The contribution of secondhand tobacco smoke exposure to pediatric multiple sclerosis risk

Amy M Lavery; Bradley N Collins; Amy T Waldman; Chantelle N Hart; Amit Bar-Or; Ruth Ann Marrie; Douglas Arnold; Julia O'Mahony; Brenda Banwell

doi:10.1177/1352458518757089

The contribution of secondhand tobacco smoke exposure to pediatric multiple sclerosis risk

Mult Scler. 2019 Apr;25(4):515-522. doi: 10.1177/1352458518757089. Epub 2018 Feb 2.

Authors

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

Affiliations

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.

PMID: 29393768
DOI: 10.1177/1352458518757089

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.

Keywords: Multiple sclerosis; epidemiology.

MeSH terms

Adolescent
Canada / epidemiology
Child
Demyelinating Diseases / chemically induced*
Demyelinating Diseases / epidemiology
Female
Gene-Environment Interaction*
HLA-DRB1 Chains / genetics*
Humans
Male
Multiple Sclerosis / chemically induced*
Multiple Sclerosis / epidemiology
Risk Factors
Tobacco Smoke Pollution / adverse effects*
Tobacco Smoke Pollution / statistics & numerical data

Substances

HLA-DRB1 Chains
HLA-DRB1*15 antigen
Tobacco Smoke Pollution