Association between allergies, asthma, and breast cancer risk among women in Ontario, Canada

Allergic Diseases and Risk of Malignancy of Gastrointestinal Cancers

The aim of this study was to investigate the effect of allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, on the development of gastrointestinal (GI) cancers. We analyzed 9,892,633 Korean adults who underwent a medical check-up in the year 2009, and they were followed up until the year 2017. Allergic diseases and cancers were defined using the International Classification of Disease Codes. A Cox proportional hazards model was adapted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). During a 7.3-year follow-up period, 48,045 patients were diagnosed with cancer. For all-combined allergic diseases, significant inverse associations were observed for cancers of the esophagus, stomach, colorectum, and liver (adjusted hazard ratios (aHRs [95% confidence interval, CI] 0.86 [0.82-0.91], 0.93 [0.91-0.94], 0.95 [0.93-0.96], and 0.90 [0.88-0.92], respectively). The sex-stratified analysis showed that the preventive effect of allergic diseases was persistent in gastric, colorectal, and liver cancers regardless of sex, while the inverse associations with esophageal and pancreatic cancers were observed only in men (aHR [95% CI] 0.84 [0.80-0.89] and 0.96 [0.93-0.99]). Allergic diseases, particularly allergic rhinitis, in adults were significantly associated with a decreased risk of most GI cancers, except for gallbladder and biliary tract cancers.

Mycoviruses in Fungi: Carcinogenesis of Fungal Agents May Not Always Be Mycotoxin Related

Certain viruses have been found to induce diverse biological pathways to carcinogenesis, evidenced by the presence of viral gene products in some tumors. Despite the fact that many fungal agents contain mycoviruses, until recently, their possible direct effects on human health, including carcinogenesis and leukemogenesis, had not been explored. In this regard, most studies of fungal agents have rightly concentrated on their mycotoxin formation and effects. Recently, the direct role of yeasts and fungi in the etiology of cancers, including leukemia, have been investigated. While greater attention has been placed on the carcinogenic effects of Candida, the role of filamentous fungi in carcinogenesis has also been explored. Recent findings from studies using the enzyme-linked immunosorbent assay (ELISA) technique indicate that the plasma of patients with acute lymphoblastic leukemia (ALL) uniformly contains antibodies for a certain mycovirus-containing Aspergillus flavus, while controls are negative. The exposure of mononuclear leukocytes from patients with ALL in full remission, and long-term survivors, to the product of this organism was reported to result in the re-development of typical genetics and cell surface phenotypes characteristic of active ALL. Mycoviruses are known to be able to significantly alter the biological characteristics and functions of their host. The possible carcinogenic and leukemogenic role of mycoviruses, with and without their host, needs to be further investigated.

Risk, Mechanisms and Implications of Asthma-Associated Infectious and Inflammatory Multimorbidities (AIMs) among Individuals With Asthma: a Systematic Review and a Case Study

Our prior work and the work of others have demonstrated that asthma increases the risk of a broad range of both respiratory (e.g., pneumonia and pertussis) and non-respiratory (e.g., zoster and appendicitis) infectious diseases as well as inflammatory diseases (e.g., celiac disease and myocardial infarction [MI]), suggesting the systemic disease nature of asthma and its impact beyond the airways. We call these conditions asthma-associated infectious and inflammatory multimorbidities (AIMs). At present, little is known about why some people with asthma are at high-risk of AIMs, and others are not, to the extent to which controlling asthma reduces the risk of AIMs and which specific therapies mitigate the risk of AIMs. These questions represent a significant knowledge gap in asthma research and unmet needs in asthma care, because there are no guidelines addressing the identification and management of AIMs. This is a systematic review on the association of asthma with the risk of AIMs and a case study to highlight that 1) AIMs are relatively under-recognized conditions, but pose major health threats to people with asthma; 2) AIMs provide insights into immunological and clinical features of asthma as a systemic inflammatory disease beyond a solely chronic airway disease; and 3) it is time to recognize AIMs as a distinctive asthma phenotype in order to advance asthma research and improve asthma care. An improved understanding of AIMs and their underlying mechanisms will bring valuable and new perspectives improving the practice, research, and public health related to asthma.

Decreased Risk in the Pancreatic Cancer With History of Hay Fever: A Meta-Analysis

Background: An increasing incidence of pancreatic cancer has been observed worldwide over the last few decades. Previous reports suggested that hay fever, a common allergic disease, may function in pancreatic cancer. Data on hay fever as a risk or protective factor for pancreatic cancer was controversial in several case–control reports. So, we here did a meta-analysis on published studies to evaluate the association of hay fever and the risk of pancreatic cancer.

Methods: A comprehensive literature search was performed through public databases. The association between hay fever and pancreatic cancer was evaluated by odds ratios (ORs) and 95% confidence intervals (CIs). The Cochran's Q test and I² index were used to evaluate heterogeneity.

Results: We included 8 population-based case–control studies involving 10,454 participants from 1986 to 2014. A history of hay fever was associated with a decreased risk of pancreatic cancer (OR, 0.57; 95% CI, 0.50–0.64, P < 0.00001) through fixed effect model.

Conclusion: The result of our study suggested that hay fever may significantly decrease the risk of pancreatic cancer.

Current status and perspectives regarding the association between allergic disorders and cancer

While activation of immune system may lead to a lower risk of some diseases, it has been shown that a history of atopic allergic disorders such as asthma, hay fever, eczema, and food allergies could be related to several types of cancer. However, the evidence is not entirely conclusive. Two proposals suggest a possible mechanism for the association between allergic disorders and cancers: immune surveillance and the antigenic stimulation. The association of allergy and cancer may vary by cancer site and the type of exposure. The aim of current review was to summarize the current knowledge of the association between allergic diseases and the risk of cancers with particular emphasis on case-controls and cohort studies to estimate the cancer risk associated with allergy.

Allergy, asthma, and the risk of breast and prostate cancer: a Mendelian randomization study

PURPOSE

The relationship of allergic diseases, such as asthma, hay fever, and eczema, with cancer is under debate. Observational studies have reported conflicting findings, but such studies are susceptible to confounding and reverse causation. Understanding the potential role of allergy in carcinogenesis may shed new light on the biological mechanisms underpinning intrinsic immunity and cancer.

METHODS

We conducted a Mendelian randomization study, using germline genetic variants as instrumental variables, to determine the causal relevance of allergic disease and on two most common malignancies: breast cancer and prostate cancer. We used the summary statistics from the largest ever genome-wide association studies conducted on allergic disease (ncase = 180,129), asthma (ncase = 14,085), breast (ncase = 122,977), and prostate cancer (ncase = 79,148) and calculated odds ratios (ORs) and 95% confidence intervals (CIs) of cancer for allergic disease.

RESULTS

We did not observe any evidence to support a causal association between allergic disease and risk of breast cancer overall [OR 1.00 (95% CI 0.96-1.04), p = 0.95] or by subtype (estrogen receptor (ER)+ [0.99 (0.95-1.04), p = 0.71], ER- [1.05 (0.99-1.10), p = 0.11]). We also did not find any evidence for an association with prostate cancer [1.00 (0.94-1.05), p = 0.93] or advanced subtype [0.97 (0.90-1.05), p = 0.46]. Sensitivity analyses did not reveal directional pleiotropy.

CONCLUSION

Our study does not support a causal effect of allergic disease on the risk of breast or prostate cancer. Future studies may be conducted to focus on understanding the causal role of allergic disease in cancer prognosis or drug responses (e.g., immunotherapy).

Allergy-Related Diseases and Risk of Breast Cancer: The Role of Skewed Immune System on This Association

Background

The role of allergy in breast cancer (BC) development remains inconclusive. A comprehensive review article is required to present and discuss all findings on this topic and to clarify the association between allergic disorders and the risk of BC.

Objective

We aimed to explain the association between atopy, different types of allergic disorders, and the risk of BC. Moreover, we explored the immunological mechanism behind this association.

Methods

We electronically reviewed publications in PubMed from 1979 to 2018 relating to atopy, allergy, asthma, atopic dermatitis, allergic rhinitis, food allergy, drug allergy, immunoglobulin E (IgE) or prick test, and BC.

Results

Most of the identified studies demonstrated nonsignificant results. However, the pattern of the results indicated an increased risk of BC in individuals with a history of allergies. The majority of studies reported higher prevalence of atopic dermatitis and allergic rhinitis among individuals with BC compared to the control groups. Similarity, most of the studies revealed an increased risk of BC among people with a positive history of atopic using IgE specific or prick test. However, a null association was reported in most of the asthmatic studies, and controversial results were detected in the individuals with history of food and drug allergies.

Conclusion

The majority of findings were not statistically significant. Moreover, bias and other methodological problems are the major issues, which make it challenging to compare the findings of different studies and reach a strong conclusive result. However, the pattern of the results from most studies indicated that allergic diseases might be associated with an increased risk of BC. Skewed immune system toward T-helper 2 might have an important role in this association.

Allergies and Asthma in Relation to Cancer Risk

BACKGROUND

Allergies and asthma, conditions commonly characterized by immunoglobulin E-mediated atopic reactions, may decrease cancer risk via increases in immunosurveillance, but may increase risk due to persistent immune stimulation. Associations between allergies and asthma and cancer risk remain unclear, and it is unknown whether associations vary by race/ethnicity.

METHODS

We evaluated these associations in the Southern Community Cohort Study. At baseline (2002-2009), 64,170 participants were queried on history of allergies and asthma; participants were followed through 2011, during which time 3,628 incident, invasive cancers were identified, including 667 lung cancers, 539 breast cancers, and 529 prostate cancers. Cox proportional hazards regression was used to estimate multivariable-adjusted HRs and 95% confidence intervals (CI).

RESULTS

Neither allergies nor asthma was associated with risk of developing invasive cancer overall. Asthma was associated with increased lung cancer risk (HR, 1.25; 95% CI, 1.00-1.57), with no variation by race/ethnicity (P _interaction = 0.84). Conversely, history of allergies was associated with decreased lung cancer risk (HR, 0.80; 95% CI, 0.65-1.00), with an inverse association observed among non-Hispanic whites (HR, 0.65; 95% CI, 0.45-0.94) but not non-Hispanic blacks (HR, 0.95; 95% CI, 0.73-1.25; P _interaction = 0.10). No statistically significant associations were observed for risk of breast or prostate cancers, overall or by race/ethnicity.

CONCLUSIONS

No associations were observed for risk of overall cancer, breast cancer, or prostate cancer. While asthma was associated with increased lung cancer risk, history of allergies was associated with decreased risk, an association driven by an inverse association among non-Hispanic whites.

IMPACT

Associations pertaining to lung cancer merit follow up in a large, diverse study.

Overview of air pollution and endocrine disorders

Over recent years, many environmental pollutant chemicals have been shown to possess the ability to interfere in the functioning of the endocrine system and have been termed endocrine disrupting chemicals (EDCs). These compounds exist in air as volatile or semi-volatile compounds in the gas phase or attached to particulate matter. They include components of plastics (phthalates, bisphenol A), components of consumer goods (parabens, triclosan, alkylphenols, fragrance compounds, organobromine flame retardants, fluorosurfactants), industrial chemicals (polychlorinated biphenyls), products of combustion (polychlorinated dibenzodioxins/furans, polyaromatic hydrocarbons), pesticides, herbicides, and some metals. This review summarizes current knowledge concerning the sources of EDCs in air, measurements of levels of EDCs in air, and the potential for adverse effects of EDCs in air on human endocrine health.

Atopy and Specific Cancer Sites: a Review of Epidemiological Studies

Mounting evidence appears to link asthma and atopy to cancer susceptibility. This review presents and discusses published epidemiological studies on the association between site-specific cancers and atopy. PubMed was searched electronically for publications between 1995 and 2015, and cited references were researched manually. Quantitative studies relating to atopy, allergy, or asthma and cancer were identified and tabulated. Despite many exposure-related limitations, patterns in the studies were observed. Asthma, specifically, has been observed to be a risk factor for lung cancer. A protective effect of atopic diseases against pancreatic cancer has been shown consistently in case-control studies but not in cohort studies. Allergy of any type appears to be protective against glioma and adult acute lymphoblastic leukemia. Most studies on atopic diseases and non-Hodgkin lymphoma or colorectal cancer reported an inverse association. The other sites identified had varying and non-significant outcomes. Further research should be dedicated to carefully defined exposure assessments of "atopy" as well as the biological plausibility in the association between atopic diseases and cancer.

Analysis of the involvement of cytokines in allergy and breast cancer association

AIM OF THE STUDY

The existence of a correlation between allergy disorders and cancer diseases has been confirmed by several epidemiological studies. Although the molecular mechanism involved in this phenomenon remains unknown, there are data indicating that certain cytokines, engaged in allergic processes, have antineoplastic activities. The aim of the present study was to explore the association between advanced breast cancer and allergic state on the molecular level.

MATERIAL AND METHODS

We determined and compared the mRNA and protein expression of interleukin-1β (IL-1β), IL-4, IL-6, and interferon-γ (IFN-γ), cytokines known for antitumor properties, in the blood of advanced breast cancer patients and individuals with allergic diseases related to type 2 response. In addition, we performed an in vitro assay of reactivity of peripheral blood mononuclear cells after exogenous antigen stimulation. As a preliminary to molecular analysis we conducted a questionnaire study concerning the incidence of allergy among breast cancer patients and healthy subjects without malignancy.

RESULTS

The results of the survey study revealed a negative relation between breast cancer and allergy prevalence. Subsequent molecular analysis, however, did not show statistically significant differences in cytokines mRNA and protein expression levels between allergic patients and those with malignancy. The in vitro reactivity test also did not reveal marked differences between IL-1β, IL-4 and IL-6 production after PBMC triggering with exogenous antigen.

CONCLUSIONS

We concluded that the studied cytokines (IL-1β, IL-4, IL-6, and IFN-γ) are not engaged in breast cancer-allergy negative relation.

Objective allergy markers and risk of cancer mortality and hospitalization in a large population-based cohort

Purpose

There are indications that a history of allergy may offer some protection against cancer. We studied the relation of three objectively determined allergy markers with cancer mortality and hospitalization risk.

Methods

Associations between three allergy markers (number of peripheral blood eosinophil counts, skin test positivity, and serum total IgE) with mortality and hospitalization from any type and four common types of cancer (lung, colorectal, prostate, and breast cancer) were assessed in the Vlagtwedde–Vlaardingen cohort (1965–1990), with follow-up of mortality until 31 December 2008. Hospitalization data were available since 1 January 1995.

Results

There were no significant associations between objective allergy markers and cancer mortality or hospitalization. We found several associations in specific subgroups. A higher number of eosinophils was associated with a decreased risk of colorectal cancer mortality in ever smokers HR (95 % CI) = 0.61 (0.45–0.83) and in males 0.59 (0.42–0.83); however, no overall association was observed 0.84 (0.64–1.09). Skin test positivity was associated with a decreased risk of any cancer mortality only among females 0.59 (0.38–0.91) and showed no overall association 0.83 (0.67–1.04). Serum total IgE levels were associated with an increased risk of lung cancer mortality among females 4.64 (1.04–20.70), but with a decreased risk of cancer hospitalization in ever smokers 0.77 (0.61–0.97) and males 0.72 (0.55–0.93); however, no overall associations were observed [mortality 0.99 (0.79–1.25), and hospitalization 0.86 (0.71–1.04)].

Conclusions

We found no associations between objective allergy markers and cancer in the total population. However, skin test positivity and a high number of eosinophils were associated with a reduced risk to die of cancer in specific subgroups. Hence, it seems important to study specific subgroups defined by gender and smoking habits in order to identify allergy markers of predictive value for cancer mortality.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-014-0489-9) contains supplementary material, which is available to authorized users.

Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009-2010

PURPOSE

The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type.

METHODS

We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n = 18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking.

RESULTS

Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26-2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05-1.86) and urinary (PR 2.19; 95 % CI 1.21-3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12-2.83) and hormone-related (PR 1.20; 95 % CI 1.01-1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49-3.43), hormone- (PR 1.46; 95 % CI 1.21-1.77), and tobacco- (PR 1.86; 95 % CI 1.25-2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22-3.83) and tobacco-related (PR 2.24; 95 % CI 1.37-3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00-2.56).

CONCLUSIONS

This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology.

IMPLICATIONS FOR CANCER SURVIVORS

A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.