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© The Author 2007. Published by Oxford University Press.
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Atopy and Risk of Non-Hodgkin Lymphoma
Affiliations of authors: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (MM, KR, CS, HH); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (KES, HOA); University of Tampere Medical School, Tampere, Finland (TL); Department of Pathology and Oncology, Karolinska University Hospital, Stockholm, Sweden (BG); Department of Oncology, Radiology, and Clinical Immunology, Akademiska Hospital, Uppsala, Sweden (BG); Department of Hematology, National University Hospital, Copenhagen, Denmark (LM); Department of Pathology, Akademiska Hospital, Uppsala, Sweden (CS); Northern California Cancer Center, Fremont, CA (ETC); Department of Viral Diseases and Immunology, National Public Health Institute, Oulu and Helsinki, Finland (PK); Department of Epidemiology, Harvard University, Boston, MA (HOA)
Correspondence to: Mads Melbye, MD, Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen, Denmark (e-mail: mme{at}ssi.dk).
BACKGROUND: A possible connection between allergy and cancer has been suspected, but allergy-related conditions or atopy have been inconsistently associated with reduced risks of non-Hodgkin lymphoma. We investigated this association in a population-based case–control study and in a prospective study with prediagnostic blood specimens.
METHODS: We carried out a population-based study of 3055 case patients with non-Hodgkin lymphoma and 3187 control subjects in Denmark and Sweden, including questionnaire information on allergy and blood specimens, and a nested case–control study within a prospective cohort of more than 400 000 Finnish women. In the second study, serum specimens from the 198 case patients who developed non-Hodgkin lymphoma within a median of 8.9 years after the blood was drawn were matched with serum specimens from 594 control subjects. In both studies, laboratory-based evidence of allergy (atopy) was determined in serum on the basis of specific IgE reactivity to common inhalant allergens. Dissemination of disease was classified by the Ann Arbor system. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression.
RESULTS: In the first study, ever having hay fever, but not other allergic conditions, was associated with a reduced risk of non-Hodgkin lymphoma. In particular, subjects with specific IgE reactivity in serum had a 32% (95% CI = 20% to 42%) lower risk of overall non-Hodgkin lymphoma than those without such reactivity. However, among case patients, dissemination of the disease was strongly inversely associated with specific IgE reactivity. In the second (i.e., prospective) study, no association was found between non-Hodgkin lymphoma and specific IgE reactivity, except possibly immediately before a diagnosis of non-Hodgkin lymphoma (
10 years before diagnosis, OR = 1.00, 95% CI = 0.48 to 2.09; 5–9 years before, OR = 0.95, 95% CI = 0.50 to 1.84; 1–4 years before, OR = 0.33, 95% CI = 0.11 to 1.02; and <1 year before, OR = 0.27, 95% CI = 0.03 to 2.31).
CONCLUSION: Allergy may not be causally associated with the risk of non-Hodgkin lymphoma. The inverse association observed in some case–control studies may arise because non-Hodgkin lymphoma suppresses the immunologic response to allergens.
| CONTEXT AND CAVEATS Prior knowledge An association between allergy and non-Hodgkin lymphoma has been suspected but not consistently found. Study design Large population-based retrospective case–control study (3055 case patients and 3187 control subjects) and prospective study with prediagnostic blood specimens (>400 000 women, of whom 198 developed non-Hodgkin lymphoma and 594 served as control subjects). Contributions The case–control study found that allergy was associated with a reduced risk of non-Hodgkin lymphoma, that specific IgE reactivity in serum was associated with lower lymphoma risk, and that among case patients, such reactivity was inversely associated with disease dissemination. The prospective study did not find an association between allergy and non-Hodgkin lymphoma, except possibly immediately before diagnosis. Implications Allergy may not be causally associated with non-Hodgkin lymphoma. The inverse association observed may arise because the disease suppresses the immunologic response to allergens. Limitations Selection bias cannot be completely excluded in the case–control study because nonparticipation between case patients and control subjects may have differed.
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Correspondence about this Article
- Re: Atopy and Risk of Non-Hodgkin lymphoma
- Andrew Edwin Grulich, Claire Melissa Vajdic, Sean Riminton, Anne Maree Hughes, Anne Kricker, and Bruce Konrad Armstrong
J Natl Cancer Inst 2007 99: 1417.[Extract] [Full Text] [PDF]
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