Introduction
Autoimmune diseases have become one of the major health challenges of modern times, manifesting in a wide variety of forms and clinical presentations. An immunologist most often oversees their management; however, because these disorders affect multiple organ systems, effective care usually requires collaboration among numerous specialists, including rheumatologists (joint diseases), dermatologists (skin disorders such as psoriasis), endocrinologists (thyroid diseases), diabetologists (diabetes), gastroenterologists (digestive disorders), nephrologists (kidney diseases), pulmonologists, ophthalmologists, and others. Unfortunately, coordination between these specialists is often limited, leaving patients to navigate multiple consultations on their own.
My journey into immunology began more than forty-five years ago while I was working as a research scientist and searching for an explanation for the health problems that had accompanied me since early childhood. Those problems originated in traumatic experiences and prolonged stress, the consequences of which gradually emerged over the years as multi-system disorders. The first diagnosed condition was peptic ulcer disease affecting both the stomach and the duodenum. A gastroscopic examination performed at that time revealed hemorrhagic lesions within the visible portion of the gastrointestinal mucosa. That experience inspired me to investigate the local immune system of the mucous membranes, focusing on secretory immunoglobulin A (sIgA). This subject ultimately became the foundation of my doctoral dissertation. I will return to this topic in the following chapter because it has remained central to my understanding of health and disease.
Just as the skin protects the external surface of the body, mucous membranes line and protect its internal cavities. In my earlier book, Systemic Autoimmune Diseases, I discussed their structure and function in detail.
In this book, however, I would like to focus specifically on the mucous membranes of the throat and larynx, the problems associated with their chronic dryness, and their relationship to autoimmune diseases. At the same time, I will discuss environmental factors that may aggravate these symptoms and reduce quality of life. As will become clear throughout the following chapters, it is impossible to consider these tissues in isolation. They interact continuously with the rest of the body, and the body, in turn, influences their condition. Consequently, neither treatment nor understanding can be limited solely to the throat or larynx, because the condition of these tissues often reflects processes occurring throughout the entire organism.
The complexity of these conditions also means that they rarely fall entirely within the expertise of a single medical specialty. They frequently require input from several specialists working together. In reality, however, patients usually consult only one physician, who may recommend symptomatic measures such as throat rinses, lozenges, or moisturizing preparations. While these approaches may provide temporary relief, their effects often last only a few minutes. Moreover, many over-the-counter lozenges contain sucrose or artificial sweeteners, potentially increasing the long-term risk of dental caries.
Persistent dryness of the oral cavity and throat is far more than a minor inconvenience. It often begins with a tickling sensation in the throat, triggering repeated throat clearing or coughing. The mechanical irritation caused by frequent coughing stimulates the production of small amounts of mucus which, when combined with already dry and inflamed mucous membranes, creates an ongoing urge to clear the throat. This vicious cycle may eventually involve neighboring mucosal surfaces, including those of the nasal passages, leading to watery nasal discharge resembling an allergic reaction. Beyond these local effects, chronic irritation may contribute to broader respiratory problems. Bronchiectasis, for example, can further complicate the clinical picture. This condition transforms what initially appears to be a localized complaint into a systemic challenge. In such circumstances, a persistent cough may reflect not only disorders of the respiratory tract but also disturbances involving the nervous system, the gastrointestinal tract, and other interconnected body systems.
These are among the issues explored in this book, together with practical strategies that may help patients manage chronic symptoms in everyday life.
This publication does not address acute bacterial, viral, or parasitic infections of the throat or upper respiratory tract. Instead, it focuses on chronic conditions, particularly those accompanying autoimmune diseases or other long-term disorders already managed by medical specialists. The book does not intend to provide treatment recommendations for acute infections. Appropriately qualified physicians should continue to care for patients with acute infections.
Dryness of the mouth and throat is generally regarded as a secondary symptom, and management usually relies on supportive products rather than prescription medications. These include numerous over-the-counter (OTC) preparations available in pharmacies without a prescription, as well as products sold through drugstores, specialized manufacturers" websites, and online marketplaces. Most of these products are classified as supportive care rather than medicinal drugs.
Online retail platforms often contain numerous user reviews describing real-life experiences with these products. Although such opinions cannot replace scientific evidence or professional medical advice, they may provide valuable insights into how individual patients perceive the effectiveness and tolerability of different preparations. When interpreted with appropriate caution, these experiences may complement information supplied by manufacturers.
As with any health-related product, honesty and transparency are essential. Patients deserve reliable information about both potential benefits and possible limitations because it is ultimately they who bear the consequences of using these products.
Pharmacies sell many over-the-counter preparations, and today's market has a saturation of them. Independent consumer reviews available online may therefore help individuals make more informed decisions. History shows that manufacturers occasionally withdraw even approved pharmaceutical products due to defects or contamination. Consequently, both manufacturers and advertisers have an ethical responsibility to avoid overstating the effectiveness or safety of their products. If an individual experiences an unexpected adverse reaction after using any preparation, they should promptly report it through the appropriate pharmacovigilance or consumer safety channels.
Public awareness of potential adverse reactions remains relatively limited. Many people continue to assume that products available without a prescription cannot cause harm. In reality, every product that comes into contact with the human body - including household products, personal care items, foods, medications, and OTC preparations - may produce unwanted effects in susceptible individuals. For this reason, medicinal products, whether prescription or non-prescription, are accompanied by detailed patient information leaflets describing indications, contraindications, possible side effects, and procedures for reporting adverse events.
Every individual is biologically unique. People living with multiple chronic conditions, particularly autoimmune diseases, may respond unpredictably to substances that are well tolerated by others. Reactions may occur not only to the active ingredients but also to flavoring agents, preservatives, colorants, parabens, or other inactive components present in products such as eye drops or mouthwashes. In susceptible individuals, these substances may function as allergens or trigger adverse immune responses. I have discussed many of these issues in greater detail in my earlier book Health at Your Fingertips: Fighting for the Future and the Planet. During my academic career, I also supervised several graduate theses devoted to these important topics.
A personal story: understanding the secretory immune system
In the previous chapter, I mentioned my doctoral research on the local immune protection of mucous membranes. Looking back after many years, I now realize how profoundly this work contributed to my understanding of the health problems that continue to accompany me today. The following overview summarizes the key scientific concepts that shed light on the development of autoimmune diseases, in which immunoglobulin A (IgA), together with its secretory component forming secretory IgA (SIgA), plays an important role. I will also refer to the scientific studies that formed the basis for many of the clinical conclusions drawn several decades ago.
Scientific interest in the role of SIgA in the local protection of mucosal surfaces began during the 1960s, when its presence in external secretions was first demonstrated. Earlier reports published between the 1920s and the 1950s had already suggested that the gastrointestinal tract was capable of mounting a local immune response independent of the central humoral immune system. During the following fifteen years, particularly by the mid-1970s, a better understanding of the unique biological properties of SIgA led to the development of the concept of the secretory immune system (SIS), now recognized as part of the mucosal immune system, and provided important insights into the mechanisms governing mucosal immunity. In most external secretions, IgA is the predominant immunoglobulin, accounting for approximately 60-80% of all immunoglobulins present. Saliva, for example, contains both monomeric and dimeric IgA, together with the secretory component that forms secretory IgA (SIgA). In 1963, Tomasi and Zigelbaum were the first to propose that secretory IgA could be produced locally, while Shearman and colleagues demonstrated that approximately 80% of plasma cells within the gut-associated lymphoid tissue (GALT) are responsible for IgA production.
Secretory IgA is considered one of the key components of the human immune defense system. It is the predominant class of antibodies found in secretions covering mucosal surfaces. Large numbers of IgA-producing plasma cells are located within the lamina propria of the gastrointestinal and respiratory mucosa, from where SIgA is transported into the various body secretions.
The discovery that SIgA is produced locally in response to antigenic stimulation led directly to the concept of the secretory immune system. This first line of mucosal defense, with SIgA as its principal component, helps eliminate foreign antigens, including infectious microorganisms and dietary proteins. A deficiency of SIgA may weaken the protective barrier function of mucous membranes and contribute to the development of disorders affecting these tissues.
Importantly, IgA concentrations in external secretions do not necessarily correlate with IgA concentrations in the bloodstream. Consequently, localized deficiencies of SIgA may occur even when serum IgA levels remain within the normal range. According to the concept proposed by Glauser and colleagues, absent or deficient SIgA may predispose individuals to recurrent infections that can eventually lead to chronic respiratory disorders, including bronchiectasis.
Chronic inflammation of the gastrointestinal tract, particularly during childhood, may result in atrophy of the intestinal villi. Because SIgA plays a central role in neutralizing antigens at the mucosal surface, its deficiency may allow these antigens to come into direct contact with antibodies of other immunoglobulin classes. This may promote hypersensitivity reactions and autoimmune responses, including the production of antibodies directed against collagen, tissue antigens, or dietary proteins, potentially contributing to conditions such as cow's milk allergy. SIgA deficiency is also frequently associated with various enteropathies, either as a contributing factor or as a consequence of intestinal disease.
SIgA deficiency may likewise increase susceptibility to gluten sensitivity in individuals with celiac disease.
In newborn infants, maturation of the secretory immune system begins during fetal development. Following a vaginal birth, exposure to the maternal microbiota is accompanied by the transfer of IgA through colostrum during the first feedings after delivery. This maternally derived IgA helps maintain adequate levels of immunoglobulin A within the infant's gastrointestinal tract, providing an important form of mucosal protection during the transitional period before the infant's own secretory immune system has fully matured.
The impact of stress on the whole body. Education comes first
Stress is the body's natural response to situations perceived as difficult or threatening. It functions as an internal alarm system that mobilizes both the body and the mind to cope with challenges.
Stress triggers a series of biochemical processes designed to increase the body's readiness to respond. The heart beats faster, breathing becomes shallower, and the nervous system prepares for action. A cascade of chemical reactions occurs throughout the body, enabling it to deal with potential danger. Stress therefore acts as a biological alarm signal that warns of a threat and subsides once the situation has stabilized. It is an adaptive mechanism indicating that attention, decision-making, or change may be required.
The stress response generally takes one of three forms: fight, flight, or freeze.
The alarm stage of the stress response
The first phase of the stress response corresponds to the alarm stage described in Hans Selye's classical model of stress.
During this stage, the body mobilizes its resources within fractions of a second in preparation for action. Heart rate increases, blood pressure rises, breathing accelerates, and muscles become tense. This represents the body's automatic response, coordinated by the nervous and endocrine systems, with the purpose of maximizing the chances of survival in the face of perceived danger.
Originally, this adaptive response evolved to protect humans from predators and other immediate threats. Today, however, everyday life presents different challenges - work deadlines, interpersonal conflicts, financial pressures, or excessive responsibilities - yet the body continues to react in much the same way by activating the mechanisms of fight, flight, or freeze.
Stress is also highly individual. What is intensely stressful for one person may have little impact on someone else.
Symptoms and types of stress
Stress affects every aspect of life, including emotions, behaviour, cognitive function, and physical health. At times, it may seem to arise without any obvious cause, although its true source may remain hidden or outside conscious awareness.
Because individuals cope with stress differently, its manifestations also vary. The symptoms of stress often resemble those of various medical conditions and may involve both psychological and physical changes. These symptoms frequently overlap and evolve depending on how long the stress persists.
Psychological symptoms of stress
- Anxiety and irritability, including difficulty concentrating, emotional tension, and becoming easily upset.
- Intrusive thoughts and excessive worrying, with persistent mental replaying of problems (rumination).
- Low mood, pessimism, and feelings of discouragement. Sometimes stress appears to arise "for no reason," although its underlying cause may simply remain unrecognized.
- Sleep disturbances, including insomnia or frequent awakenings during the night. Many people also experience morning stress, waking with a sense of tension rather than calm.
Physical symptoms of stress
- Muscle tension, particularly in the neck, shoulders, and jaw.
- Increased heart rate and rapid breathing as part of the body's natural preparation for action.
- Headaches and gastrointestinal complaints, including constipation or diarrhoea, which commonly accompany prolonged nervous tension.
- Fatigue and reduced immune function, as the body consumes greater amounts of energy, increasing susceptibility to infections and impairing overall vitality.
During short-term stress, the body responds with a surge of adrenaline, increasing alertness, raising blood pressure, and rapidly mobilizing energy. When the stressor persists over time, however, cortisol - the body's primary stress hormone - becomes chronically elevated. Persistently increased cortisol levels may disrupt the function of numerous physiological systems by suppressing immune activity, placing additional strain on the cardiovascular system, slowing tissue repair, and negatively affecting memory and mood.
Chronic stress therefore becomes a genuine threat to both physical and mental health.
In everyday life, the stress response may gradually become habitual. It is then activated even in situations that require neither physical confrontation nor escape. Under these circumstances, what was once a protective mechanism becomes an unnecessary burden, contributing to a wide range of adverse health consequences.
The sources of everyday stress are diverse and highly subjective. Common examples include excessive workload, lack of control, relationship conflicts, social pressure, and financial insecurity. When such stress persists, it can significantly impair both psychological well-being and physical health.
Work-related stress has become one of the most common threats to modern well-being. Constant deadlines, increasing expectations, and workplace competition may function as a "silent destroyer," gradually weakening immunity, lowering mood, and eventually contributing to occupational burnout.
For this reason, education is essential. Learning effective strategies for managing stress is one of the most valuable investments we can make, since stress itself can never be completely eliminated from life.
The impact of stress on human health
The human body is well adapted to cope with short-term stress, which enhances survival under acute circumstances. It is not, however, designed to withstand chronic stress lasting for months or years - a pattern that has become increasingly characteristic of modern lifestyles.
The effects of chronic stress extend to virtually every aspect of health. Persistent psychological tension stimulates excessive production of cortisol and adrenaline, placing strain on the cardiovascular system, suppressing immune function, and disturbing hormonal balance. Long-term elevation of cortisol may impair the function of numerous body systems, contributing to chronic anxiety, sleep disturbances, depressed mood, and a variety of other health problems.
For these reasons, chronic stress is increasingly regarded as one of the major health challenges of modern civilization, influencing virtually every dimension of human functioning.
Stress and the cardiovascular system
When the body experiences stress, the fight-or-flight response is activated, causing blood vessels to constrict. As a result, heart rate and blood pressure increase. Prolonged exposure to stress may increase the risk of hypertension and cardiovascular disease.
Chronic stress may also influence heart rhythm, contributing to arrhythmias such as atrial fibrillation or atrial flutter. These rhythm disturbances can increase the risk of serious cardiovascular complications, including the formation of blood clots, thereby raising the likelihood of heart attack or stroke.
Stress and the respiratory system
Stressful situations are often accompanied by rapid, shallow breathing, which may reduce the efficiency of gas exchange within the lungs.
Stress also causes muscle tension, including the diaphragm and intercostal muscles that play an essential role in breathing. Persistent muscle tension may reduce the flexibility of the chest wall and limit full expansion of the lungs during respiration.
Long-term stress may weaken immune function, increasing susceptibility to respiratory infections. In people with pre-existing respiratory conditions, stress may worsen symptoms such as shortness of breath or asthma attacks.
Some studies also suggest that chronic stress may influence breathing during sleep and contribute to conditions associated with sleep hypoventilation, in which impaired gas exchange during sleep may lead to a variety of health problems.
Stress and digestion
Stress can affect both the digestive tract and its normal functioning.
In some individuals, stress alters appetite and eating habits. Some experience increased hunger, often resulting in excessive consumption of high-calorie foods, while others lose their appetite altogether.
Stress may also interfere with digestive function, contributing to heartburn, indigestion, abdominal pain, and altered intestinal motility. Depending on the individual, intestinal transit may either accelerate or slow down.
Stress is considered one of the factors capable of aggravating the symptoms of irritable bowel syndrome (IBS). It may also disturb the balance of the intestinal microbiota, which plays an essential role in maintaining digestive health.
In response to stress, the body releases hormones such as cortisol and adrenaline. These substances can influence digestion by affecting nutrient absorption, digestive processes, and the permeability of the intestinal mucosal barrier.
Stress and the menstrual cycle
Stress hormones may disrupt the hormonal balance that regulates the menstrual cycle. As a result, menstrual periods may become irregular. In some women, chronic stress is associated with increased menstrual pain and more severe premenstrual syndrome (PMS) symptoms.
Stress and cholesterol
Long-term stress may contribute to metabolic disturbances, including increased levels of low-density lipoprotein (LDL, often referred to as "bad" cholesterol) and reduced levels of high-density lipoprotein (HDL, "good" cholesterol). These changes may increase the risk of atherosclerosis and cardiovascular disease.
Stress and skin disorders
Psychological stress also affects immune function and hormonal balance.
Stress may aggravate acne, psoriasis, eczema, and excessive hair loss. It also appears to delay tissue repair, causing wounds and skin irritation to heal more slowly.
Stress, female reproductive health, and pregnancy
