Horror autotoxicus: The story of autoimmunity

Autoimmunity has become a well-known concept in our modern world, although it was not widely accepted in mainstream medicine until the 1950s and 1960s.   Many of us have a general idea what the term means or can list a number of autoimmune conditions.

Paul Erlich, German Immunologist

Paul Erlich, German Immunologist

Diseases such as multiple sclerosis (MS), systemic lupus erythmatosis (SLE), type 1 diabetes, Hashimoto’s thyroiditis, Sjogren’s syndrome, rheumatoid arthritis (RA), Crohn’s disease and celiac disease are now widely recognized.  Over 23.5 million Americans have an autoimmune disease, and autoimmune diseases have been identified in virtually every organ system.

What is autoimmunity?  It literally means “immunity against self” or an immune system mistakenly attacking healthy tissue.  The German immunologist and Nobel Laureate, Paul Ehrlich (1845-1915), coined the term horror autotoxicus “the horror of self-toxicity” to describe the body’s aversion to immunological self-destruction.  Our bodies are equipped with powerful defenses against invading microorganisms like viruses and bacteria.   We have protective mechanisms directing the immune system to distinguish between “self” and “non-self,” preventing the immune system from attacking and destroying healthy tissue.

Factors that can contribute to autoimmune disease

Factors that can contribute to autoimmune disease

During an autoimmune reaction, this recognition of “self” is impaired, resulting in an increased immune response.  While we all have a small degree of autoimmunity occurring within our bodies, autoimmune diseases develop when benign autoimmunity progresses to pathogenic autoimmunity.

The puzzling question of why our immune systems would initiate an attack on our own tissues is an area of ongoing research.  Autoimmunity has been attributed to a number of suspected causes including genetic susceptibility, environmental triggers, and immune dysregulation.  While these causes can overlap and interact, there is at this time no single causative factor.

Autoimmunity can contribute to a number of symptoms

Autoimmunity can contribute to a number of symptoms

Autoimmune disease symptoms wax and wane, and signs can vary greatly from patient, making diagnosis difficult.  Flare ups, or periods of worsening symptoms,  are often interspersed with periods of remission or few to no symptoms.  Initial autoimmunity symptoms include:  fatigue, unexplained rashes, abdominal pain, low grade fever, and malaise, among others.  A classic indicator of autoimmunity is inflammation, which may lead to redness, heat, pain or swelling of the affected tissue.

Autoimmunity can be identified by the presence of autoantibodies that are part of the immune reaction to “self.”

A number of lab test parameters are useful.  The chart below (click for larger image) provides a summary of autoantibody clinical correlations.

A summary of autoantibody clinical correlations

A summary of autoantibody clinical correlations

Combining clinical observations, general autoimmune lab tests and disease-specific markers, clinicians improve their chances to diagnose a patient’s autoimmune disease.

Autoimmune diagnosis arrow

References:
Paul Erlich Image Source: Bildarchiv Bayerische Staatsbibliothek, Portrat-und Ansichtensammlung, Bild-Nr. port-003494
Bell, E. and Bird, E. (2005). Autoimmunity. Nature Reviews, 7042:583.
Johns Hopkins Autoimmune Research Center. (September 10, 2001). What is autoimmunity? Retrieved from: http://autoimmune.pathology.jhmi.edu/whatisautoimmunity.html
National Institutes of Health. (March 8, 2013). Autoimmune diseases. Medline Plus. Retrieved from: http://www.nlm.nih.gov/medlineplus/autoimmunediseases.html
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5 Responses to Horror autotoxicus: The story of autoimmunity

  1. A nice summary of Autoimmune disease. Thank you!

  2. .V. van Vessem says:

    you did not mention Sarcoidosis. Why?

    • Sarah Mo says:

      This blog post was intended to be a brief overview of autoimmune reactions in general, rather than an all-inclusive list of autoimmune conditions. We do note that autoimmune disorders have been identified in virtually every organ system, therefore listing them all would not be practical for this succinct overview. Instead, our goal was to provide information relevant to all forms of autoimmunity.

  3. Pingback: Autoimmune Disorders / Symptoms and Research / Is There Hope?

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