For better or worse: common determinants influencing health and disease in parasitic infections, asthma and reproductive biology.

What represents a protective or beneficial immune response in one scenario, may contribute to the pathogenesis of disease in another. This review explores the plasticity of immune responses and the delicate balance between health and disease, using examples from immunoparasitology, allergic lung disease and reproductive biology. Cytokines secreted by lymphocytes and other leukocytes are central to this balance because they regulate both inflammation and adaptive immunity. The type and quantity of cytokines, the timing and location of cytokine release, and coordinated expression with other signals can all contribute in determining the nature of immune responses and, therefore, of disease outcomes. Of necessity, leukocytes control and eliminate infectious agents by interacting with other cells. However, leukocytes also communicate with other cells to maintain homeostasis in healthy organisms. Tissue development, repair, remodelling and immunopathology can be viewed as parts of a continuum and leukocytes are major contributors to all of these processes. The factors, which influence the extent to which an infection will result in host pathology, are multifarious, but include as yet poorly determined elements within the genetic background of the host. Nowhere is this more obvious than in animals chronically infected with parasites. There are parallels between parasite infections and pregnancy, since to survive and develop, the conceptus also must avoid immunological rejection. Therapeutic intervention through manipulation of cytokine profiles may be feasible, but is fraught with risk and should not be undertaken without careful analysis of the possible consequences in a range of genetic backgrounds and with consideration of the diversity of infectious agents which might be encountered.