Autoimmune Diseases in Asthma

20 June 2006 | Volume 144 Issue 12 | Pages 877-883

Background: Previous research has suggested an inverse relationship between T-helper 2–related atopic disorders, such as asthma, and T-helper 1–related autoimmune diseases. One controversial hypothesis postulates that asthma provides a protective effect for the development of autoimmune-related disorders.

Objective: To assess the rate of newly diagnosed autoimmune disorders in a large cohort of young adults.

Design: Using cross-sectional data from the Israeli Defense Force database, the authors analyzed the prevalence of autoimmune disorders in asthmatic and nonasthmatic military personnel between 1980 and 2003. A follow-up study traced newly diagnosed autoimmune disorders among asthmatic and nonasthmatic individuals from the time of enrollment in military service until discharge (22 and 36 months for women and men, respectively).

Setting: General community.

Patients: 307 367 male and 181 474 female soldiers in compulsory military service who were between 18 and 21 years of age.

Measurements: Cases of type 1 diabetes mellitus, vasculitis, immune thrombocytopenic purpura, inflammatory bowel disease, rheumatoid arthritis, and the antiphospholipid syndrome.

Results: Of 488 841 participants at enrollment, significantly more women than men had autoimmune disorders. Compared with asthmatic women, nonasthmatic women had a significantly higher prevalence of all autoimmune disorders except for the antiphospholipid syndrome. Type 1 diabetes mellitus, vasculitis, and rheumatoid arthritis were less prevalent in men with asthma than in those without. During the follow-up period, vasculitis and rheumatoid arthritis were more frequently diagnosed in nonasthmatic persons of both sexes. There was a significantly higher incidence of immune thrombocytopenic purpura, inflammatory bowel disease, and the antiphospholipid syndrome in nonasthmatic women and a statistically significantly higher incidence of type 1 diabetes mellitus in nonasthmatic men.

Limitations: The study was limited to a population of young military recruits; therefore, its findings are not necessarily applicable to the general population. Because of the noninterventional nature of the study, it describes associations but cannot prove causality.

Conclusions: Asthma status may affect the prevalence of major autoimmune disorders. Preexisting asthma seems to protect against the development of autoimmune disorders to varying degrees in men and women.

Editors' Notes Context Previous investigators have suggested that asthma, a T-helper allergic disease, may protect against the development of T-helper 1–mediated autoimmune diseases. Contribution These investigators surveyed nearly half a million military conscripts for evidence of asthma and autoimmune disease and followed them during their period of military service. The prevalence of autoimmune diseases was significantly lower in persons with asthma than in those without. Cautions Follow-up covered only the period of military service. Some asthmatic persons may have received corticosteroid therapy, which may have suppressed autoimmune disease manifestations. Implications Hygienic measures to prevent asthma may have unanticipated effects on the incidence of autoimmune disease. —The Editors

 

Author and Article Information

From the Sheba Medical Center, Tel Hashomer, and the Israel Defense Forces Medical Corps, Israel.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Amir Tirosh, MD, PhD, Department of Internal Medicine A+C, Sheba Medical Center, Tel Hashomer 52662, Israel; e-mail, amirt{at}bgumail.bgu.ac.il.

Current Author Addresses: Dr. Tirosh: Department of Internal Medicine A + C, Sheba Medical Center, Tel Hashomer 52662, Israel.

Drs Mandel, Mimouni, Zimlichman, and Kochba and Ms. Shochat: Israel Defense Forces Medical Corps Headquarters, Israel.

Author Contributions: Analysis and interpretation of the data: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman, I. Kochba.

Drafting of the article: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman.

Critical revision of the article for important intellectual content: F.B. Mimouni.

Final approval of the article: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman, T. Shochat, I. Kochba.

Provision of study materials or patients: A. Tirosh, I. Kochba.

Statistical expertise: T. Shochat.

Obtaining of funding: I. Kochba.

Administrative, technical, or logistic support: I. Kochba.

Collection and assembly of data: A. Tirosh, T. Shochat.

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