Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: A register study

doi:10.1067/mai.2001.119557

Journal of Allergy and Clinical Immunology

Volume 108, Issue 5, November 2001, Pages 781-783

https://doi.org/10.1067/mai.2001.119557 Get rights and content

Abstract

Background: Asthma is generally regarded as a disease with strong T_H2-type cytokine expression, whereas in autoimmune disorders, such as coeliac disease (CD), insulin-dependent diabetes mellitus (IDDM), and rheumatoid arthritis (RA), T_H1-type expression is seen. According to the cross-regulatory properties of T_H1 and T_H2 cells, one would assume that these diseases exist in different patient populations. Objective: We sought to test the hypothesis that asthma could exist in children with T_H1-type diseases, such as CD, IDDM, and RA. Methods: Comparison was made of the cumulative incidence of asthma in children with CD, IDDM, or RA by linking Finnish Medical Birth Register data on the whole 1987 birth cohort (n = 60,254 births) with the data of several national health registers to obtain information on the incidences of these diseases during the first 7 years of life. Results: The cumulative incidence of asthma in children with CD (24.6%) or RA (10.0%) was significantly higher than in children without CD (3.4%) or RA (3.4%; P < .001 and P = .016, respectively). Asthma tended to be more common in children with IDDM than in children without IDDM. Conclusion: These data indicate that the T_H1 and T_H2 diseases can coexist, indicating a common environmental denominator behind the disease processes. (J Allergy Clin Immunol 2001;108:781-3.)

Section snippets

Methods

The basic data stem from the 1987 Finnish Medical Birth Register supplemented by data linkage between the Central Population Register and the Cause-of-Death Register. More specifically, the basic data were linked with the following register sources covering the years 1987 to 1994: (1) Central Population Register; (2) Cause-of-Death Register; (3) Hospital Discharge Register; (4) register data on free or heavily subsidized medication and on care support (a social benefit granted to a family

Results

The cumulative disease incidences at the age of 7 years were 34.2 of 1000 for asthma, 1.9 of 1000 for CD, 3.0 of 1000 for IDDM, and 1.3 of 1000 for RA. To test for the presence of T_H1 and T_H2 diseases in different populations, the cumulative incidences of asthma in children with autoimmune-type diseases, such as CD, IDDM, and RA, were compared with those in children without these conditions. The cumulative incidence of asthma in children with CD or RA was significantly elevated (Table I), being

Discussion

An imbalance between distinct T_H subtypes has been reported to underlie the pathogenesis of asthma and autoimmune disorders, such as CD, IDDM, and RA. In asthma the balance is typically skewed toward expression of T_H2 cytokines,¹² and in RA, IDDM, or CD, the balance is skewed toward T_H1 cytokines.13, 14, 15 Notwithstanding the counterregulatory effects of these T_H phenotypes,5, 16 asthma was here shown to coexist preferentially in children with CD or RA. The customary categorization of T_H1/T_H2

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^☆: Reprint requests: Jukka Kero, MD, Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimerfeld 366/ Room 309, Heidelberg D-69120, Germany.

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Mechanisms of AllergyCould TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: A register study☆

Abstract

Section snippets

Methods

Results

Discussion

Immunol Today

Semin Arthritis Rheum

J Allergy Clin Immunol

Immunol Today

Immunol Today

Lancet

Lancet

J Allergy Clin Immunol

An update on human Th1 and Th2 cells

Int Arch Allergy Immunol

Human Th1 and Th2 lymphocytes: their role in the pathophysiology of atopy

Allergy

Divergent T-cell cytokine patterns in rheumatoid arthritis

Proc Natl Acad Sci

Functional diversity of helper T lymphocytes

Nature

Worldwide increase in incidence of Type I diabetes—the analysis of the data on published incidence trends

Diabetologia

High incidence and prevalence of adult coeliac disease. Augmented diagnostic approach

Scand J Gastroenterol

Mechanisms of Allergy
Could T_H1 and T_H2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: A register study☆