Immunosuppressants: Autoimmunity is controlled through balanced suppression of the immune system. The goal of treatment is to minimize the immune response against body cells without completely eliminating the immune response toward harmful invaders. Corticosteroids and immunosuppressant medications, including cyclosporine(Gengraf®, Neoral®, or Sandimmune®) and azathioprine (Azasan® or muran®) are commonly used to reduce the immune response. Immunomodulatory therapies, such as etanercept (Enbrel®), have been shown to be useful in treating some autoimmune disorders, including rheumatoid arthritis. Side effects of immunosuppressants may lead to severe infections because these drugs weaken the immune system.
Anti-inflammatories: Anti-inflammatories are often used to treat autoimmune disorders. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®) or celecoxib (Celebrex®), have been used to relieve pain and reduce inflammation in patients suffering from autoimmune disorders, such as rheumatoid arthritis.
Antimicrobials: Medications called antimicrobials are used to treat infections in patients with immune deficiencies. Antimicrobials kill the disease-causing organism. Antibiotics are used to treat bacterial infections; antivirals are used to treat viral infections; and anti-fungals are used to treat fungal infections. These medications may be taken by mouth, applied to the skin or eyes, or injected into a vein. The specific dose and duration of treatment depends on the type and severity of the infection and the patient's overall health.
Bone marrow transplant (BMT): A bone marrow transplant (BMT) can be performed in patients who have life-threatening immune deficiencies, such as severe combined immunodeficiency (SCID) and Wiskott-Aldrich syndrome. A successful BMT can permanently cure primary immune deficiencies.
However, not everyone is a candidate for a bone marrow transplant. The transplant must come from a donor whose body tissues are a close biological match to the recipient. Serious health risks are also associated with the procedure, as with any major surgery. Individuals who have weakened immune systems are at risk of developing graft-versus-host disease after surgery. This condition occurs when the transplanted bone marrow attacks the recipient's weakened immune system. Other recipients may experience transplant rejection, which occurs when the body's immune system attacks the donated organ.
Interferon-gamma injections: Interferon-gamma injections have been used to treat certain immune deficiencies. Interferon-gamma solutions contain cytokines, which are natural chemicals produced by immune cells during an immune response. For instance, interferon-gamma injections are commonly used to treat a condition called chronic granulomatous disease. This disease is caused by faulty white blood cells, called phagocytes, that ingest and destroy foreign substances that enter the body. Interferon injections have been shown to activate the phagocytes and help restore the immune response in these patients.
Intravenous immune globulin (IVIG): Intravenous immune globulin (IVIG) consists of immunoglobulin antibodies extracted from 3,000-10,000 healthy blood donors. In some instances, blood from as many as 100,000 donors is used. The U.S. Food and Drug Administration (FDA) has approved IVIG for the treatment of primary immune deficiencies.
Immune globulin products contain sterile, purified immunoglobulin G (IgG). The products typically contain more than 95% unmodified IgG and only trace amounts of immunoglobulin A (IgA) or immunoglobulin M (IgM). IgG antibodies are the smallest, but most abundant antibodies in the body and make up 75-80% of all the antibodies in the body. They are present in all body fluids. The IgG antibodies are considered the most important antibodies for fighting against bacterial and viral infections, and they are the only antibodies that can cross the placenta during pregnancy. IgA antibodies are primarily found in the nose, airway passages, digestive tract, ears, eyes, saliva, tears and vagina. These antibodies protect body surfaces that are frequently exposed to foreign organisms and substances from outside of the body. IgM antibodies are present in the blood and lymph fluids, and they are the first antibodies that are produced in response to an infection.
The immune globulin is typically injected for about two to four hours a day for two to seven days. The patient usually receives another single dose every 10-21 days, or every three to four weeks depending on the condition. Patients typically start responding to treatment after eight days.
Side effects from IVIG occur in less than five percent of patients, according to researchers. Common side effects typically occur immediately after infusions and may include flushing (reddening of the cheeks), headache, chills, dizziness, increased sweating, leg cramps, pain and tenderness at the injection site, tiredness, muscle pain, lower back pain, nausea, and low blood pressure. Immunoglobulin levels should be tested to make sure the patient does not have an IgA deficiency. Individuals who are IgA deficient should not receive IVIG because they may experience a severe allergic reaction called anaphylaxis.
IVIG is available in different concentration (strengths). The U.S. Food and Drug Administration (FDA) has approved Gammagard S/D®, Gammar-P IV®, Gamimune-N®, Iveegam®, Polygam® S/D, Sandoglobulin® Venoglobulin-I®, Venoglobulin-S®, Carimune/Panglobulin®, Gamunex®, and Baxter AG®.
Ginseng: A small number of studies report that ginseng may stimulate the immune cells in the body, improve the effectiveness of antibiotics in people with acute bronchitis, and enhance the body's response to flu vaccines.
Avoid if allergic to ginseng or plants in the Araliaceae family, such as English ivy. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
Zinc: Zinc products have been used since ancient Egyptian times to enhance wound healing. Zinc appears to be an essential element that the immune system needs to function properly. However, there is limited research available on the effect of zinc supplementation on immune function. Also, most research focuses on patients with specific diseases. Zinc gluconate appears to have beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed to determine if zinc supplementation can enhance immune function.
Zinc is generally considered safe when taken at the recommended dosages. Avoid a zinc product called zinc chloride because studies have not been done to evaluate its safety or effectiveness. While zinc appears safe during pregnancy in the recommended doses, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence
Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research and in traditional accounts. Reliable human studies are lacking. High-quality human research is necessary before a firm conclusion can be drawn.
Avoid if allergic to astragalus, peas, or any related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking aspirin, aspirin products, or herbs and supplements with similar effects. Avoid with inflammation, fever, stroke, organ transplant, or autoimmune diseases (such as lupus). Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously if taking blood-thinners, blood sugar drugs, diuretics, or with herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oils and vegetables (e.g. green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Preliminary research of beta-carotene for immune system maintenance or stimulation shows mixed results. Further research is needed before a conclusion can be drawn.
Avoid if sensitive to beta-carotene, vitamin A, or any other ingredient in beta-carotene products (e.g. gelatin).
Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow breast glands during the first two to four days after birth. Bovine colostrum contains proteins called immunoglobulin antibodies that are involved in the immune response. It has been suggested that bovine colostrum may improve immune function. However, further research is needed before a firm conclusion can be made.
Avoid if allergic or hypersensitive to dairy products. Use bovine colostrum cautiously. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE) have been found in human colostrum and breast milk. Thus, it is possible that these substances may be found in bovine colostrum. Avoid with cancer or if at high-risk of cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (e.g. amphetamines, caffeine). Avoid if pregnant or breastfeeding.
Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold, despite a lack of high-quality human evidence. A few early studies suggest that cat's claw may boost the immune system. However, results from different studies have produced conflicting results. Therefore, there is not enough information to make a firm recommendation for this use.
Avoid if allergic to Cat's claw, Uncaria plants or plants in the Rubiaceae family (e.g. gardenia, coffee, or quinine). Avoid with a history of immune disorders (e.g. AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, or lupus). Use cautiously with bleeding disorders or with a history of stroke. Use cautiously if taking drugs that may increase the risk of bleeding. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species, including Uncaria rhynchophylla (used in Chinese herbal preparations under the name Gou-Teng), which may cause low blood pressure, lower heart rate, or act as a neuroinhibitor. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw.
Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs (e.g. liver and kidneys). Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have negative effects on immune function. However, further research is needed to fully understand copper's effects on the immune system.
Patients should talk to their healthcare providers before taking copper supplements. Avoid if allergic to copper. Avoid use of copper supplements when recovering from diarrhea. Avoid with hypercupremia. Avoid with HIV/AIDS, genetic disorders affecting copper metabolism (e.g. Wilson's disease), Indian childhood cirrhosis, or idiopathic copper toxicosis. Use water containing copper concentrations greater than six milligrams per liter cautiously. Use cautiously with anemia, arthralgias, myalgias, or if at risk for selenium deficiency. The recommended dietary allowance (RDA) is 1,000 micrograms for pregnant women. The RDA for breastfeeding women is 1,300 micrograms.
Echinacea: The roots and herb of echinacea species have attracted recent scientific interest because they may have immune stimulant properties. Echinacea has been studied alone and in combination with other herbs and supplements for immune system stimulation (including in patients receiving cancer chemotherapy). It remains unclear if this is an effective treatment. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
Avoid if allergic to plants in the Asteraceaeor Compositaefamily (e.g. ragweed, chrysanthemums, marigolds, daisies). Avoid echinacea injections. Avoid with a history of liver disease or if taking an antibiotic called amoxicillin. Avoid in organ transplant recipients. Use cautiously if driving or operating heavy machinery or with history of asthma, diabetes, immune disorders (e.g. lupus, tuberculosis, AIDS/HIV), or rheumatologic conditions (e.g. rheumatoid arthritis ). Avoid if pregnant or breastfeeding. Tinctures may contain large amounts of alcohol.
Gamma linolenic acid (GLA): Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Commercial products are typically made from seed extracts from evening primrose (average oil content 7-14%), blackcurrant (15-20%), borage oil (20-27%), and fungal oil (25%). Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. GLA, as blackcurrant seed oil, may offer some benefits. Further study is required before a definite conclusion can be made.
Use cautiously with drugs that increase the risk of bleeding, such as anticoagulants or anti-platelet drugs. Avoid if pregnant or breastfeeding.
Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. Goldenseal has sometimes been suggested as an immune system stimulant. However, there is little human or laboratory evidence in this area. More research is needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to goldenseal or any of its constituents (e.g. berberine and hydrastine). Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
Maitake: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. Animal and laboratory studies suggest that beta-glucan extracts from maitake may alter the immune system. However, no reliable studies in humans are available.
Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic or hypersensitive to maitake. Use cautiously with a medical history of low blood pressure, diabetes, and with drugs, herbs, or supplements that treat such conditions. Avoid if pregnant or breastfeeding.
Massage: Preliminary evidence suggests that massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (e.g. heparin or warfarin). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
Meditation: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. Preliminary research reports increased antibody response after meditation. Further study is needed to confirm these findings.
Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation, and they should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or to find treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.
Mistletoe: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further study is needed to determine whether or not mistletoe can help boost the body's immune system.
Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Life-threatening allergic reactions, called anaphylactic reactions, have been described after injections of mistletoe. Avoid with acute highly febrile inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking drugs called cholinergics, which treat nervous system disorders.
Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine and aid in digestion. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. A type of probiotic, called Lactobacillus, which is found in fermented milk, low-fat milk, and lactose-hydrolyzed low-fat milk, may enhance immune function. Another probiotic, called Bifidobacterium, has been studied in the elderly, and it may have similar effects. However, commercially produced yogurt may not yield similar benefits. There is some evidence that probiotics added during food preparation (e.g., waffles with Enterococcus faecium M-74 added) can enhance immune functioning. More studies are needed, particularly with yogurt, before a firm conclusion can be made.
Probiotics are generally considered safe and side effects are uncommon. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Shiitake: Shiitake mushrooms were originally grown on natural oak logs found in Japan. Today, they are sold throughout the United States. These mushrooms are large, black-brown, and have an earthy rich flavor. Early research suggests that shiitake may enhance the immune response. However, further research is needed to confirm these findings.
Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract increases T- and B-lymphocyte counts, the number of rosette-forming cells, and the response of white blood cells, called T-lymphocytes. Also, in cancer patients, T-activin significantly increases the number of natural killer cells (CD16+). Additional study is needed in this area.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (a neuromuscular disorder), or untreated hypothyroidism. Avoid if taking immunosuppressants or hormonal therapy. Avoid if pregnant or breastfeeding. Thymic extract increases the ability of a male's sperm to move and swim towards a female's egg.
Vitamin A: Vitamin A is a fat-soluble vitamin, which is derived from two sources: retinoids and carotenoids. Retinoids (e.g. retinal and retinoic acid) are found in animal sources, including the liver, kidney, eggs, and dairy products. Carotenoids (e.g. beta-carotene) are found in plants, including dark or yellow vegetables and carrots. Vitamin A deficiency may weaken the immune system, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Vitamin B6: Major sources of vitamin B6 include cereal grains, legumes (beans), vegetables (e.g. carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Vitamin B6 is important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse weakened immune systems in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a recommendation can be made.
Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Vitamin B6 is likely safe when taken by mouth in doses that do not exceed the recommended dietary allowance (RDA). Avoid excessive dosing. The RDA for pregnant women is 1.9 milligrams per day. There is some concern that high-dose pyridoxine taken by a pregnant mother can cause seizures in a newborn. The RDA in breastfeeding women is 2 milligrams per day.
Vitamin E: Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams per day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams, and the recommended dose for breastfeeding women of any age is 19 milligrams. Use beyond this level in pregnant or breastfeeding women is not recommended.
Fair negative scientific evidence
DHEA: DHEA (dehydroepiandrosterone) is a hormone produced by the adrenal glands in the body. Although authors of some textbooks and review articles have suggested that DHEA may stimulate the immune system, current scientific evidence does not support this claim.
Avoid if allergic to DHEA. Avoid with a history of seizures. Use with cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Lycopene: Lycopene is a carotenoid found tomatoes, and it is present in human serum, liver, adrenal glands, lungs, prostate, colon, and the skin. It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans report no effects on the immune system.
Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
Intravenous immune globulin (IVIG) may help prevent infections in patients who have weakened immune systems.
Patients should talk to their healthcare providers about recommended vaccinations. Patients who are born with immune deficiencies should not receive live virus vaccines, such as the oral polio, measles, or chicken pox. This is because live viral vaccines can sometimes infect the recipient if he/she is immunocompromised. In some cases, immunocompromised individuals can become infected after coming into close contact with a recently vaccinated individual.
Some secondary immune deficiencies can be prevented by avoiding or minimizing exposure to disease-causing organisms (pathogens), such as bacteria or viruses. Individuals should regularly wash their hands with soap and water and avoid close contact with individuals who have contagious infections or diseases.