Table 3.
Panel findings on human studies on the role of environmental factors and development of autoimmune disease.
| We Are Confident of the Following | We Consider the Following Likely, but Requiring Confirmation | Broad Themes to Be Pursued in Future Investigations |
|---|---|---|
| Chemicals | ||
| Crystalline silica (quartz) contributes to development of several systemic autoimmune diseases, including RA, systemic sclerosis (SSc), SLE and anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis. Solvents contribute to development SSc. Smoking contributes to development of anti-citrullinated protein antibody (ACPA)-positive and anti-rheumatoid factor. (RF)-positive RA (with an interaction with the shared eptiope genetic susceptibility factor). |
Solvents contribute to development of MS. Smoking contributes to development of seronegative RA, MS, SLE, Hashimoto’s thyroiditis (HT), Graves’ disease (GD) and Crohn’s disease (CD). Current smoking protects against development of ulcerative colitis (UC). |
There is insufficient evidence on the role of metals, including those associated with animal models of autoimmunity, e.g., mercury.
The identification of single causal agents within groups of exposures is needed (e.g., specific solvents or pesticides contributing to increased risk for the group). Studies are needed on plasticizers (e.g., phthalates and bisphenol A), some of which may be endocrine or immune disruptors, and have been associated with other immune mediated diseases. There is insufficient evidence on the role of cosmetics in autoimmune diseases. |
| Physical factors | ||
| An inverse association exists between increased ultraviolet radiation exposure and risk of developing MS. | Ionizing radiation contributes to development of HT and GD. | There is insufficient evidence on a possible protective role of ultraviolet radiation on type 1 diabetes (T1D). Prospective data are needed on sun exposure as a risk factor for SLE (prior to early clinical symptoms) and dermatomyositis. |
| Biologic agents | ||
| Ingestion of gluten contributes to development of gluten-sensitive enteropathy (GSE). Ingestion of certain lots of l-Tryptophan contributes to development of eosinophilia myalgia syndrome. Dietary intake of 1,2-di-oleyl ester (DEPAP)- and oleic anilide-contaminated rapeseed oil contributes to development of toxic oil syndrome. |
Epstein-Barr virus (EBV) infection contributes to MS development.
Early introduction of complex foods contributes to development of T1D and GSE. Low dietary vitamin D intake and blood levels contribute to development of MS. |
Studies are needed on MS and vitamin D in racial/ethnic groups with darker skin (associated with UV-associated vitamin D deficiency), and examining dose-effects. Prospective data are needed on vitamin D and other autoimmune diseases. Additional studies are needed on associations of food chemicals, dyes, or additives. Prospective studies are needed on nitrates/nitrosamines and T1D. |