Mortality from malignant disease in patients with asthma

Evidence from a large-scale meta-analysis indicates eczema reduces the incidence of glioma

We investigated the relationship between eczema and the risk of primary glioma. Relevant studies were selected through electronic searches of PubMed and EMBASE. A meta-analysis of 12 case-control studies and one cohort study was performed. A fixed effect model was applied to analyze 13 studies consisting of 10,897 glioma cases and 56,081 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the strength of the associations. The data demonstrate that eczema significantly reduces the risk of glioma (OR = 0.69, 95% CI = 0.61-0.78, P < 0.001). Additional studies with larger patient cohorts are required to validate our findings.

Asthma and the risk of lung cancer: a meta-analysis

Some studies found that there was a significant association between asthma and the risk of lung cancer. However, the results are inconclusive. Therefore, we performed a meta-analysis. We searched the electronic databases for all relevant articles. Odds ratio (OR) with 95% confidence interval (CI) were used to calculate the strength of the association between asthma and lung cancer risk. Asthma was significantly associated with the increased risk of lung cancer (OR = 1.44; 95% CI 1.31-1.59; P < 0.00001; I2 = 83%). Additionally, asthma patients without smoking also had the increased lung cancer risk. In the subgroup analysis of race and gender, Caucasians, Asians, male, and female patients with asthma showed the increased risk of lung cancer. However, asthma was not significantly associated with lung adenocarcinoma risk. In the stratified analysis by asthma definition, significant associations were found between asthma and lung cancer in self-reported subgroup, questionnaire subgroup, and register databases subgroup. However, no significant association was observed in physician-diagnosed asthma subgroup. In conclusion, this meta-analysis suggested that asthma might be significantly associated with lung cancer risk.

Association between allergic conditions and risk of prostate cancer: A Prisma-Compliant Systematic Review and Meta-Analysis

Association between allergic conditions and prostate cancer risk has been investigated for many years. However, the results from available evidence for the association are inconsistent. We conducted a meta-analysis to evaluate the relationship between allergic conditions (asthma, atopy, hay fever and “any allergy”) and risk of prostate cancer. The PubMed and Embase databases were searched to screen observational studies meeting our meta-analysis criteria. Study selection and data extraction from included studies were independently performed by two authors. Twenty studies were considered eligible involving 5 case-control studies and 15 cohort studies. The summary relative risk (RR) for developing prostate cancer risk was 1.04 (95%CI: 0.92–1.17) for asthma, and 1.25 (95%CI: 0.74–2.10) for atopy, 1.04 (95%CI: 0.99–1.09) for hay fever, 0.96 (95%CI: 0.86–1.06) for any allergy. In the Subgroup and sensitivity analysis, similar results were produced. Little evidence of publication bias was observed. The present meta-analysis of observational studies indicates that no indication of an association between allergic conditions and risk of prostate cancer was found, and the meta-analysis does not support neither the original hypothesis of an overall cancer protective effect of allergic conditions, nor that of an opposite effect in the development of prostate cancer.

History of allergy and atopic dermatitis in relation to squamous cell and Basal cell carcinoma of the skin

BACKGROUND

Little is known about whether history of allergies and atopy is related to the occurrence of keratinocyte cancers. Thus, we evaluated the association between history of allergies and atopy and the incidence of squamous cell carcinoma (SCC) and early onset basal cell carcinoma (BCC).

METHODS

As part of a population-based case-control study, interviews were conducted with 1,050 residents of New Hampshire (375 early onset BCC cases and 251 controls, 254 SCC cases and 432 controls). ORs of SCC and early onset BCC and history of allergy and atopic dermatitis were computed using logistic regression, while controlling for potential confounding factors.

RESULTS

An overall inverse association was observed between a history of allergy and early onset BCC [OR, 0.61; 95% confidence interval (CI), 0.38-0.97] but not SCC (OR, 1.18; 95% CI, 0.78-1.79). Among women, we found reduced ORs of both early onset BCC and of SCC in relation to allergy history (early onset BCC OR, 0.53; 95% CI, 0.31-0.92 and SCC OR, 0.59; 95% CI, 0.29-1.19). Among men, we observed no clear association with early onset BCC (OR, 0.87; 95% CI, 0.39-1.99) and an increased risk of SCC (OR, 1.58; 95% CI, 0.93-2.69).

CONCLUSION

Our findings suggest that allergies and atopy may influence risk of early onset BCC and SCC, and that effects may be gender specific.

IMPACT

A deeper understanding of the immune mechanisms underlying allergies and atopy may provide new routes of preventing keratinocyte cancers.

Cancer risk and mortality in asthma patients: A Swedish national cohort study

BACKGROUND

Previous studies found an increased risk of cancer in hospitalized asthma patients, but it is not known whether patients from primary health care show a similar risk pattern. In addition, it is unclear whether the diagnosis of asthma can influence the prognosis of subsequent cancer.

METHODS

Asthma patients were identified from Swedish inpatient, outpatient, and primary health care registers, and were linked to the Swedish Cancer Registry to identify subsequent diagnoses of cancer. Standardized incidence ratios (SIRs) were used to examine the risk of cancer in asthma patients compared with subjects without asthma. In addition, we used Cox proportional hazards regression to estimate hazard ratios (HRs) for mortality in patients with both asthma and cancer.

RESULTS

A total of 10 649 cancers were diagnosed in patients with previous asthma, with a SIR of 1.19 (95% CI 1.17-1.21). A total of 15 cancer sites showed an increased incidence, whereas two cancer sites showed a decreased risk. Non-allergic asthma showed the highest risk of cancer (SIR = 1.25, 95% CI 1.18-1.32), followed by unspecified asthma (SIR = 1.22, 95% CI 1.19-1.25), status asthmaticus (SIR = 1.19, 95% CI 1.02-1.39), and allergic asthma (SIR = 1.14, 95% CI 1.06-1.22). The risk of cancer was similarly increased in asthma patients diagnosed in primary health care and those diagnosed in hospitals. Cancer patients with previous asthma had increased mortality, with a HR of 1.55 (95% CI 1.50-1.60). HRs ranged from 1.09 to 1.94 for different sites/types of cancer.

CONCLUSIONS

Patients with asthma, irrespective of whether they were treated in primary health care or hospitals, had an increased risk of cancer. In addition, cancer patients with previous asthma had a worse prognosis compared with those without asthma, suggesting that these patients may require a multidisciplinary approach to manage the comorbidity.

History of allergic diseases and lung cancer risk

BACKGROUND

The exact nature and direction of the association between a history of allergic diseases and lung cancer risk remain controversial.

OBJECTIVE

To examine the association between self-reported history of allergic diseases and lung cancer using data from a population-based case-control study conducted in the Montreal metropolitan area (1996-2002).

METHODS

The study is based on interview data collected from 1,169 incident lung cancer cases and 1,486 controls. Separate logistic regression models were used to estimate the relative risk of lung cancer, using odds ratios (ORs) and 95% confidence intervals (CIs), in subjects with vs without asthma, eczema, or hay fever after adjustment for several sociodemographic and lifestyle factors, including smoking.

RESULTS

For asthma, the OR was 0.90 (95% CI 0.65-1.24), which decreased to 0.76 (95% CI 0.54-1.08) for subjects whose onset was more than 2 years before lung cancer diagnosis or interview and then to 0.64 (95% CI 0.44-0.93) when restricted to subjects who reported using medication for their asthma. For eczema, the point estimate was 0.73 (95% CI 0.48-1.12), which decreased to 0.63 (95% CI 0.38-1.07) when considering eczema only in those who reported medication use. Hay fever showed the strongest inverse association with lung cancer (OR 0.37, 95% CI 0.24-0.59).

CONCLUSION

All 3 allergic diseases examined were inversely associated with lung cancer, although the strength of the protective effect varied. History of allergic diseases seems to have a protective role in lung cancer incidence, after consideration of potential confounders, including lifetime smoking history.

Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines

BACKGROUND

Ever since a lung cancer epidemic emerged in the mid-1900 s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research.

METHODS

A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk.

RESULTS

Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application.

CONCLUSIONS

Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers.

Association between common allergic symptoms and cancer in the NHANES III female cohort

BACKGROUND

Previous epidemiological studies have investigated the association between allergic symptoms and cancer occurrence. However, the role of allergy in cancer has been elusive, especially for the female population.

METHODS

We examined the relationship between cancer prevalence and common allergic symptoms of rhinoconjunctivitis (RC) and wheezing (WZ) among NHANES III female participants.

RESULTS

Among 4600 people, 36.3% (n = 1669) did not have any allergic symptoms (NO), while 47.6% (n = 2188) reported RC, and 16.2% (n = 743), WZ. The proportion of cancer among NO groups was 5.43% (91/1669), among RC group, 7.63% (167/2188), and among WZ group, 11.23% (83/743) (RC group- OR 1.44 with 95% CI 1.00-2.08; p = 0.05 while for WZ group- OR 2.20 with 95%CI 1.27-3.80; p = 0.01). After adjusting for all the possible confounding variables including age, smoking, or COPD, having symptoms of RC (AOR 1.49 with 95%CI 1.12-2.36; p = 0.01) or WC (AOR 2.08 with 95%CI 1.11-3.89; p = 0.02) demonstrated consistent strong association with cancer. Among nonsmokers (n = 2505, 54.5%) only symptoms of RC showed association with cancer (AOR 1.51 with 95%CI 1.00-2.28; p = 0.05). Among former or current smokers (n = 2094, 45.5%), only symptoms of WZ demonstrated association with cancer (AOR 2.38 with 95%CI 1.16-4.87; p = 0.02). Among different types of cancers, odds of having breast cancer among participants with symptoms of RC or WZ were approximately twice the odds of having breast cancer among participants without any of these symptoms. AOR for RC group was 1.89 with 95%CI 1.04-3.42 and p = 0.04 while AOR for WC group was 2.08 with 95%CI 0.90-4.78 and p = 0.08.

CONCLUSIONS

In summary, we found associations between common allergic symptoms like rhinitis/conjunctivitis and wheezing and prevalence of cancer, specifically between rhinitis/conjunctivitis and breast cancer that were not found in previous studies. Larger prospective studies are required to validate our findings.

Asthma and lung cancer risk: a systematic investigation by the International Lung Cancer Consortium

Asthma has been hypothesized to be associated with lung cancer (LC) risk. We conducted a pooled analysis of 16 studies in the International Lung Cancer Consortium (ILCCO) to quantitatively assess this association and compared the results with 36 previously published studies. In total, information from 585 444 individuals was used. Study-specific measures were combined using random effects models. A meta-regression and subgroup meta-analyses were performed to identify sources of heterogeneity. The overall LC relative risk (RR) associated with asthma was 1.28 [95% confidence intervals (CIs) = 1.16-1.41] but with large heterogeneity (I(2) = 73%, P < 0.001) between studies. Among ILCCO studies, an increased risk was found for squamous cell (RR = 1.69, 95%, CI = 1.26-2.26) and for small-cell carcinoma (RR = 1.71, 95% CI = 0.99-2.95) but was weaker for adenocarcinoma (RR = 1.09, 95% CI = 0.88-1.36). The increased LC risk was strongest in the 2 years after asthma diagnosis (RR = 2.13, 95% CI = 1.09-4.17) but subjects diagnosed with asthma over 10 years prior had no or little increased LC risk (RR = 1.10, 95% CI = 0.94-1.30). Because the increased incidence of LC was chiefly observed in small cell and squamous cell lung carcinomas, primarily within 2 years of asthma diagnosis and because the association was weak among never smokers, we conclude that the association may not reflect a causal effect of asthma on the risk of LC.

The association of atopic diseases with breast, prostate, and colorectal cancers: a meta-analysis

There is a long-standing interest in finding whether allergic disorders cause or prevent cancer. We meta-analyzed associations of allergies with prostate, breast, and colorectal cancers. We searched MEDLINE, EMBASE, and Web of Science between 1966 and 2008 and eligible reference lists. A total of 16 observational studies were included. Meta-analyses revealed no evidence that asthma, hay fever, or 'any allergy' are associated with cancers of the breast (relative risk, RR = 0.93, 95% CI: 0.73-1.19 for asthma; 1.04, 0.94-1.16 for hay fever; 1.01, 0.94-1.08 for any allergy); prostate (RR = 0.93, 95% CI: 0.76-1.15 for asthma; 0.96, 0.87-1.05 for hay fever; 1.01, 0.87-1.17 for any allergy); or colorectum (RR = 0.95, 95% CI: 0.77-1.16 for asthma; 0.95, 0.86-1.05 for hay fever; 0.94, 0.85-1.04 for any allergy). There was a positive association of atopy (assessed by allergen-specific IgE or skin prick testing) with prostate cancer (RR = 1.43, 95% CI: 1.08-1.91), but not breast (1.18, 0.90-1.55) or colorectal (1.32, 0.69-2.53) cancers. There is little epidemiological support for the immune surveillance theory or antigenic stimulation theory in breast or colorectal carcinogenesis. The findings for prostate cancer warrant further investigation.

Cancer risk in hospitalised asthma patients

Asthma is an increasingly common disorder, affecting 5–10% of the population. It involves a dysregulated immune function, which may predispose to subsequent cancer. We examined cancer risk among Swedish subjects who had hospital admission once or multiple times for asthma. An asthma research database was created by identifying asthma patients from the Swedish Hospital Discharge Register and by linking them with the Cancer Registry. A total of 140 425 patients were hospitalised for asthma during 1965–2004, of whom 7421 patients developed cancer, giving an overall standardised incidence ratio (SIR) of 1.36. A significant increase was noted for most sites, with the exception of breast and ovarian cancers and non-Hodgkin's lymphoma and myeloma. Patients with multiple hospital admissions showed a high risk, particularly for stomach (SIR 1.70) and colon (SIR 1.99) cancers. A significant decrease was noted for endometrial cancer and skin melanoma. Oesophageal and lung cancers showed high risks throughout the study period, whereas stomach cancer increased towards the end of the period. The relatively stable temporal trends suggest that the asthmatic condition rather than its medication is responsible for the observed associations.

Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)

BACKGROUND

The objective of this study was to summarize the published literature concerning the epidemiology of lung cancer.

METHODS

A narrative review of published evidence was conducted, identifying and summarizing key reports that describe the occurrence of lung cancer in populations and factors that affect lung cancer risk.

RESULTS

In the United States, lung cancer remains the leading cause of cancer death in both men and women, even though an extensive list of modifiable risk factors has long been identified. The predominant cause of lung cancer is exposure to tobacco smoke, with active smoking causing most cases but passive smoking also contributing to the lung cancer burden.

CONCLUSIONS

The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease. Fortunately, exposures to major occupational respiratory carcinogens have largely been controlled, but the population is still exposed to environmental causes of lung cancer, including radon, the second leading cause of lung cancer death.

Cancer incidence in a general population of asthma patients

PURPOSE

Several studies have assessed the association between asthma and cancer but none of them revealed a clear pattern of association. We aimed to examine the association between asthma, chronic obstructive pulmonary disease (COPD), and cancer.

METHODS

We performed a cohort study with a nested case-control analysis using the General Practitioner Research Database in the UK. We defined three cohorts: patients with asthma, patients with COPD, and general population. During the follow-up, we identified a total of 5263 incident cases of cancer. We conducted a nested case-control analysis that included all cancer cases as well as 20 000 controls free of cancer frequency-matched on age, sex, and calendar year.

RESULTS

Patients with asthma did not have an overall greater risk of cancer compared with the general population (odds ratio = 0.93, 95% confidence interval (CI): 0.86-1.00). However, they presented an elevated risk of experiencing lung cancer (odds ratio = 1.84, 95%CI: 1.58-2.15). Controlling for smoking and other potential confounding factors yielded a lower estimate (odds ratio = 1.35, 95%CI: 1.15-1.59). This estimate contrasted with that observed for non-smoking related cancer (0.87, 95%CI: 0.80-0.94). Overall, respiratory drugs did not seem to be associated with cancer among asthmatic patients. Patients with COPD had an Odds ratio of cancer of 1.26 (95%CI: 1.12-1.43) compared with the general population.

CONCLUSIONS

Asthma was not associated with an increased risk of cancer. In fact, the risk of non-smoking related cancer was slightly reduced. However, we observed a small-elevated risk of lung cancer among asthmatic patients. Whether this result is a due to residual confounding and/or protopathic bias remains unclear. Further investigation is warranted to confirm or discard these associations.

An overview of the association between allergy and cancer

Numerous epidemiological studies have evaluated some aspect of the association between a history of allergy and cancer occurrence. In this article, an overview of the epidemiological evidence is presented with a discussion of a number of methodological issues important in this area of study. Literature searches were conducted using the MEDLINE database from 1966 through to August 2005 to identify articles that explored a personal history of allergic disorders as a risk factor for cancer. Although it is difficult to draw conclusions between allergy and cancer at many sites because of insufficient evidence or a lack of consistency both within and among studies completed to date, strong inverse associations have been reported for pancreatic cancer and glioma, whereas lung cancer was positively associated with asthma. Additional studies are needed to confirm these finding and to address the limitations of previous studies, including the validity and reliability of exposure measures and control for confounding. Further, large prospective studies using cancer incidence would be particularly useful, including studies using biological markers of allergic status to reduce potential misclassification and to confirm the results of previous studies based on self-report. There is also a need for further basic research to clarify a potential mechanism, should an association exist.

Safety and tolerability of omalizumab (Xolair), a recombinant humanized monoclonal anti-IgE antibody

Omalizumab (Xolair) is a humanized monoclonal antibody designed to bind specifically to immunoglobulin (Ig)E. It is indicated in the United States for the treatment of adolescent and adult patients (>or=12 yr) with moderate-to-severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen, and whose symptoms are inadequately controlled with inhaled corticosteroids. Omalizumab was evaluated in an extensive clinical development program that included 12 controlled phase IIB/III clinical trials with more than 5,243 patients who were appropriate for inclusion in the safety analysis (all ages in all controlled studies). In these studies, omalizumab had an adverse event profile comparable to that of the control group (i.e., placebo or standard therapy). Data presented in this article supports omalizumab as a safe and well-tolerated agent for the treatment of IgE-mediated asthma.

Cancer risk in asthmatic populations

OBJECTIVE

To conduct a meta-analysis of epidemiologic studies to derive a pooled estimate of the association between asthma and cancer incidence and between allergy and cancer incidence.

DATA SOURCES

Five cohort studies and 1 case-control study of cancer incidence in asthma, 4 studies of cancer mortality in asthma, and 3 studies of cancer incidence in allergy.

STUDY SELECTION

We searched the National Library of Medicine Gateway to identify observational studies of cancer incidence in asthma and included any case-control or cohort study of incident cancers or of cancer mortality that met the predefined inclusion criteria.

RESULTS

There was no significant association between asthma and cancer incidence. A single large cohort study demonstrated a protective effect of asthma; the remaining cohort studies demonstrated a slightly elevated risk of cancer associated with asthma. Inconsistencies in study design features included control of smoking in analyses, use of a control group, and methods to identify asthma status.

CONCLUSIONS

The method of asthma identification affects the validity of asthma classification and the severity of asthma examined. The inconsistency in study designs could have contributed to the variability in results and the underestimation of the impact of asthma on cancer incidence.

Allergy and cancer

BACKGROUND

Conflicting results have provided support for two distinct and contradictory hypotheses: (i) allergy has a protective effect against cancer by enhanced immune surveillance, and (ii) allergy is associated with an increased risk of cancer by chronic immune stimulation. We therefore aimed us to perform a large epidemiological study with a defined allergic disease cohort.

METHODS

During the years 1988-2000, 70 136 patients tested for total serum immunoglobulin E (IgE) and 57 815 tested with Phadiatop for diagnosing allergic disease at Karolinska University Hospital, Stockholm, Sweden, were linked with the Swedish Cancer Registry for a virtually complete follow up with regard to cancer.

FINDINGS

The total number of observed cancers was normal in the total serum IgE-cohort; standardized incidence ratio (SIR) = 0.98 (95% CI: 0.92-1.04) and in the Phadiatop-cohort: SIR = 0.99 (0.92-1.06) independent of the level of IgE and positive or negative Phadiatop. Specific analysis was done for cancer of the lung, cervix, pancreas, lymphoma, and nonmelanoma skin cancer. None of these forms of cancer had increased risks.

INTERPRETATION

The study does not support the hypothesis that allergy has a protective effect against cancer, nor does it support an increased risk.

Allergic conditions and risk of hematological malignancies in adults: a cohort study

BACKGROUND

Two contradictory hypotheses have been proposed to explain the relationship between allergic conditions and malignancies, the immune surveillance hypothesis and the antigenic stimulation hypothesis. The former advocates that allergic conditions may be protective against development of cancer, whereas the latter proposes an increased risk. This relationship has been studied in several case-control studies, but only in a few cohort studies.

METHODS

The association between allergic conditions and risk of developing leukemia, Hodgkin's disease, non-Hodgkin's lymphoma and myeloma was investigated in a cohort of 16,539 Swedish twins born 1886-1925. Prospectively collected, self-reported information about allergic conditions such as asthma, hay fever or eczema was obtained through questionnaires administered in 1967. The cohort was followed 1969-99 and cancer incidence was ascertained from the Swedish Cancer Registry.

RESULTS

Hives and asthma tended to increase the risk of leukemia (relative risk [RR] = 2.1, 95% Confidence Interval [CI] 1.0-4.5 and RR = 1.6, 95% CI 0.8-3.5, respectively). There was also an indication of an increased risk of non-Hodgkin's lymphoma associated with eczema during childhood (RR = 2.3, 95% CI 1.0-5.3).

CONCLUSION

In contrast to most previous studies, our results do not indicate a protective effect of allergic conditions on the risk of developing hematological malignancies. Rather, they suggest that allergic conditions might increase the risk of some hematological malignancies.

Lymphoproliferative Disease in Human Peripheral Blood Mononuclear Cell-Injected SCID Mice. IV. Differential Activation of Human Th1 and Th2 Lymphocytes and Influence of the Atopic Status on Lymphoma Development

Intraperitoneal transfer of PBMC from EBV+ donors into SCID mice leads to high human Ig levels in mouse serum and B cell lymphoproliferative disease. As these events depend on the activation of coinjected human T cells, we addressed the behavior of the Th1 and Th2 subsets in this model. Production of IFN-γ, but not of Th2 cytokines such as IL-4, was detected in culture supernatants of PBMC stimulated in vitro with mouse splenocytes. Moreover, anti-CD3 stimulation of the human cells recovered from mice brought about IFN-γ, but not IL-4, synthesis; on the other hand, PCR and in situ hybridization analysis of ex vivo-recovered cells disclosed the presence of mRNA for both cytokines following in vitro restimulation, thus suggesting post-transcriptional regulation of IL-4 gene expression. When SCID mice were inoculated with PBMC from atopic donors, whose Th1/Th2 profile displays an imbalance toward Th2 cells, tumor development rates were lower, and tumor latency was higher, compared with those in mice injected with PBMC from normal donors. Isotypic analysis of human Ig in mouse serum showed the exclusive presence of IFN-γ-driven IgG subclasses; in addition, human IgE were low or undetectable in most cases. These findings indicate that following transfer into SCID mice, human Th1 lymphocytes undergo preferential activation, whereas Th2 function is down-regulated. Th1 lymphocytes probably are a major component in promoting EBV+ B cell expansion and tumor development; the individual Th1/Th2 profile could in part account for the as yet unexplained donor variability in tumor generation in this experimental model.

Mortality of adults with asthma: a prospective cohort study

BACKGROUND

Few studies have been published on the overall survival of adult patients with asthma. A cohort study was performed to assess the mortality from all causes, from chronic obstructive pulmonary disease, and from lung cancer among adult asthmatic subjects.

METHODS

A population of 31,110 Finnish adult women and men, mostly twins, was studied to compare the 16 year mortality rates among asthmatic (n = 471) and non-asthmatic persons. A further 293 twin pairs, discordant for asthma, were also studied to determine whether the mortality of patients with asthma differs from that of their age matched siblings.

RESULTS

Mortality from all causes was increased among asthmatic adults (age adjusted hazard ratios 1.49, 95% CI 1.09 to 2.05 for men and 1.53, 95% CI 1.10 to 2.13 for women), and mortality due to chronic obstructive pulmonary diseases was also significantly increased in asthmatic subjects. The risk of death due to lung cancer was increased in men with asthma (hazard ratio adjusted for smoking 3.19, 95% CI 1.39 to 7.31). The risk ratios found among twins discordant for asthma corresponded to those found in the whole cohort.

CONCLUSIONS

Survival in adults with asthma is worse than in those without asthma. The excess deaths due to chronic obstructive pulmonary disease may explain some part of the increased mortality rates, but not all of it.

Mortality in adults with self-reported asthma. Copenhagen City Heart Study Group

BACKGROUND

On the question of whether asthma shortens survival the published work gives no clear answer. We have prospectively analysed overall and cause-specific mortality in persons with self-reported asthma. METHODS A sample of 13 540 individuals (6104 men) 20 years of age or older, randomly selected from the general population of the city of Copenhagen, was followed for 17 years.

FINDINGS

Survival in participants with self-reported asthma was significantly poorer than in non-asthmatics, the excess mortality being limited to pulmonary mortality. After statistical adjustment for age, length of school education, and smoking, women with asthma had a 1.7 higher risk of dying than women without asthma (95% confidence interval 1.3--2.2). Although the relative risk (RR) of dying with asthma was slightly lower in men (RR = 1.5, 95% Cl 1.2-1.9) the difference between sexes was not significant. The results were similar within smoking groups and the highest risk of death associated with asthma was seen among never-smokers (RR = 2.1, 95% Cl 1.6-2.3). Inclusion of one-second forced expiratory volume, in % predicted, in the mortality analyses showed that the increased risk of death associated with asthma was mediated mainly through reduced lung function.

INTERPRETATION

We conclude that, in the general population, self-reported asthma is associated with a slight excess of mortality, mainly from respiratory diseases.

A prospective study of cancer incidence in a cohort examined for allergy

In order to assess the association between atopy and cancer risk, a cohort of 6593 skin-prick-tested patients was established. Among atopic subjects, no overall increased cancer risk was found, but the incidence of both breast cancer (standardized incidence ratio (SIR) 2.50, 95% CI 1.01-5.16) and malignant lymphomas (SIR 4.40, 95% CI 1.20-11.3) was significantly enhanced. Atopic subjects with asthma showed a decreased overall cancer risk (SIR 0.73, 95% CI 0.27-1.60), as compared with the other asthmatic subjects (SIR 1.46, 95% CI 1.03-2.04). The cancer risk for subjects with rhinitis was near unity (SIR 1.11), irrespective of whether the subjects were atopic or not. An almost significant risk increase for cancer was observed among subjects with urticaria (SIR 1.70, 95% CI 0.99-2.80). Our results support neither the original hypothesis of an overall cancer protective effect of atopy, nor that of an opposite effect; rather, they strengthen the view that the association between atopic diseases and cancer is complex.

Human immune toxicity

This review examines xenobiotic toxicity to the immune system, stressing in particular those aspects of most relevance to humans. Immunotoxicity is examined especially from three points of view: by what immunological component is affected, by classes of foreign agents that adversely affect the human immune system and by critical evaluation of human case reports and epidemics. Mechanisms by which xenobiotics interrupt cytokine networks are emphasized. The concept that microbial agents, both environmental as well as infectious, may act as immunotoxicants, either alone or in synergism with conventional agents is introduced. Instances of human immunotoxicology are critically evaluated in terms of clinical relevance, i.e. whether increased susceptibility to opportunistic infections or tumor emergence takes place in the affected individuals.

Cutaneous response to intradermal histamine in lung cancer

Recent evidence has suggested that human neoplastic patients show decreased blood histamine levels and cutaneous responses to intradermal histamine. In this study we evaluate the skin response to intradermal injections of histamine and IgE levels in 34 male patients with lung cancer (of which 21 had metastasis) and in 16 control subjects. Analysis of our data does not reveal any difference in the areas of wheal and flare between control subjects and lung cancer patients with or without metastasis. Moreover the evaluation of the different histologic cell type of lung cancer provides the same results. In addition, the sensitivity (Histamine Threshold Concentration) and reactivity (slopes) to histamine is not statistically different. No difference is found for IgE levels between controls and cancer patients. In the light of our finding we believe that in lung cancer patients skin response to intradermal histamine is not decreased, and therefore that the hypothesis concerning the existence of H1-histamine receptor antagonist released by tumour is not confirmed.

Atopy and primary lung cancer. Histology and sex distribution

Atopy, defined as the ability to develop IgE antibodies to commonly encountered allergens under conditions of normal exposure, has an inherited component with pleiotropic effects. An inverse relationship between the occurrence of atopy, allergy-related diseases, and cancers at specific sites has been reported. The familial association of primary lung cancer is most evident among women, nonsmokers, and those with adenocarcinomas. In order to determine whether the relationship between a lower prevalence of atopy among patients with lung cancer compared to control subjects was consistent between histologic cell types, we used seven common allergens to allergy prick skin test 209 community control subjects (46 women), 109 cases with primary squamous cell carcinoma of the lung (25 women), and 67 patients with primary adenocarcinomas of the lung (23 women). We have confirmed earlier reports of an inverse relationship between atopy and lung cancer risk. In analyses focusing on sex and histologic cell type, we found that women with adenocarcinomas were an exception and were as likely to be atopic as control subjects. The evidence does not support a protective role for atopy among these women.

Inhibition of natural killer cell activity by oral administration of theophylline

Asthmatic patients have a low incidence of malignancies, and this is possibly due to higher NK cell activity in this population. Because theophylline is used widely in this population, we evaluated the influence of theophylline on NK cell activity in vitro and in vivo. The NK cell activity was significantly inhibited by direct addition of concentrations of aminophylline that exceeded 5 x 10(-5) M. To test whether such an effect can be observed in vivo, we administered one sustained-release tablet of theophylline (400 to 500 mg twice daily) to five normal volunteers for seven days. Significant inhibition of NK activity was noted after administration (mean percentage of inhibition, 41.3 percent), but the serum concentrations observed gave a mean value of 2 x 10(-5) M, which was lower than that yielding the same degree of inhibition by direct addition in vitro (about 20 x 10(-5) M). These results suggest that long-term theophylline therapy may inhibit NK cell activity, and thus more information would be needed to determine the position of such therapy in the management of asthmatic patients.

Acute myelocytic leukemia and prior allergies

The relationship between prior allergies and adult acute myelocytic leukemia was investigated in a population-based case-control study. Based on data from personal interviews of 98 cases and 133 controls, a history of any type of allergy was associated with a significantly decreased risk of acute myelocytic leukemia (OR = 0.35, 95% CI = 0.20-0.60). Risk declined with the total number of specific allergies reported (p less than 0.001), and was reduced in relation to a history of prior asthma, eczema and hives. The implications of these findings in relation to natural immune surveillance against developing neoplasms are discussed.

Allergy and risk of cancer. A prospective study using NHANESI followup data

The First National Health and Nutrition Examination Survey (NHANESI), conducted in 1971-1975, included a cohort of 6913 adults for whom history of smoking, allergies, and other factors was obtained. These persons were traced (with 93% success) approximately 10 years later by the NHANESI Epidemiologic Followup Survey, and incidence of malignancy in the interim period was determined. Primary allergy variables were physician-diagnosed asthma, hay fever, hives, food allergy, or other allergies. Excluded were persons with a prior history of cancer and cases of nonmelanoma skin cancer. After adjustment by logistic regression for age, sex, race, and smoking history, allergic history was found to increase the risk of subsequent malignancy (risk odds ratio = 1.40, 95% confidence interval = 1.10-1.77). The specific allergy type with the strongest cancer risk was hives. The cancer group with the strongest allergy association was lymphatic-hematopoietic (leukemia, lymphoma, myeloma). The risk odds ratio of developing leukemia, lymphoma, or myeloma for persons with hives history was 7.89 (95% CI = 3.13-19.89). These findings suggest that a history of allergy does not protect against subsequent cancer, and may be a risk factor. The possibility is raised that a history of hives may be a particular risk factor for lymphatic-hematopoietic malignancies.

Natural killer and interleukin-2 induced cytotoxicity in asthmatics. I. Effect of acute antigen-specific challenge

Natural killer (NK) cell activity and interleukin-2 (IL-2) induced cytotoxicity to NK-resistant targets T24 in a group of patients with grass pollen seasonal asthma were investigated. Acute bronchial provocation with this antigen was also performed and blood samples were taken before and 15 min after the maximal clinical response. NK activity was elevated in this group but there was a significant decrease after acute challenge. IL-2 induced cytotoxicity was also increased and declined after antigen challenge. Limiting dilution analysis for minimal frequencies of precursors of the IL-2 induced killer cells was introduced and showed increased numbers of lymphokine-activated killing precursors in this group of patients. These data might indicate the aberrations of the IL-2 system in immediate type allergy but the clinical significance of these findings remains to be determined.

Lower prevalence of positive atopic skin tests in lung cancer patients

Allergy prick skin testing was performed on 137 newly diagnosed patients with primary lung cancer and 137 age-(+/- 3 years) and sex-matched randomly selected control subjects. We also compared 38 patients with lung cancer and 38 of their closest in age, same-sex siblings. Demographic data, personal, medical, smoking and occupational histories were obtained by personal interview. We skin tested these individuals with a standard battery of seven common allergens and a diluent control. Fewer patients (35.8 percent) than control subjects (58.4 percent) responded with one or more positive skin reactions (p less than .005). There was no significant difference between patients (27.8 percent) and control subjects (37.2 percent) responding to more than one allergen. Fewer of the 38 sibling-matched patients had one or more positive skin tests (23.7 percent) than did their siblings (55.3 percent) (p less than .01). There were fewer patients with greater than one positive skin test (15.8 percent) than sibling control subjects (42.1 percent) (p less than .025). There were no differences in smoking pack-years between patients and siblings. Historic evidence of allergy was greater in both control groups compared to their matched cancer groups; p less than .05 for community controls, p less than .005 for sibling control subjects. These findings raise the possibility that atopy, by either immunologic or nonimmunologic means, protects against development of lung cancer, or alternately, that lung cancer affects immunologic status as gauged by (type 1) skin sensitivity.

Prognosis in adult asthma: a national study

Although one million people consult their general practitioners for asthma each year, data on the prognosis of this disease are scarce, particularly in adults. Mortality was studied among 2547 adult asthmatics attending a national sample of 60 general practices between 1970 and 1976; they were compared with a matched group of non-asthmatic patients. Mortality from all causes was significantly raised in the asthmatic cohort (189 deaths v 112 among controls; relative risk 1.61, 95% confidence interval 1.3 to 2.0), especially in women (92 v 42 deaths; relative risk 2.2 (1.5 to 3.1)), and in the oldest age group (55-59 years). In both sexes the predominant cause of excess mortality was respiratory disease, particularly asthma (25 v 0 deaths) and chronic obstructive airways disease (37 v 4 deaths; relative risk 8.8 (2.8 to 23)). Overall, 94% of the asthmatic cohort survived the mean follow up period of eight years compared with 96% of the controls. In contrast to previous findings, the risk of death due to malignant neoplasms was not significantly reduced overall (34 v 36 deaths), though the risk was significantly reduced among those aged under 45 years (2 v 10 deaths; relative risk 0.2 (0.02 to 0.9)) and there was a significant trend of lowering of relative risk with younger age (p less than 0.01).

Immunobiologic staging of patients with carcinoma of the head and neck

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.

Decreased blood histamine levels in patients with solid malignant tumours

In a one-year follow-up study, 444 blood histamine determinations were performed in 163 patients with solid malignant tumours. Compared with normal subjects, blood histamine levels were significantly lower in patients with unresected primary tumours (30.7 +/- 19.9 ng ml-1), metastases (34.1 +/- 17.1 ng ml-1), or both (24.5 +/- 12.8 ng ml-1). By contrast, after successful tumour resection, histamine blood levels were nearly normal (52.1 +/- 18.4 ng ml-1, versus 59.6 +/- 22.6 in control patients). Stability of the histamine blood levels was associated with stability of the disease. A progressive decrease in histamine blood levels preceded clinical relapse or detection of metastasis. In patients with consecutive histamine blood levels which were less than 15 ng ml-1, survival did not exceed 2 months. In patients with gastrointestinal tumours, blood histamine levels provided information additional to that derived from serum CEA determination. In patients with non-gastrointestinal tumours, the blood histamine level may be of more value than CEA as a marker of disease progression.

Immunobiology in otolaryngology

Immunologic aspects of otolaryngologic diseases are appearing in our literature, and clinical applications of these concepts are becoming available. The significance of these advances is obscured by the confusing terminology usually employed; however, the terminology can be mastered without much difficulty. The humoral and cellular divisions of the immune system have long been recognized. The humoral division of the immune system appears to play a major role in the prevention of infection, autoimmune disease, and atopic disease. The cellular division is probably most important in the prevention of neoplastic disease. There is overlap and the systems do interact. Future manipulations of the immune system may assist in the diagnosis and treatment of diseases such as chronic secretory otitis media, allergic rhinitis, and cancer of the head and neck.

Mortality from respiratory disease at follow-up of patients with asthma

Over a 20-year period 765 men and 1127 women with asthma were followed up; 272 men and 282 women died compared with expected deaths of 165 men and 185 women. As anticipated there was an appreciable number of deaths attributed to asthma but an even higher absolute excess of deaths attributed to bronchitis when compared with the expected numbers. The relative excess from asthma and bronchitis was highest in the younger subjects. Mortality from all other causes was lower than expected.