Influence of the T H 1/T H 2 Paradigm: The Prevalence of Asthma and Allergic Diseases in Patients with Type 1 Diabetes in the United States

Abstract

To test the T_H1/T_H2 paradigm, we determined the prevalence of asthma and allergic disorders (T_H2-driven diseases) in children with type 1 diabetes (a T_H1-driven disease) in the United States. The survey was conducted using an online survey (www.childrenwithdiabetes.com). In 3 months, we enrolled a total of 403 children with diabetes (under the age of 18) and 480 nonaffected siblings (also under the age of 18) for statistical analysis. We compared the prevalence of allergic diseases in patients with type 1 diabetes to that of their nonaffected siblings and used the general population as a control. Our results were as follows for children with/without diabetes/general population respectively: bronchial asthma, 18 of 403 (4.4%) versus 35 of 480 (7.2%) versus 1025 of 10,904 (9.4%); allergic rhinitis, 57 of 403 (14.1%) versus 101 of 480 (21.0%) versus 1203 of 4295 (28.0%); atopic dermatitis, 22 of 403 (5.5%) versus 39 of 480 (8.1%) versus 113 of 1126 (10.0%). The difference between the patients and the controls was significant for all three diseases (p = 0.0033 to 0.0055), but not between the patients and their nonaffected siblings or between the siblings and the controls. The lower prevalence of asthma and allergic disorders in children with type 1 diabetes was also confirmed in patients in the United States, suggesting that T_H1- and T_H2-driven diseases can be mutually exclusive (although this is not absolute). Genetic and environmental factors are equally important in modulating T_H1 and T_H2 responses.