Rafiq, M;
Hayward, A;
Warren-Gash, C;
Denaxas, S;
Gonzalez-Izquierdo, A;
Lyratzopoulos, G;
Thomas, S;
(2019)
Allergic disease, corticosteroid use and risk of Hodgkin's lymphoma: A UK Nationwide case-control study.
Journal of Allergy and Clinical Immunology
10.1016/j.jaci.2019.10.033.
(In press).
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Abstract
BACKGROUND: Immunodeficiency syndromes (acquired/congenital/iatrogenic) are known to increase Hodgkin's lymphoma (HL) risk, but the effect of allergic immune dysregulation and corticosteroids are poorly understood. OBJECTIVE: To assess the risk of HL associated with allergic disease (asthma, eczema and allergic rhinitis) and corticosteroid use. METHODS: We conducted a case-control study using the UK Clinical Practice Research Datalink (CPRD) linked to hospital data. Multivariable logistic regression investigated associations between allergic diseases and HL after adjusting for established risk factors. Potential confounding or effect modification by steroid treatment were examined. RESULTS: 1,236 cases of HL were matched to 7,416 controls. Immunosuppression was associated with 6-fold greater odds of HL (Adjusted Odds Ratio (AOR), 6.18; 95%CI, 3.04-12.57), with minimal change after adjusting for steroids. Any prior allergic disease or eczema alone were associated with 1.4-fold increased odds of HL (AOR, 1.41; 95%CI, 1.24-1.60; AOR, 1.41; 95%CI, 1.20-1.65, respectively). These associations decreased but remained significant after adjustment for steroids (AOR, 1.25; 95%CI, 1.09-1.43; AOR, 1.27; 95%CI, 1.08-1.49, respectively). There was no effect modification by steroid use. Previous steroid treatment was associated with 1.4-fold greater HL odds (AOR, 1.38; 95%CI, 1.20-1.59). CONCLUSIONS: In addition to established risk factors (immunosuppression and infectious mononucleosis), allergic disease and eczema are risk factors for developing HL. This association is only partially explained by steroids, which are associated with increased HL risk. These findings add to the growing evidence that immune system malfunction, following allergic disease or immunosuppression, is central to HL development.
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