**5.2 Stress as a trigger for autoimmune diseases**

Stress was shown to lead glandular disturbance including autoimmune endocrine disorders [213]. In autoimmune diseases, there is a close link between stress and major stress hormones as an etiological factor [214]. Immune dysregulation could lead to atopic autoimmune diseases due to the infiltration of cytokine production and increased host defense. The repetition and the duration of stress could lead to an acute phase response that results in a chronic inflammatory process [215]. The inflammatory response is contained within the stress response, implying that stress can affect the innate immune system and causing an inflammatory response [216]. There is an association between some sort of psychological stress especially PTSD with elevated T cells that can lead to hyperreactive immune responses, higher igM, and lower dehydroepiandrosterone levels which is found in many cardiovascular and autoimmune diseases [217].
