Asthma is a chronic inflammatory lung disease affecting approximately 7.7% of the US population. Sex differences in the prevalence, incidence, and severity of asthma have been widely described throughout the lifespan, showing higher rates in boys than girls before puberty, but a reversed pattern in adults. Asthma is often associated with atopy, i.e. the tendency to develop allergic diseases, and can be worsened by environmental stimuli and/or exercise. While not exclusive to patients with asthma, exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. Currently, there is limited research on sex differences in EIB and its relationship with atopy and asthma in men and women. In this minireview, we summarize the available literature on this topic. Overall, the collective knowledge supports the notion that physiological changes triggered during exercise affect males and females differently, suggesting an interaction among sex, exercise, sex hormones, and atopic status in the course of EIB pathophysiology. Understanding these differences is important to provide personalized management plans to men and women who exercise regularly and suffer from underlying asthma and/or atopy.
Centers for Disease Control and Prevention. Most recent asthma data, 2020. Available from: www.cdc.gov/asthma/most_recent_data.htm [accesed March 19, 2021]
2.
KeselmanAHellerN.Estrogen signaling modulates allergic inflammation and contributes to sex differences in asthma. Front Immunol2015;
6:568
3.
ShahRNewcombDC.Sex bias in asthma prevalence and pathogenesis. Front Immunol2018;
9:2997
4.
ZeinJGErzurumSC.Asthma is different in women. Curr Allergy Asthma Rep2015;
15:28
5.
MelgertBNRayAHylkemaMNTimensWPostmaDS.Are there reasons why adult asthma is more common in females?Curr Allergy Asthma Rep2007;
7:143–50
6.
RedlineSGoldD.Challenges in interpreting gender differences in asthma. Am J Respir Crit Care Med1994;
150:1219–21
7.
SchatzMCamargoCA.The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Ann Allergy Asthma Immunol2003;
91:553–8
8.
NaeemASilveyraP.Sex differences in paediatric and adult asthma. Eur Med J2019;
4:27–35
9.
FuentesNSilveyraP. Endocrine regulation of lung disease and inflammation. Exp Biol Med (Maywood) 2018;243:1313--22. DOI: 10.1177/1535370218816653
10.
CareyMACardJWVoltzJWArbesSJJrGermolecDRKorachKSZeldinDC.It's all about sex: gender, lung development and lung disease. Trends Endocrinol Metab2007;
18:308–13
11.
Di CiccoMD'EliosSPeroniDGComberiatiP.The role of atopy in asthma development and persistence. Curr Opin Allergy Clin Immunol2020;
20:131–7
12.
ArbesSJGergenPJVaughnBZeldinDC.Asthma cases attributable to atopy: results from the Third National Health and Nutrition Examination Survey. J Allergy Clin Immunol2007;
120:1139–45
13.
DidierAMazieresJKouevijinGTetuLRivièreD. [
Sport and atopy]. Rev Mal Respir2003;
20:727–34
14.
HeleniusIJTikkanenHOSarnaSHaahtelaT.Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. J Allergy Clin Immunol1998;
101:646–52
15.
RodriguezBD.SilveyraP. Sex differences in exercise induced bronchoconstriction in athletes: a systematic review and meta-analysis. Int J Environ Res Public Health 2020;17:7270. doi: 10.3390/ijerph17197270
16.
StormsWW.Asthma associated with exercise. Immunol Allergy Clin North Am2005;
25:31–43
ParsonsJPHallstrandTSMastronardeJGKaminskyDARundellKWHullJHStormsWWWeilerJMCheekFMWilsonKCAndersonSD.Bronchoconstriction ATSSoE-i. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med2013;
187:1016–27
19.
WeilerJMBoniniSCoifmanRCraigTDelgadoLCapão-FilipeMPassaliDRandolphCStormsW, Ad Hoc Committee of Sports Medicine Committee of American Academy of Allergy AtI. American Academy of Allergy, Asthma & Immunology Work Group report: exercise-induced asthma. J Allergy Clin Immunol2007;
119:1349–58
20.
JosephVBehanMKinkeadR.Sex, hormones, and stress: how they impact development and function of the carotid bodies and related reflexes. Respir Physiol Neurobiol2013;
185:75–86
21.
ConstantiniNWDubnovGLebrunCM.The menstrual cycle and sport performance. Clin Sports Med2005;
24:e51–82, xiii–xiv
22.
KukafkaDSLangDMPorterSRogersJCiccolellaDPolanskyMD'AlonzoGEJr.Exercise-induced bronchospasm in high school athletes via a free running test: incidence and epidemiology. Chest1998;
114:1613–22
23.
Ng'ang'aLWOdhiamboJAMungaiMWGichehaCMNderituPMaingiBMacklemPTBecklakeMR.Prevalence of exercise induced bronchospasm in Kenyan school children: an urban-rural comparison. Thorax1998;
53:919–26
24.
SonnaLAAngelKCSharpMAKnapikJJPattonJFLillyCM.The prevalence of exercise-induced bronchospasm among US Army recruits and its effects on physical performance. Chest 2001;119:1676--84. doi: 10.1378/chest.119.6.1676
25.
CaillaudDHoroKBaizNBanerjeeSCharpinDLavaudFde BlayFRaherisonC,
Annesi-Maesano I. Exercise-induced bronchospasm related to different phenotypes of rhinitis without asthma in primary schoolchildren: the French Six Cities Study. Clin Exp Allergy2014;
44:858–66
26.
KutiBPKutiDKOmoleKOMohammedLOOlogunBGOsoBI.Prevalence and factors associated with exercise-induced bronchospasm among rural school children in Ilesa, Nigeria. Niger Postgrad Med J2017;
24:107–13
27.
ParsonsJPKaedingCPhillipsGJarjouraDWadleyGMastronardeJG.Prevalence of exercise-induced bronchospasm in a cohort of varsity college athletes. Med Sci Sports Exerc2007;
39:1487–92
28.
WeilerJMAndersonSDRandolphCBoniniSCraigTJPearlmanDSRundellKWSilversWSStormsWWBernsteinDIBlessing-MooreJCoxLKhanDALangDMNicklasRAOppenheimerJPortnoyJMSchullerDESpectorSLTillesSAWallaceDHendersonWSchwartzLKaufmanDNsouliTShiekenLRosarioN;
American Academy of Allergy AtaI, American College of Allergy AtaI, Joint Council of Allergy AtaI. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol2010;
105:S1–47
29.
NorthoffHSymonsSZiekerDSchaibleEVSchäferKThomaSLöfflerMAbbasiASimonPNiessAMFehrenbachE.Gender- and menstrual phase dependent regulation of inflammatory gene expression in response to aerobic exercise. Exerc Immunol Rev2008;
14:86–103
30.
HolzerKAndersonSDDouglassJ.Exercise in elite summer athletes: challenges for diagnosis. J Allergy Clin Immunol2002;
110:374–80
31.
HolzerKBruknerP.Screening of athletes for exercise-induced bronchoconstriction. Clin J Sport Med2004;
14:134–8
32.
AndersonSDArgyrosGJMagnussenHHolzerK.Provocation by eucapnic voluntary hyperpnoea to identify exercise induced bronchoconstriction. Br J Sports Med2001;
35:344–7
33.
BrannanJDPorsbjergC.Testing for exercise-induced bronchoconstriction. Immunol Allergy Clin North Am2018;
38:215–29
34.
BrannanJDAndersonSDPerryCPFreed-MartensRLassigARCharltonB.The safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic (4.5%) saline. Respir Res2005;
6:144
LangdeauJBDayATurcotteHBouletLP.Gender differences in the prevalence of airway hyperresponsiveness and asthma in athletes. Respir Med2009;
103:401–6
37.
McFaddenERIngramRH.Exercise-induced asthma: observations on the initiating stimulus. N Engl J Med1979;
301:763–9
38.
AndersonSDSchoeffelREBlackJLDaviskasE.Airway cooling as the stimulus to exercise-induced asthma – a re-evaluation. Eur J Respir Dis1985;
67:20–30
39.
KrafczykMAAsplundCA.Exercise-induced bronchoconstriction: diagnosis and management. Am Fam Physician2011;
84:427–34
40.
McFaddenER.Hypothesis: exercise-induced asthma as a vascular phenomenon. Lancet1990;
335:880–3
41.
HallstrandTSAltemeierWAAitkenMLHendersonWR.Role of cells and mediators in exercise-induced bronchoconstriction. Immunol Allergy Clin North Am2013;
33:313–28, vii
42.
BrannanJDGullikssonMAndersonSDChewNKumlinM.Evidence of mast cell activation and leukotriene release after mannitol inhalation. Eur Respir J2003;
22:491–6
43.
KippelenPAndersonSDHallstrandTS.Mechanisms and biomarkers of exercise-induced bronchoconstriction. Immunol Allergy Clin North Am2018;
38:165–82
44.
HallstrandTSDebleyJSFarinFMHendersonWR.Role of MUC5AC in the pathogenesis of exercise-induced bronchoconstriction. J Allergy Clin Immunol2007;
119:1092–8
45.
DealECMcFaddenERIngramRHStraussRHJaegerJJ.Role of respiratory heat exchange in production of exercise-induced asthma. J Appl Physiol Respir Environ Exerc Physiol1979;
46:467–75
46.
KallingsLVEmtnerMBäcklundL.Exercise-induced bronchoconstriction in adults with asthma–comparison between running and cycling and between cycling at different air conditions. Ups J Med Sci1999;
104:191–8
47.
EvansTMRundellKWBeckKCLevineAMBaumannJM.Cold air inhalation does not affect the severity of EIB after exercise or eucapnic voluntary hyperventilation. Med Sci Sports Exerc2005;
37:544–9
48.
SachaJJQuinnJM.The environment, the airway, and the athlete. Ann Allergy Asthma Immunol2011;
106:81–7; quiz 88
49.
SchwartzLBDelgadoLCraigTBoniniSCarlsenKHCasaleTBDel GiaccoSDrobnicFvan WijkRGFerrerMHaahtelaTHendersonWRIsraelELötvallJMoreiraAPapadopoulosNGRandolphCCRomanoAWeilerJM.Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Allergy2008;
63:953–61
50.
Peral-SuárezÁCuadrado-SotoEPereaJMNaviaBLópez-SobalerAMOrtegaRM.Physical activity practice and sports preferences in a group of Spanish schoolchildren depending on sex and parental care: a gender perspective. BMC Pediatr2020;
20:337
51.
TsaiLTLoFEYangCCKellerJJLyuSY.Gender differences in recreational sports participation among Taiwanese adults. Int J Environ Res Public Health2015;
12:829–40
52.
ButtJWeinbergRSBreckonJDClaytorRP.Adolescent physical activity participation and motivational determinants across gender, age, and race. J Phys Act Health2011;
8:1074–83
53.
LundTPedersenLLarssonBBackerV.Prevalence of asthma-like symptoms, asthma and its treatment in elite athletes. Scand J Med Sci Sports2009;
19:174–8
54.
RundellKWSpieringBAJudelsonDAWilsonMH.Bronchoconstriction during cross-country skiing: is there really a refractory period?Med Sci Sports Exerc2003;
35:18–26
55.
LevaiIKHullJHLoosemoreMGreenwellJWhyteGDickinsonJW.Environmental influence on the prevalence and pattern of airway dysfunction in elite athletes. Respirology2016;
21:1391–6
56.
HallstrandTSCurtisJRKoepsellTDMartinDPSchoeneRBSullivanSDYoriokaGNAitkenML.Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. J Pediatr2002;
141:343–8
57.
CoutoMStangJHortaLStensrudTSeveroMMowinckelPSilvaDDelgadoLMoreiraACarlsenKH.Two distinct phenotypes of asthma in elite athletes identified by latent class analysis. J Asthma2015;
52:897–904
58.
Becerril-ÁngelesMVargasMHHernández-PérezLRivera-IstepanNJPérez-HidalgoRIOrtega-GonzálezAGRubio-DomínguezSRodríguez-GutiérrezMCGaxiola-CortésRDosal-UlloaRGochicoa-RangelLG.Prevalence and characteristics of exercise-induced bronchoconstriction in high school and college athletes at 2,240 m altitude. Rev Invest Clin2017;
69:20–7
59.
CouillardSBougaultVTurmelJBouletLP.Perception of bronchoconstriction following methacholine and eucapnic voluntary hyperpnea challenges in elite athletes. Chest2014;
145:794–802
60.
NorqvistJErikssonLSöderströmLLindbergAStenforsN.Self-reported physician-diagnosed asthma among Swedish adolescent, adult and former elite endurance athletes. J Asthma2015;
52:1046–53
61.
ParsonsJPCosmarDPhillipsGKaedingCBestTMMastronardeJG.Screening for exercise-induced bronchoconstriction in college athletes. J Asthma2012;
49:153–7
62.
AllenHHullJHBackhouseSHDe CarnéTDimitriouLPriceOJ.The Allergy Questionnaire for Athletes provides value in ruling-out exercise-induced bronchoconstriction. Allergy2019;
74:1794–6
63.
BoniniMGramiccioniCFiorettiDRuckertBRinaldiMAkdisCTodaroAPalangePCarlsenKHPellicciaARasiGBoniniS.Asthma, allergy and the Olympics: a 12-year survey in elite athletes. Curr Opin Allergy Clin Immunol2015;
15:184–92
64.
BougaultVTurmelJBouletLP.Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest2010;
138:31s–7s
65.
BurnettDMBurnsSMerrittSWickJSharpeM.Prevalence of exercise-induced bronchoconstriction measured by standardized testing in healthy college athletes. Respir Care 2016;61:571--6. doi: 10.4187/respcare.04493. Epub 2016 Feb 9
66.
BurnettDMVardimanJPDeckertJAWardJLSharpeMR.Perception of exercise-induced bronchoconstriction in college athletes. Respir Care2016;
61:897–901
67.
DurandFKippelenPCeugnietFGomezVRDesnotPPoulainMPréfautC.Undiagnosed exercise-induced bronchoconstriction in ski-mountaineers. Int J Sports Med2005;
26:233–7
68.
OsthoffMMichelFStruplerMMiedingerDTaegtmeyerABLeuppiJDPerretC.Bronchial hyperresponsiveness testing in athletes of the Swiss Paralympic team. BMC Sports Sci Med Rehabil2013;
5:7
69.
PohjantähtiHLaitinenJParkkariJ.Exercise-induced bronchospasm among healthy elite cross country skiers and non-athletic students. Scand J Med Sci Sports2005;
15:324–8
70.
SallaouiRChamariKChtaraMAlarantaAManaiYGhediraHAmriM.Asthma in Tunisian elite athletes. Int J Sports Med2007;
28:571–5
71.
SallaouiRChamariKMossaATabkaZChtaraMFekiYAmriM.Exercise-induced bronchoconstriction and atopy in Tunisian athletes. BMC Pulm Med2009;
9:8
72.
SallaouiRZendahIGhediraHBelhaouzMGhrairiMAmriM.Exercise-induced bronchoconstriction in Tunisian elite athletes is underdiagnosed. Open Access J Sports Med2011;
2:41–6
73.
SeysSFHoxVVan GervenLDilissenEMarijsseGPeetersEDekimpeEKasranAAertgeertsSTroostersTVanbelleVPeersKCeuppensJLHellingsPWDupontLJBullensDM.Damage-associated molecular pattern and innate cytokine release in the airways of competitive swimmers. Allergy2015;
70:187–94
74.
StenforsN.Self-reported symptoms and bronchial hyperresponsiveness in elite cross-country skiers. Respir Med2010;
104:1760–3
75.
KrafczykMABautistaFD.When an athlete can't catch his breath. J Fam Pract2009;
58:454–9
76.
RundellKWImJMayersLBWilberRLSzmedraLSchmitzHR.Self-reported symptoms and exercise-induced asthma in the elite athlete. Med Sci Sports Exerc2001;
33:208–13
77.
LoMauroAAlivertiA.Sex differences in respiratory function. Breathe2018;
14:131–40
78.
HarmsCARosenkranzS.Sex differences in pulmonary function during exercise. Med Sci Sports Exerc2008;
40:664–8
79.
McClaranSRHarmsCAPegelowDFDempseyJA.Smaller lungs in women affect exercise hyperpnea. J Appl Physiol (1985)1998;
84:1872–81
80.
GuenetteJAWittJDMcKenzieDCRoadJDSheelAW.Respiratory mechanics during exercise in endurance-trained men and women. J Physiol2007;
581:1309–22
81.
SheelAWGuenetteJA.Mechanics of breathing during exercise in men and women: sex versus body size differences?Exerc Sport Sci Rev2008;
36:128–34
82.
KossmanDAWilliamsNIDomchekSMKurzerMSStopferJESchmitzKH.Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer. J Appl Physiol (1985)2011;
111:1687–93
83.
ChandlerMHSchuldheiszSPhillipsBAMuseKN.Premenstrual asthma: the effect of estrogen on symptoms, pulmonary function, and beta 2-receptors. Pharmacotherapy1997;
17:224–34
84.
SkoczyńskiSSemik-OrzechASzaneckiWMajewskiMKołodziejczykKSozańskaEWitekAPierzchałaW.Perimenstrual asthma as a gynecological and pulmonological clinical problem. Adv Clin Exp Med2014;
23:665–8
85.
OguzulgenIKTurktasHErbasD.Airway inflammation in premenstrual asthma. J Asthma2002;
39:517–22
86.
EliassonOScherzerHHDeGraffAC.Morbidity in asthma in relation to the menstrual cycle. J Allergy Clin Immunol1986;
77:87–94
87.
GibbsCJCouttsIILockRFinneganOCWhiteRJ.Premenstrual exacerbation of asthma. Thorax1984;
39:833–6
88.
WulfsohnNLPolitzerWM.Bronchial asthma during menses and pregnancy. S Afr Med J1964;
38:173
89.
BrennerBEHolmesTMMazalBCamargoCA.Relation between phase of the menstrual cycle and asthma presentations in the emergency department. Thorax2005;
60:806–9
90.
SkobeloffEMSpiveyWHSilvermanREskinBAHarchelroadFAlessiTV.The effect of the menstrual cycle on asthma presentations in the emergency department. Arch Intern Med1996;
156:1837–40
91.
StanfordKIMickleboroughTDRaySLindleyMRKocejaDMStagerJM.Influence of menstrual cycle phase on pulmonary function in asthmatic athletes. Eur J Appl Physiol2006;
96:703–10
92.
StathamG.Understanding the effects of the menstrual cycle on training and performance in elite athletes: a preliminary study. Prog Brain Res2020;
253:25–58
93.
MatteisMPolverinoFSpazianoGRoviezzoFSantorielloCSulloNBucciMRRossiFPolverinoMOwenCAD'AgostinoB.Effects of sex hormones on bronchial reactivity during the menstrual cycle. BMC Pulm Med2014;
14:108
94.
PauliBDReidRLMuntPWWigleRDForkertL.Influence of the menstrual cycle on airway function in asthmatic and normal subjects. Am Rev Respir Dis1989;
140:358–62
95.
TanKSMcFarlaneLCLipworthBJ.Modulation of airway reactivity and peak flow variability in asthmatics receiving the oral contraceptive pill. Am J Respir Crit Care Med1997;
155:1273–7
96.
ZhaoXJMcKerrGDongZHigginsCACarsonJYangZQHanniganBM.Expression of oestrogen and progesterone receptors by mast cells alone, but not lymphocytes, macrophages or other immune cells in human upper airways. Thorax2001;
56:205–11
97.
AgarwalSKMarshallGDJr.Perimenstrual alterations in type-1/type-2 cytokine balance of normal women. Ann Allergy Asthma Immunol1999;
83:222–8
98.
BalzanoGFuschilloSMelilloGBoniniS.Asthma and sex hormones. Allergy2001;
56:13–20
99.
HanleySP.Asthma variation with menstruation. Br J Dis Chest1981;
75:306–8
100.
MirdalGMPeterssonBWeekeBVibitsA.Asthma and menstruation: the relationship between psychological and bronchial hyperreactivity. Br J Med Psychol1998;
71:47–55.
101.
Oertelt-PrigioneS.Immunology and the menstrual cycle. Autoimmun Rev2012;
11:A486–92
102.
TamAMorrishDWadsworthSDorscheidDManSFSinDD.The role of female hormones on lung function in chronic lung diseases. BMC Womens Health2011;
11:24
103.
TakedaMTanabeMItoWUekiSKonnnoYChiharaMItogaMKobayashiYMoritokiYKayabaHChiharaJ.Gender difference in allergic airway remodelling and immunoglobulin production in mouse model of asthma. Respirology2013;
18:797–806
104.
Riffo-VasquezYLigeiro de OliveiraAPPageCPSpinaDTavares-de-LimaW.Role of sex hormones in allergic inflammation in mice. Clin Exp Allergy2007;
37:459–70
105.
HayashiTAdachiYHasegawaKMorimotoM.Less sensitivity for late airway inflammation in males than females in BALB/c mice. Scand J Immunol2003;
57:562–7
106.
FreedAN.Models and mechanisms of exercise-induced asthma. Eur Respir J1995;
8:1770–85
107.
KodeshEZaldivarFSchwindtCTranPYuACamilonMNanceDMLeuSYCooperDAdamsGR.A rat model of exercise-induced asthma: a nonspecific response to a specific immunogen. Am J Physiol Regul Integr Comp Physiol2011;
300:R917–24
108.
UenoHKoyaTTakeuchiHTsukiokaKSaitoAKimuraYHayashiMWatanabeSHasegawaTArakawaMKikuchiT. Cysteinyl leukotriene synthesis via phospholipase A2 group IV mediates exercise-induced bronchoconstriction and airway remodeling. Am J Respir Cell Mol Biol. Epub ahead of print 2020
109.
JohanssonSGBieberTDahlRFriedmannPSLanierBQLockeyRFMotalaCOrtega MartellJAPlatts-MillsTARingJThienFVan CauwenbergePWilliamsHC.Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol2004;
113:832–6
110.
ToskalaEKennedyDW.Asthma risk factors. Int Forum Allergy Rhinol2015;
5 Suppl 1:S11–6
111.
FuentesNNicoleauMCabelloNMontesDZomorodiNChroneosZCSilveyraP. 17b-estradiol affects lung function and inflammation following ozone exposure in a sex-specific manner. Am J Physiol Lung Cell Mol Physiol. Epub ahead of print 2019
112.
FuentesNSilveyraP.Estrogen receptor signaling mechanisms. Adv Protein Chem Struct Biol2019;
116:135–70
113.
YungJAFuseiniHNewcombDC.Hormones, sex, and asthma. Ann Allergy Asthma Immunol2018;
120:488–94
114.
BondsRSMidoro-HoriutiT.Estrogen effects in allergy and asthma. Curr Opin Allergy Clin Immunol2013;
13:92–9
115.
ZierauOZenclussenACJensenF.Role of female sex hormones, estradiol and progesterone, in mast cell behavior. Front Immunol2012;
3:169
116.
BrabinL.Interactions of the female hormonal environment, susceptibility to viral infections, and disease progression. AIDS Patient Care STDS2002;
16:211–21
117.
ChenWMempelMSchoberWBehrendtHRingJ.Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy2008;
63:1418–27
118.
CunninghamMGilkesonG.Estrogen receptors in immunity and autoimmunity. Clin Rev Allergy Immunol2011;
40:66–73
LefflerJStumblesPAStricklandDH.Immunological processes driving IgE sensitisation and disease development in males and females. Int J Mol Sci 2018;19:1554. doi: 10.3390/ijms19061554
123.
MarriottIHuet-HudsonYM.Sexual dimorphism in innate immune responses to infectious organisms. Immunol Res2006;
34:177–92
124.
StraubRH.The complex role of estrogens in inflammation. Endocr Rev2007;
28:521–74
125.
SternbergEM.Neuroendocrine regulation of autoimmune/inflammatory disease. J Endocrinol2001;
169:429–35
126.
De SouzaMJToombsRJScheidJLO'DonnellEWestSLWilliamsNI.High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod2010;
25:491–503
127.
DeSMMillerBELoucksABLucianoAAPescatelloLSCampbellCGLasleyBL.High frequency of luteal phase deficiency and anovulation in recreational women runners: blunted elevation in follicle-stimulating hormone observed during luteal-follicular transition. J Clin Endocrinol Metab1998;
83:4220–32
ZannolliRMorgeseG.Does puberty interfere with asthma?Med Hypotheses1997;
48:27–32
130.
NinanTKRussellG.Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. BMJ1992;
304:873–5
131.
DaveyRAGrossmannM.Androgen receptor structure, function and biology: from bench to bedside. Clin Biochem Rev2016;
37:3–15
132.
AraneoBADowellTDiegelMDaynesRA.Dihydrotestosterone exerts a depressive influence on the production of interleukin-4 (IL-4), IL-5, and gamma-interferon, but not IL-2 by activated murine T cells. Blood1991;
78:688–99
133.
LivaSMVoskuhlRR.Testosterone acts directly on CD4+ T lymphocytes to increase IL-10 production. J Immunol2001;
167:2060–7
134.
WulfsohnNLPolitzerWMHenricoJS.Testosterone therapy in bronchial asthma. S Afr Med J1964;
38:170–2
135.
NewcombDCPeeblesRSJr.Th17-mediated inflammation in asthma. Curr Opin Immunol2013;
25:755–60
136.
CanguvenOAlbayrakS.Do low testosterone levels contribute to the pathogenesis of asthma?Med Hypotheses2011;
76:585–8
