5.2: Evaluation of the evidence for immunological factors in the pathophysiology of CFS

General

• Despite numerous studies there is no consensus on the pattern and prevalence of immunological disturbance in people with CFS (reviewed in Lloyd et al. 1993; Strober 1994) (Level III-4)  

Lymphocytes

• Reduced lymphocyte proliferation and natural killer cell cytotoxicity are common but non-specific findings (Landay et al. 1991; Behan et al. 1985; Kibler et al. 1985; Caligiuri et al. 1987; Lloyd et al. 1989, 1992; Gold et al. 1990; Klimas et al. 1990; Gupta and Vayuvegula 1991; Ho-Yen et al. 1991; Morrison et al. 1991; Straus et al. 1993; Barker et al. 1994; Ojo-Amaize et al. 1994; Tirelli et al. 1994; Peakman et al. 1997; Mawle et al. 1997) (Level I)

• Despite numerous studies there is no consensus on the pattern and prevalence of changes in peripheral blood lymphocyte subpopulations or activation status (Landay et al. 1991; Klimas et al. 1990; Gupta and Vayuvegula 1991; Straus et al. 1993; Barker et al. 1994; Tirelli et al. 1994; Swanink et al. 1996; Peakman et al. 1997; Mawle et al. 1997) (Level III-4)  

Immunoglobulins

• Conflicting evidence for reduced serum immunoglobulin G (IgG) and IgG subclass levels (Bennett et al. 1996; Read et al. 1988; Linde et al. 1988; Lloyd et al. 1989; Wakefield et al. 1990; Peterson et al. 1990) (Level III-4)  

Atopy

• Conflicting evidence for an increased prevalence of atopy (Tobi et al. 1982; Straus et al. 1985; Tobi and Straus 1985; Olson et al. 1986a, 1986b; Straus 1988b; MacDonald et al. 1996) (Level III-4).  

Delayed type hypersensitivity skin responses

• Conflicting evidence for impaired DTH skin responses (Lloyd et al. 1988b, 1989, 1990a, 1992; Mawle et al. 1997) (Level III-4)  

Cytokines

• Numerous studies using different methodologies have yielded conflicting evidence for increased serum levels of cytokines or cytokine production (Kibler et al. 1985; Lever et al. 1988; Lloyd et al. 1991; Morte et al. 1988, 1989; Cheney et al. 1989; Straus et al. 1989; Chao et al. 1990, 1991; Gold et al. 1990; Linde et al. 1992; Swanink et al. 1996; Buchwald et al. 1997; Cannon et al. 1997; Mawle et al. 1997) (Level III-4)  

Autoimmunity

• A single study found an increased prevalence of novel antinuclear envelope antibodies (Konstantinov et al. 1996; von Mikecz et al. 1997) (Level III-3)

• Sicca symptoms are common and a subset of people with CFS meet clinical but not laboratory criteria for Sjögren's syndrome (Komaroff and Buchwald 1991; Kuratsune et al. 1992; Calabrese et al. 1994; Nishikai et al. 1996) (Level II)

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