Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 145, Issue 3, Pages 868-876Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2019.10.033
Keywords
Allergic disease; Hodgkin lymphoma; corticosteroids; asthma; eczema; allergic rhinitis; risk; atopic dermatitis
Categories
Funding
- National Institute for Health Research (NIHR) [IPF-2017-11-011]
- NIHR
- Cancer Research UK Advanced Clinician Scientist Fellowship [C18081/A18180]
- Cancer Research UK [C8640/A23385]
- ESRC [ES/L007517/1] Funding Source: UKRI
- MRC [1940103] Funding Source: UKRI
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Background: 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. Objective: We sought 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 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. Results: 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 associatedwith 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). Conclusions: 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.
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