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Original Research |

Autoimmune Diseases in Asthma

Amir Tirosh, MD, PhD; Dror Mandel, MD; Francis B. Mimouni, MD; Eyal Zimlichman, MD; Tzippora Shochat, MSc; and Ilan Kochba, MD
[+] Article, Author, and Disclosure Information

From the Sheba Medical Center, Tel Hashomer, and the Israel Defense Forces Medical Corps, Israel.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Amir Tirosh, MD, PhD, Department of Internal Medicine A+C, Sheba Medical Center, Tel Hashomer 52662, Israel; e-mail, amirt@bgumail.bgu.ac.il.

Current Author Addresses: Dr. Tirosh: Department of Internal Medicine A + C, Sheba Medical Center, Tel Hashomer 52662, Israel.

Drs Mandel, Mimouni, Zimlichman, and Kochba and Ms. Shochat: Israel Defense Forces Medical Corps Headquarters, Israel.

Author Contributions: Analysis and interpretation of the data: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman, I. Kochba.

Drafting of the article: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman.

Critical revision of the article for important intellectual content: F.B. Mimouni.

Final approval of the article: A. Tirosh, D. Mandel, F.B. Mimouni, E. Zimlichman, T. Shochat, I. Kochba.

Provision of study materials or patients: A. Tirosh, I. Kochba.

Statistical expertise: T. Shochat.

Obtaining of funding: I. Kochba.

Administrative, technical, or logistic support: I. Kochba.

Collection and assembly of data: A. Tirosh, T. Shochat.

Ann Intern Med. 2006;144(12):877-883. doi:10.7326/0003-4819-144-12-200606200-00004
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There were 488 841 participants who enrolled in the IDF between 1980 and 2003 and fulfilled the inclusion criteria; the sample included 181 474 women and 307 367 men. Table 1 shows the rates of various autoimmune disorders present in the entire cohort at the time of enrollment. The prevalence of type 1 diabetes in men and women was not significantly different, but all other documented autoimmune disorders were present at significantly higher rates in women than in men. Compared with asthmatic women, nonasthmatic women had a significantly higher prevalence of type 1 diabetes (risk ratio, 1.56 [95% CI, 1.02 to 2.61]; P = 0.008), vasculitis (risk ratio, 1.58 [CI, 1.01 to 2.48]; P = 0.004), and rheumatoid arthritis (risk ratio, 2.40 [CI, 1.19 to 4.85]; P = 0.011). Nonasthmatic men also had a significantly higher prevalence of these 3 conditions than their asthmatic counterparts; the risk ratios were 1.83 (CI, 1.33 to 2.53; P < 0.001) for type 1 diabetes, 1.90 (CI, 1.02 to 3.87; P = 0.037) for vasculitis, and 1.67 (CI, 1.01 to 3.05; P = 0.042) for rheumatoid arthritis. Immune thrombocytopenic purpura and inflammatory bowel disease were found to be significantly more prevalent in nonasthmatic women only; no significant differences were found between asthmatic and nonasthmatic men. The prevalence of the antiphospholipid syndrome was similar between asthmatic and nonasthmatic men and women. Overall, the prevalence of any autoimmune disease was 1.62-fold higher in nonasthmatic women and 1.23-fold higher in nonasthmatic men than in their asthmatic counterparts. The rates of nephrolithiasis and cholelithiasis were not significantly different between asthmatic and nonasthmatic persons of both sexes.

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Submit a Comment/Letter
Asthma and autoimmune disease
Posted on July 18, 2006
Atul A Khasnis
Michigan State University
Conflict of Interest: None Declared

I read with great interest the recent article by Tirosh et al. in the June 20, 2006 issue of the Annals of Internal Medicine. I would like to make some interesting points regarding the article.

The hypothesis of Th1 versus Th2 phenotypes as explanatory for autoimmune diseases and asthma is not sharply defined. This hypothesis is supported by the recent trials using parasites (human hookworm - Necator americanus) to treat asthma (1); the proposed mechanism being subversion of the immune system from a Th2 to Th1 response and improved regulatory T cell function (2). Although the authors have stated that vasculitis stems from a Th1 dependent profile, Churg-Strauss vasculitis has the distinction of having a significant Th2 cytokine profile (3).

The investigators enrolled recruits from the Israeli military. They have included various autoimmune disorders including some of the systemic vasculitides, but Behcet's disease, which has a high incidence in this region (the Silk Road) (4), is not quoted. Interestingly, Behcet's disease can present as asthma secondary to gastro-esophageal reflux following esophageal stricture formation (5).

Most autoimmune diseases exhibit a latent period of months to many years. The period of follow- up (maximum three years) for new-onset autoimmune disease may also account for the differences seen in the two groups and may disappear at longer follow-up.


1. Falcone FH, Pritchard DI. Parasite role reversal: worms

on trial. Trends Parasitol. 2005; 21:157-60.

2. Ling EM, Smith T, Nguyen XD, Pridgeon C, Dallmann M,

Arbery J, et al. Relation of CD4+CD25+ regulatory T-cell

suppression of allergen-driven T-cell activation to

atopic status and expression of allergic disease.

Lancet. 2004; 363: 608 "“ 15.

3. Hellmich B, Csernok E, Gross WL. Proinflammatory

cytokines and autoimmunity in Churg-Strauss syndrome.

Ann N Y Acad Sci. 2005; 1051:121-31.

4. Sakane T, Takeno M, Suzuki N, Inaba G. Current concepts:

Behcet's disease. N Engl J Med 1999; 341:1284-1291.

5. Wooster D, Henderson RD, Lilker ES, Peress L. Further

manifestations of Behcet's syndrome. Can J Surg. 1980;


Conflict of Interest:

None declared

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Summary for Patients

What Are the Risks of Using Inhaled Long-Acting Beta-Agonist Medications for the Relief of Asthma?

The summary below is from the full report titled “Meta-Analysis: Effect of Long-Acting β-Agonists on Severe Asthma Exacerbations and Asthma-Related Deaths.” It is in the 20 June 2006 issue of Annals of Internal Medicine (volume 144, pages 904-912). The authors are S.R. Salpeter, N.S. Buckley, T.M. Ormiston, and E.E. Salpeter.


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