In the September 2011 issue of InFocus, we reported "Environmental factors in autoimmune disease; more questions than answers." Researchers stated the need for good epidemiology studies, including a national registry. As Dr. K. Michael Pollard, of The Scripps Research Institute said, "We need hard data on populations who are exposed and who are not exposed, and those studies aren't easy to do."

Autoimmune disease affects more people in the U.S. than cancer or heart disease. It occurs when the immune system goes awry and attacks the body's own tissues and organs. NIH estimates that 23.5 million persons in the U.S. are affected. However, that figure doesn't reflect 2010 U.S. Census data; it counts only 24 of the 80-120 diseases that are considered autoimmune. The total, as estimated in AARDA studies, is probably in the area of 50 million--the reason for AARDA's awareness campaign: "We Are 50 Million."

A paper prepared by AARDA staff expresses particular concern for children who are affected by autoimmune disease. It reports that autoimmune disease is one of the top ten causes of death in children aged 1-14, and it is one of the top eight causes of death in children and young adults aged 15-24. In fact, autoimmune disease has a high prevalence in the pediatric and adolescent population, and the prevalence is rising.

     • Type 1 Diabetes -- A study in Finland, tracked by its national health system, indicates that type 1 diabetes has doubled from 1980 to 2005. The authors of that study predict that the number of new cases in children younger than 5 years of age in Europe will double by 2020, compared to 2005; and the cases among those under 15 will rise by 70 percent.
     • Celiac disease - A 2003 study in Finland estimates that the prevalence is at least 1 in 99 children.
     • Approximately 1.7 percent (1,277,000) of the children in the U.S. suffer from alopecia areata.
     • About 4,200 children in the U.S. are diagnosed with Kawasaki disease each year, and 80 percent of them are under 5 years of age.
While a genetic predisposition has been implicated as a major risk factor in the development of autoimmune disease, that is only one-third of the risk. Because the prevalence of autoimmune disease is rising more quickly than one would expect by genetic mechanisms alone, this suggests that environmental changes likely have contributed to the rising incidence of these diseases. Now research attention is focused on the complex and thus-far poorly understood interaction between genetic predisposition and environmental exposures.
     • Drugs are recognized to be a non-infectious environmental exposure associated with autoimmunity.
     • Occupational exposures, including silica, solvents, and pesticides, are associated with autoimmune diseases.
     • Other exposures, such as those to foods (e.g., gluten), cigarette smoking, ultraviolet radiation, heavy metals, collagen implants, silicone implants, stress, and infections, have been proposed as risk factors for autoimmune disease.

The role of infections in autoimmune diseases includes streptococcal infections which trigger pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS), hallmarked by the presence of obsessive-compulsive disorder or a tic disorder. And in about 60 percent of pediatric cases of immune thrombocytopenic purpura (ITP), there is a history of prior infection. An increased risk of ITP is also associated with the MMR vaccination.

This increasing incidence suggests that addressing environmental factors is critical, and the mortality rates among children suffering from autoimmune disease lends an urgency to support for autoimmune disease research.