Are salivary immunoglobulin A and lysozyme biomarkers of stress among nurses?

J Occup Environ Med. 1999 Oct;41(10):920-7. doi: 10.1097/00043764-199910000-00013.


Salivary immunoglobulin A (IgA) and lysozyme have been studied as possible biomarkers of stress. This study examined the stress levels among female nurses in various units and the relationship between these stress levels and salivary IgA and lysozyme secretion. One hundred ninety-five (43%) of 457 eligible female nurses from surgical wards/operating theaters (SURG), medical wards (MED), and outpatient clinics/day-surgery theaters (OPD) completed a self-administered questionnaire. From this group of 195 nurses, 124 provided a salivary sample accumulated over 5 minutes. Stress levels were assessed with a ten-point Stress Assessment Score (SAS) for Asians and a direct question on perceived life stress. Enzyme-linked immunosorbent assay and lyso-plate methods were used to determine salivary IgA and lysozyme levels. Forty-five percent of SURG, 35% of MED, and 17% of OPD nurses scored at least four points on the SAS. SURG nurses had the lowest IgA secretion (geometric mean; 95% confidence interval [CI]) rates (43 micrograms/min; 36 to 51 micrograms/min). The other groups had significantly higher salivary IgA secretion rates: MED (96 micrograms/min; 80 to 116 micrograms/min) and OPD (77 micrograms/min; 60 to 98 micrograms/min) Findings for salivary lysozyme (microgram/min) were similar; SURG (9 micrograms/min; 6 to 13 micrograms/min) MED (19 micrograms/min; 12 to 28 micrograms/min) and OPD (16 micrograms/min; 9 to 28 micrograms/min). The salivary IgA (Spearman's r = -0.22, P = 0.01) but not the lysozyme (Spearman's r = -0.01, P = 0.9) secretion rate correlated negatively with SAS. Nurses working in various units under different conditions experienced dissimilar levels of stress. Salivary IgA, but not lysozyme, correlated inversely with self-reported levels of stress. It may thus be a potential biomarker in future studies on stress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Biomarkers / analysis
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Immunoglobulin A, Secretory / analysis*
  • Middle Aged
  • Muramidase / analysis*
  • Nurses / psychology*
  • Saliva / immunology*
  • Stress, Psychological / etiology
  • Stress, Psychological / immunology*
  • Surveys and Questionnaires


  • Biomarkers
  • Immunoglobulin A, Secretory
  • Muramidase