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What is Immunology?
Immunology is the study of the immune system, which functions to protect the body from harmful bacteria and viruses. Sometimes the immune system does not function optimally resulting in immune system disorders such as: immunodeficiency, where the immune system fails to recognize foreign agents intruding the body; and autoimmunity, in which the immune system may attack its own body due to over response [1]. In addition, individuals with asthma and allergies have a hypersensitive immune system that reacts defensively to harmless components [1]. The field of immunology is important because it has transformed modern medicine through the introduction of vaccinations, safe organ transplants, the identification of blood types and the use of monoclonal antibodies which are antibodies constructed in the lab used to fight off a particular infection [2]. Today, immunological research continues to grow, and the knowledge gained helps inform advancements in immunotherapy treatment efforts for cancer, hepatitis, asthma, lupus, AIDS, and, most recently, Covid-19 [1,2].
Immunology and Minority Health
Although the field of immunology has led to a number of health advancements, disparities in the field still exist. In particular, negative health outcomes pertaining to immunologic diseases persist among racial and ethnic minority groups. The disparities are most notably seen in asthma where Black/African American and Latinx individuals experience disproportionately higher rates of asthma morbidity and mortality compared to their white counterparts [3]. The disparities in health outcomes of asthma are strongly associated with a lack of diverse allergists and immunologists in the field. Failure to diversify this field runs the risk of patients’ identity and experiences that differ from their providers being overlooked or downplayed. It, also, may discourage patients to seek help if they feel unheard, unseen and/or judged by their providers. Representation is integral in improving trust and boosting comfortability between patient and provider. It also creates an opportunity for allergists and immunologists to provide culturally mindful care.
Increasing diversity starts with academic leadership; in the beginning of medical school, first years will not only benefit from gaining more exposure about career opportunities in immunology, but, also, from seeing diverse academic staff in this field. Records from the allergy and immunology residency fellowships reveal that only 10% of applicants identify as Black or Hispanic. Most recently, of the 278 2019-2020 allergist fellows, only 1.8% were Black and 6.8% were Hispanic [3]. It has been proposed that adding immunology classes in medical school can increase visibility to the field, and creating mentorship programs with current medical students and residents and minority high school students can spark an interest in immunology at an earlier age [3]. When minority providers occupy more leadership positions, it creates opportunities to improve healthcare equity and access to populations who are commonly underrepresented or overlooked. This collaborative effort can also help improve patient engagement and empower patients to take a more active role in their health.
Immunology and Environmental Justice
Climate change also adds some complexity to increased prevalence of immunologic diseases specifically among underserved populations. Climate change disproportionately affects individuals with lower income statuses and communities of color because they commonly have less time, energy, and resources to deal with its effects [4]. Evidence shows that disadvantaged communities are exposed to much higher concentrations of particulate matter, air pollutant that causes severe health concerns with high exposures, than their white counterparts [4]. Environmental racism is an important factor contributing to racial and ethnic disparities in asthma. Environmental racism is defined as racial discrimination in environmental policy-making that intentionally targets communities of color and low-income communities to be the home of polluting facilities and the disposal of toxic waste [5]. The consequences of these discriminative practices have led to poor air quality in disadvantaged communities and increased their susceptibility asthma and other respiratory illnesses [6]. Asthma triggers are even more exacerbated by the negative effects climate change.
Due to climate change, we are now experiencing longer and more intense pollen seasons which has led to individuals with asthma and other allergic diseases experiencing worse symptoms. Studies also show a link between increased air pollutants (ozone, nitric oxide etc.) caused by climate change and an increase in allergic diseases. Inhaling these pollutants causes inflammation in one’s airways, and early exposure to these pollutants are shown to lead to higher incident risk of asthma [7]. Specifically, one study found that children exposed to ozone and nitrogen dioxide at birth have a 17% increased risk of developing asthma by age 4 [7]. Climate change does not only worsen symptoms for individuals with respiratory allergic diseases, but it may also contribute to the incident of respiratory diseases to people who do not already have predispositions to allergic diseases. Our immune system is an antigen-specific system, meaning it can differentiate between benign antigens and pathogenic antigens; however, as a result of climate change, the antigens our bodies are exposed to on a daily basis have changed dramatically, fatiguing the body’s ability to differentiate amongst antigens and lowering its immune tolerance [7]. The weakening of our immune system is leading to a rise in immunologic diseases. For example, food allergies have been on the rise; the American College of Allergy, Asthma and Immunology found that peanut allergies in children increased by 21% from 2010 to 2017 [7].
It is also proposed that lack of exposure to biodiversity is associated with an increased prevalence in asthma, allergy, and inflammatory diseases. This idea is referred to as the biodiversity hypothesis, and it suggests that because of the decrease in biodiversity, human interactions with the natural environment have decreased, causing dysfunctions in the immune system and reducing antigen specific tolerance. One study supporting this hypothesis showed that children who lived on farms and had an increased exposure to biodiversity had a lower prevalence of asthma than compared to children who had less exposure to biodiversity.
Conclusion
The diversity gap in immunology shows how health is experienced differently across the nation. When researchers and healthcare providers do not represent the patients they are caring for, some groups can be overlooked, affecting the quality of care experienced. Actions to increase diversity in the field should be implemented to ensure high quality immunological care is provided to all individuals. In addition, environmental racism and climate change have contributed to lower air quality and increased prevalence of respiratory diseases within disadvantaged communities. To address the impact climate change has on our immune system, we, as a society on a global level, need to take action in preserving and restoring our natural environment and adopting a greener lifestyle to reduce greenhouse gas emissions.
References:
1. What is Immunology? Carter Immunology Center. Accessed July 12, 2022. https://research.med.virginia.edu/cic/mission/what-is-immunology/
2. British Society for Immunology. Accessed June 25, 2022. https://www.immunology.org/public-information/what-is-immunology
3. Carter MC, Saini SS, Davis CM. Diversity, Disparities, and the Allergy Immunology Pipeline. J Allergy Clin Immunol Pract. 2022;10(4):923-928. doi:10.1016/j.jaip.2021.12.029
4. Revesz RL. Air Pollution and Environmental Justice. Published online September 24, 2021. Accessed July 13, 2022. https://papers.ssrn.com/abstract=3930215
5. Environmental Racism. Oxford Reference. doi:10.1093/oi/authority.20110803095753679
6. Asthma Disparities - Reducing Burden on Racial and Ethnic Minorities | AAFA.org. Accessed July 14, 2022. https://www.aafa.org/asthma-disparities-burden-on-minorities.aspx
7. Ray C, Ming X. Climate Change and Human Health: A Review of Allergies, Autoimmunity and the Microbiome. Int J Environ Res Public Health. 2020;17(13):4814. doi:10.3390/ijerph17134814
Contributors:
Author: Claire Mayani
Editor: Lauryn Agron
Health scientist: Claire Mayani
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