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Corticosteroids given during acute viral infection may trigger myalgic encephalomyelitis
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== Immunosuppression by corticosteroids and chronic stress == Corticosteroids suppress the Th1 antiviral/intracellular immune response, up-regulate the antibacterial Th2 response,<ref>{{Cite journal | last = Elenkov|first = Ilia J. | date = Jun 2004 | title = Glucocorticoids and the Th1/Th2 balance | url =https://www.ncbi.nlm.nih.gov/pubmed/15265778|journal=Annals of the New York Academy of Sciences|volume=1024 | pages = 138–146|doi=10.1196/annals.1321.010|issn=0077-8923|pmid=15265778}}</ref> and suppresses T-cell function.<ref>{{Cite journal | last = Davis | first = Trevor E | last2 = Kis-Toth | first2 = Katalin | last3 = Szanto | first3 = Attila | last4 = Tsokos | first4 = George C. | date = Jul 2013 | title = Glucocorticoids suppress T cell function by upregulating microRNA 98 | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713788/|journal=Arthritis and rheumatism|volume=65 | issue = 7 | pages = 1882–1890|doi=10.1002/art.37966|issn=0004-3591|pmc=3713788|pmid=23575983}}</ref> In the [[International Consensus Criteria|international consensus criteria]] for ME/CFS, under the list of environmental events leading to ME/CFS, it is recognised that "steroids before or during acute respiratory illness can turn immune response to Th2 and suppress T cell numbers".<ref name="ICP2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> Interestingly, ME/CFS is usually precipitated by viral infection, and several studies found it is common to experience major psychological chronic stress in the year prior to developing ME/CFS.<ref>{{Cite journal | last = Hatcher | first = Simon | last2 = House | first2 = Allan | date = Oct 2003 | title = Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study | url = https://www.ncbi.nlm.nih.gov/pubmed/14580073|journal=Psychological Medicine|volume=33 | issue = 7 | pages = 1185–1192|doi=10.1017/s0033291703008274|issn=0033-2917|pmid=14580073}}</ref><ref>{{Cite journal | last = Theorell|first = T. | last2 = Blomkvist | first2 = V. | last3 = Lindh | first3 = G. | last4 = Evengård | first4 = B. | date = May 1999 | title = Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis |url =https://www.ncbi.nlm.nih.gov/pubmed/10367610|journal=Psychosomatic Medicine|volume=61 | issue = 3 | pages = 304–310|issn=0033-3174|pmid=10367610}}</ref><ref>{{Cite journal | last = Salit | first = Irving E. | date = 1997-01-01 | title = Precipitating factors for the chronic fatigue syndrome | url =http://www.sciencedirect.com/science/article/pii/S0022395696000507|journal=Journal of Psychiatric Research|volume=31 | issue = 1 | pages = 59–65|doi=10.1016/S0022-3956(96)00050-7|issn=0022-3956}}</ref> Chronic psychological stress elevates cortisol which suppresses the Th1 antiviral/intracellular immune response,<ref>{{Cite journal | last = Dhabhar | first = Firdaus S | date = 2008-03-15 | title = Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869337/|journal=Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology|volume=4 | issue = 1 | pages = 2–11|doi=10.1186/1710-1492-4-1-2|issn=1710-1484|pmc=2869337|pmid=20525121}}</ref> and the T-cell response.<ref>{{Cite journal | last = Dhabhar | first = Firdaus S | date = 2008-03-15 | title = Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869337/|journal=Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology|volume=4 | issue = 1 | pages = 2–11|doi=10.1186/1710-1492-4-1-2|issn=1710-1484|pmc=2869337|pmid=20525121}}</ref> Thus immonologically, chronic stress has a similar effect to corticosteroid administration, and both these factors appear to increase the risk of development of ME/CFS from viral infection.
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