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Allergic disease, corticosteroid use, and risk of Hodgkin lymphoma: A United Kingdom nationwide case-control study.

Authors
  • Rafiq, Meena1
  • Hayward, Andrew2
  • Warren-Gash, Charlotte3
  • Denaxas, Spiros4
  • Gonzalez-Izquierdo, Arturo4
  • Lyratzopoulos, Georgios2
  • Thomas, Sara3
  • 1 Institute of Health Informatics, UCL, London, United Kingdom. Electronic address: [email protected] , (United Kingdom)
  • 2 Institute of Epidemiology and Health Care, UCL, London, United Kingdom. , (United Kingdom)
  • 3 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. , (United Kingdom)
  • 4 Institute of Health Informatics, UCL, London, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
The Journal of allergy and clinical immunology
Publication Date
Mar 01, 2020
Volume
145
Issue
3
Pages
868–876
Identifiers
DOI: 10.1016/j.jaci.2019.10.033
PMID: 31730878
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Immunodeficiency syndromes (acquired/congenital/iatrogenic) are known to increase Hodgkin lymphoma (HL) risk, but the effects of allergic immune dysregulation and corticosteroids are poorly understood. We sought to assess the risk of HL associated with allergic disease (asthma, eczema, and allergic rhinitis) and corticosteroid use. We conducted a case-control study using the United Kingdom 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. One thousand two hundred thirty-six patients with HL were matched to 7416 control subjects. 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 was associated with 1.4-fold increased odds of HL (aOR, 1.41 [95% CI, 1.24-1.60] and 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] and 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). In addition to established risk factors (immunosuppression and infectious mononucleosis), allergic disease and eczema are risk factors for 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 after allergic disease or immunosuppression is central to HL development. Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

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