Chemotherapyis used to shrink cancer cells and help people with cancer achieve or sustainremission.
Chemotherapy drugs specifically target cells that replicate quickly. These include cancer cells but also those in hair, skin, and the gastrointestinal tract. Damage to these cells can lead tocommon side effects, including hair loss, mucosal inflammation, nausea, and vomiting.
Another fast-replicating body of cells are those found in thebone marrow. These tissues are responsible for producing the blood cells that help fight infection. The suppression of bone marrow accounts for the high risk of infections in people undergoing cancer treatment.
How to Lower Your Risk of Infection During Chemotherapy
Monoclonal Antibodies
Monoclonal antibodiesare disease-fighting proteins produced in the lab that mimic thenatural antibodiesthat the body produces to fight disease. These drugs are increasingly used to treat a variety of diseases, including:
Because monoclonal antibodies alter the normal function of the immune system, it can lead to an imbalance in immune cells and an increased risk of infection. In fact, certain types of monoclonal antibodies are associated with an increased risk of specific infections.
TNF Inhibitors
The immunosuppressive effect of TNF-α inhibitors can significantly increase the risk of so-called “opportunistic infections.” These are common infections that an intact immune system can usually control but they can turn serious if the immune system is suppressed.
TNF-α inhibitors are associated with an increased risk of tuberculosis and fungal infections like histoplasmosis,coccidioidomycosis, and blastomycosis.
This class of drug includes such commonly prescribed agents as:
TNF Blockers and the Risk of Infection
Disease and Conditions That Cause Immunosuppression
HIV
A normal CD4 count is generally defined as 500 or above.When the CD4 count falls beneath 500, a person is considered immunosuppressed. When it falls beneath 200, a person is said to haveAIDSand beimmunocompromised.
Health officials in the United States recognize a number of opportunistic infections associated with HIV. These infections include:
How HIV Is Treated
Asplenia
Asplenia describes the absence of normalspleenfunction.The spleen plays a key role in the immune response, and the loss of splenic function is associated with serious infection risks.
Asplenia may be congenital but can also occur due to underlying diseases that damage the spleen, including:
Medical Conditions That Affect the Spleen
Primary Immunodeficiency
Inherited immune disorders, called primary immunodeficiencies (PID), are considered rare. Even so, there are more than 300 different PIDs that are known to impair different facets of the immune response. These include:
The treatment of PID is complicated and requires specialist care, in part because people with PID don’t respond well toimmunizationand instead require an infusion of immune cells to provide them with an adequate immune defense.
Procedures That Cause Immunosuppression
There are several procedures that can cause immunosuppression, either directly or indirectly. This typically occurs when a key component of the immune system, like the spleen or bone marrow, is damaged or removed.
Splenectomy
The surgical removal of the spleen, called a splenectomy, is sometimes needed to treat a spleen injury, lymphoma, and autoimmune diseases likeidiopathic thrombocytopenic purpura.
Asplenia is a consequence of splenectomy and one that manifests an increased risk ofStreptococcus pneumoniae,Haemophilus influenzae, andNeisseria meningitides.These infections are more likely to occur within the first few years of having a splenectomy.
Radiation Therapy
Radiation therapyis commonly used to treat certain types of cancer and can cause immunosuppression if the radiation damages bone marrow or other components of the immune system.
With that said, newer targeted technologies, likestereotactic body radiotherapy (SBRT), are better able to spare normal tissues and reduce the risk of radiation-induced immunosuppression.
Managing Radiation Side Effects
Bone Marrow Ablation
Prior to astem cell transplantorbone marrow transplant, the recipient will undergo a procedure known as bone marrowablationin which radiation or high-dose chemotherapy kills all cancer cells as well as the bone marrow itself. It is a procedure used in people with lymphoma or leukemia to make room for the transplanted stem cells.
Without an intact immune system, people who undergo such transplants are at high risk of infection until the bone marrow rebuilds itself.
During this time, the recipient is vulnerable to fungal lung infections (including cryptococcosis and candidiasis) as well as CMV and community-acquired respiratory viruses likerespiratory syncytial virus (RSV)and influenza.
Summary
Immunosuppression can occur for a host of reasons, including medical conditions like HIV, medications including chemotherapy, and certain medical procedures like bone marrow ablation.
People who are immunosuppressed have a higher risk of infection that can become serious or even life-threatening. If you have any form of immunosuppression, you will likely need to avoid sick people who are still contagious, wear aface maskin public, andwash your handsfrequently.
Speak with your healthcare provider to better understand ways to avoid infection if you have temporary or chronic immunosuppression.
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