Amy M Lavery1, Bradley N Collins2, Amy T Waldman3, Chantelle N Hart4, Amit Bar-Or5, Ruth Ann Marrie6, Douglas Arnold7, Julia O'Mahony8, Brenda Banwell3. 1. Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA/Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA. 2. Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA. 3. Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 4. Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA/Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA. 5. Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 6. Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 7. McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada. 8. Institute of Health Policy, Management, and Evaluation, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada.
Abstract
BACKGROUND: Pediatric acquired demyelinating syndromes (ADSs) are monophasic (mono-ADS) in 70% of cases and represent the first attack of multiple sclerosis (MS) in 30%. Secondhand tobacco smoke (SHS) exposure has been implicated as a risk factor for adult-onset MS. Little is known about whether SHS presents an additive risk beyond genetic factors and other environmental exposures associated with pediatric MS. METHODS: This study examined SHS exposure in 216 children with mono-ADS and 81 children with MS. Interactions between SHS, HLA-DRB1*15 alleles, serum 25-hydroxyvitamin D concentrations, and serological evidence of remote Epstein-Barr virus (EBV) exposure were evaluated. RESULTS: SHS exposure was more common in children with MS (37% exposed) compared to mono-ADS (29.5% exposed). Compared to mono-ADS, SHS exposure was not an independent risk factor for MS. When both SHS exposure and HLA-DRB1*15 were present, the odds for MS increased (odds ratio (OR) = 3.7; 95% confidence interval (CI): 1.17-11.9) compared to mono-ADS. Interactions between SHS and vitamin D or EBV did not associate with MS. CONCLUSION: Exposure to SHS is a risk factor for central nervous system (CNS) demyelination. Results suggest that SHS exposure and HLA-DRB1*15 interact to increase risk for MS in children diagnosed with mono-ADS.
BACKGROUND: Pediatric acquired demyelinating syndromes (ADSs) are monophasic (mono-ADS) in 70% of cases and represent the first attack of multiple sclerosis (MS) in 30%. Secondhand tobacco smoke (SHS) exposure has been implicated as a risk factor for adult-onset MS. Little is known about whether SHS presents an additive risk beyond genetic factors and other environmental exposures associated with pediatric MS. METHODS: This study examined SHS exposure in 216 children with mono-ADS and 81 children with MS. Interactions between SHS, HLA-DRB1*15 alleles, serum 25-hydroxyvitamin D concentrations, and serological evidence of remote Epstein-Barr virus (EBV) exposure were evaluated. RESULTS:SHS exposure was more common in children with MS (37% exposed) compared to mono-ADS (29.5% exposed). Compared to mono-ADS, SHS exposure was not an independent risk factor for MS. When both SHS exposure and HLA-DRB1*15 were present, the odds for MS increased (odds ratio (OR) = 3.7; 95% confidence interval (CI): 1.17-11.9) compared to mono-ADS. Interactions between SHS and vitamin D or EBV did not associate with MS. CONCLUSION: Exposure to SHS is a risk factor for central nervous system (CNS) demyelination. Results suggest that SHS exposure and HLA-DRB1*15 interact to increase risk for MS in children diagnosed with mono-ADS.
Authors: Amin Ziaei; Amy M Lavery; Xiaorong Ma Shao; Cameron Adams; T Charles Casper; John Rose; Meghan Candee; Bianca Weinstock-Guttman; Greg Aaen; Yolanda Harris; Jennifer Graves; Leslie Benson; Mark Gorman; Mary Rensel; Soe Mar; Tim Lotze; Benjamin Greenberg; Tanuja Chitnis; Janace Hart; Amy T Waldman; Lisa F Barcellos; Emmanuelle Waubant Journal: Mult Scler Date: 2022-01-08 Impact factor: 5.855