Introduction: During the Arabian Gulf Wars of 1991 and 2003, the resident population of Kuwait sustained heavy exposure to environmental toxicants introduced by military activities. No comprehensive studies have been conducted to assess how exposure to the wartime and postwar environment may have altered the fundamental patterns of immune reactivity among Kuwaitis in ways that affect pathogenesis of disease. This present study addresses this issue by characterising immunological features of asthma and allergies in a Kuwaiti population that is unique and possibly correlates with toxicant exposures.Materials and Methods: Twenty-five long-term residents of Kuwait afflicted with bronchial asthma concurrent with rhinitis; and 2 healthy control groups: 18 long-term residents and 10 newcomers to Kuwait were evaluated by 2- and 3-colour flow cytometry for peripheral blood T cell subpopulation frequencies. Results: Relative to healthy, long-term residents, significantly elevated frequencies of all activated cell phenotypes were observed in the blood of the asthmatic group (P <0.001 to P < 0.001), except for CD8+HLA-DR+ cells and a presumed T-regulatory (Treg) subpopulation: CD4+CD25high. The asthmatic group was also observed to have larger populations of CD3+ (pan-T cells), CD4+ (T helper cells) and CD8+ (cytotoxic T cells), CD3+CD56 (NKT-like cells) and CD56+CD16+ (NK cells) compared to healthy long-term residents. Compared to healthy recent immigrants, the blood of long-term residents contained elevated levels of CD3+CD56+ (NK-like), CD4+CD45RA+/ CD45RO+ (Naive-to-Memory Transitional), but lower CD4+CD25+high (Treg) (P <0.05). Conclusions: Elevated representation of natural killer (NKT)-like and memory phenotypes may predispose long-term residents towards enhanced susceptibility for airway disease; while at the same time, reducing representation of Treg cells which are protective against airway disease, and this may increase vulnerability to these syndromes among the residents of Kuwait. These results may provide insight into the features of immunopathogenesis of asthma and allergies in Kuwait that arise as a result of the special environment of the country.
The Gulf Wars of 1991 and 2003 exposed the residents of Kuwait and several neighbouring countries to high levels toxicants with the capacity to cause long-term deleterious alterations in the immune reactivity. The impact of these influences on the epidemiology and pathogenesis of chronic illness in affected populations is poorly characterised and remains largely speculative at the time of this writing.
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