Coaggregation of Asthma and Type 1 Diabetes in Children: A Narrative Review

Abstract

Asthma and type 1 diabetes mellitus (T1DM) are two of the most frequent chronic diseases in children, representing a model of the atopic and autoimmune diseases respectively. These two groups of disorders are mediated by different immunological pathways, T helper (Th)1 for diabetes and Th2 for asthma. For many years, these two groups were thought to be mutually exclusive according to the Th1/Th2 paradigm. In children, the incidence of both diseases is steadily increasing worldwide. In this narrative review, we report the evidence of the potential link between asthma and T1DM in childhood. We discuss which molecular mechanisms could be involved in the link between asthma and T1DM, such as genetic predisposition, cytokine patterns, and environmental influences. Cytokine profile of children with asthma and T1DM shows an activation of both Th1 and Th2 pathways, suggesting a complex genetic-epigenetic interaction. In conclusion, in children, the potential link between asthma and T1DM needs further investigation to improve the diagnostic and therapeutic approach to these patients. The aim of this review is to invite the pediatricians to consider the potential copresence of these two disorders in clinical practice.

Microbiome First Medicine in Health and Safety

“…Table 1 shows examples of 36 comorbid NCDs where asthmatics are at a higher risk of being diagnosed with these NCDs vs. the general population [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. The 36 comorbidities of asthma range well beyond the allergic conditions.…”

Paediatric asthma and non‐allergic comorbidities: A review of current risk and proposed mechanisms

“…Furthermore, the order of appearance of the respective diseases also seems to be of importance. In both studies, a previous diagnosis of asthma increased the risk of subsequent T1D (HR 1.45, 95% CI 1.32, 1.60, 130 and HR 1.17, 95% CI 1.07, 1.28) 131 . However, the risk of asthma was reduced 132 or unchanged 133 among those who first developed T1D.…”

“…This dichotomy has remained a paradigm in the field, postulating that the two disease groups are mutually inhibitory. However, this notion has been questioned, both due to a deepened understanding of the complexities of the immune system but also because of epidemiological observations of co‐occurrence of asthma with autoimmune diseases 129,130 …”

“…It is also important to acknowledge the potential existence of common risk factors that may not be shared within families but that could independently predispose individuals to both asthma and T1D. For instance, infections, changes to the microbiome and diet have all been separately linked to both asthma and T1D 130 …”

Childhood asthma and type 1 diabetes mellitus: A meta‐analysis and bidirectional Mendelian randomization study

“…38 Future GWAS studies are required to better characterize the potential link between them. 39 At a mechanistic level, increased risk of T1DM in children with asthma could be attributed to the chronic inflammation. Interleukin 6(IL-6), matrix metalloprotein 9(MMP-9), and other biomarkers of diabetic inflammation and metabolic dysfunction can be highly expressed in lung induce chronic airway and vascular inflammation.…”