Environmental risk factors in autoimmune diseases: a review of literature
More details
Hide details
Department of Hygiene, Wrocław Medical University, Wroclaw, Poland Head of Department prof. dr hab. K. Pawlas
Clinic of Rheumatology and Internal Medicine, University Hospital in Wroclaw, Wroclaw, Poland
Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
Corresponding author
Małgorzata Chowaniec   

Katedra i Zakład Higieny Uniwersytet Medyczny we Wrocławiu ul. Mikulicza-Radeckiego 7, 50-345 Wrocław tel. 071-784-01-05 fax. 071-784-15-03
Med Srod. 2017;20(3):12-20
Autoimmune diseases are a very common group of disorders, with prevalence rate over 5%–8% in the general population. The etiology of autoimmune diseases is very complex. It is considered that they are caused by a combination of several factors, such as pathological response of the immune system, hormones, genetic factors and environmental influence. It is assumed that an increase in the incidence of autoimmune diseases may be associated with growing exposure to environmental factors. Many environmental determinants may play an important role in triggering the autoimmune response. Identification and better knowledge of environmental risk factors could lead to better prevention and control of autoimmune diseases in the future. This paper is a literature overview concerning the role of environmental factors in the development of autoimmune diseases.
Miller F.W., Alfredsson L., Costenbaderc K.H. et al: Epidemiology of Environmental Exposures and Human Autoimmune Diseases: Findings from a National Institute of Environmental Health Sciences Expert Panel Workshop. J Autoimmun. 2012; 39(4): 259-271.
Rao T., Richardson B.: Environmentally induced autoimmune diseases: potential mechanisms. Environ Health Perspect. 1999; 107(Suppl 5): 737-742.
Lis J., Jarząb A., Witkowska D.: Molecular mimicry in the etiology of autoimmune. Postepy Hig Med Dosw (online), 2012; 66: 475-491.
Cusick M.F., Libbey J.E., Fujinami R.S.: Molecular mimicry as a mechanism of autoimmune disease. Clin. Rev. Allergy Immunol., 2012; 42: 102-111.
Ray S., Sonthalia N., Kundu S. et al: Autoimmune Disorders: An Overview of Molecular and Cellular Basis in Today’s Perspective. J Clin Cell Immunol 2012; S10:003: 1-12.
Bellone M.: Autoimmune Disease: Pathogenesis. Encyclopedia of Life Sciences 2005, Ltd. ; 1-8.
Pierdominici M., Ortona E.: Estrogen Impact on Autoimmunity Onset and Progression: the Paradigm of Systemic Lupus Erythematosus. International Trends inImmunity 2013; VOL.1 NO.2: 24-34.
DeLisa Fairweather, Noel R. Rose: Women and Autoimmune Diseases., Emerg Infect Dis 2004; 10(11): 2005-2011.
Lerner A., Jeremias P., Matthias T.: The world incidence and prevalence of autoimmune diseases is increasing. Int J Celiac Dis 2015; 3(4):151-155.
Parks C.G., Miller FW, Pollard KM. et al: Expert panel workshop consensus statement on the role of the environment in the development of autoimmune disease, Int J Mol Sci 2014; 15(8):14269-97.
Cooper G.S., Miller F.W., Pandey J.P.: The Role of Genetic Factors in Autoimmune Disease: Implications for Environmental. Environ Health Perspect. 1999; 107 Suppl 5: 693- 700.
Leslie R.D., Hawa M.: Twin studies in auto-immune disease. Acta Genet Med Gemellol (Roma) 1994; 43(1-2): 71-81.
Bogdanos D.P., Smyk D.S., Rigopoulou E.I. et al: Twin studies in autoimmune disease: genetics, gender and environment. J Autoimmun 2012; 38(2-3): 156-169.
Kyvik K.O., Green A., Beck-Nielsen H.: Concordance rates of insulin dependent diabetes mellitus: a population based study of young Danish twins. BMJ 1995; 311(7010): 913- 917.
Koumantaki Y., Giziaki E., Linos A. et al: Family history as a risk factor for rheumatoid arthritis: a case-control study. J. Rheumatol. 1997;24(8): 1522-1526.
Briggs D.: Environmental pollution and the global burden of disease, Br Med Bull 2003; 68(1): 1-24.
Sly P.D., Carpenter D.O., Van den Berg M., Stein R.T. et al: Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology. Ann Glob Health. 2016; 82(1): 3-9.
Vojdani A.: A Potential Link between Environmental Triggers and Autoimmunity. Autoimmune Dis. 2014; 2014:437231: 1-18.
Simopoulos A.P.,: An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients 2016; 8(3): 128.
IBD in EPIC Study Investigators., Tjonneland A., Overvad al: Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested casecontrol study within a European prospective cohort study. Gut. 2009; 58(12): 1606-1611.
Niinistö S., Takkinen H.M., Erlund I. et al.: Fatty acid status in infancy is associated with the risk of type 1 diabetes-associated autoimmunity; Diabetologia 2017; 60(7):1223- 1233.
Xinyun Bi., Fanghong Li., Shanshan Liu. Et al.: -3 polyunsaturated fatty acids ameliorate type 1 diabetes and autoimmunity, J Clin Invest 2017; 127(5): 1757-1771.
Virtanen S.M.: Dietary factors in the development of type 1 diabetes. Pediatr Diabetes 2016;17 Suppl 22: 49-55.
Vaarala O., ParoneneJ., Otonkoski T. et al: Cow milk – Cow Milk Feeding Induces Antibodies to Insulin in Children – A Link Between Cow Milk and Insulin-Dependent Diabetes Mellitus?. Scand. J. Immunol 1998; 47: 131-135.
Luopajärvi K., Savilahti E., Virtanen S.M. et al.: Enhanced levels of cow’s milk antibodies in infancy in children who develop type 1 diabetes later in childhood. Pediatr Diabetes 2008; 9(5): 434-441.
Lamb M.M., Miller M., Seifert J.A. et al: The effect of childhood cow’s milk intake and HLA-DR genotype on risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young. Pediatr Diabetes 2015; 16(1): 31-38.
Virtanen S.M., Rasanen L., Aro al. Infant feeding in Finnish children less than 7 yr of age with newly diagnosed IDDM. Childhood Diabetes in Finland Study Group. Diabetes Care 1991; 14: 415-417.
Alves J.G, Figueiroa J.N., Meneses al: Breastfeeding pro tects against type 1 diabetes mellitus: a case-sibling study. Breastfeed Med 2012; 7(1): 25-28.
Hyppönen E., Kenward M.G., Virtanen S.M. et al: Infant feeding, early weight gain, and risk of type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes Care 1999; 22(12): 1961-1965.
Couper J.J., Steele C., Beresford al: Lack of association between duration of breast-feeding or introduction of cow’s milk and development of islet autoimmunity. Diabetes 1999; 48(11): 2145-2149.
Savilahti E., Saarinen K.M., Early infant feeding and type 1 diabetes, Eur J Nutr 2009; 48(4): 243-249.
World Health Organization (WHO). Obesity and overwight: Fact sheet, Updated June 2016. Available from:
Scotece M., Conde J., Gómez R. et al: Beyond fat mass: exploring the role of adipokines in rheumatic diseases. Scientific World Journal 2011;11:1932-1947.
Divella R., De Luca R., Abbate I. et al: Obesity and cancer: the role of adipose tissue and adipo-cytokines-induced chronic inflammation. J Cancer 2016; 7(15):2346-2359.
Chung C.P., Long A.G., Solus J.F. et al: Adipocytokines in systemic lupus erythematosus: relationship to inflammation, insulin resistance andcoronary atherosclerosis. Lupus. 2009; 18(9):799-806.
Versini M., Jeandel P-Y. , Rosenthal E. et al: Obesity in autoimmune diseases: Not a passive bystander. Autoimmunity Reviews 2014; 13: 981-1000.
Zheng Z.H., Gao C.C., Wu Z.Z. et al: High prevalence of hypovitaminosis D of patients with autoimmune rheumatic diseases in China. Am J Clin Exp Immunol 2016;5(3):48- 54.
Dankers W., Colin E.M., van Hamburg al: Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential. Front Immunol 2017;7:697.
Toloza S.M., Cole D.E., Gladman D.D. et al: Vitamin D insufficiency in a large female SLE cohort. Lupus.2010; 19(1):13-19.
Bizzaro G, Antico A, Fortunato A. et al: Vitamin D and Autoimmune Diseases: Is Vitamin D Receptor (VDR) Polymorphism the Culprit? Isr Med Assoc J 2017; 19(7):438-443.
Prietl B., Treiber G, Pieber T.R et al: Vitamin D and Immune Function. Nutrients 2013; 5(7): 2502-2521.
Lee Y.H., Bae S.C.: Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clin Exp Rheumatol 2016; 34(5):827-833 .
Kamen D.L., Cooper G.S., Bouali al: Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev 2006; 5(2):114-117.
Liontiris M.I., Mazokopakis E.E.: A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients. Points that need moreinvestigation, Hell J Nucl Med 2017; 20(1):51-56.
Luo Y., Kawashima A., Ishido Y. et al. Iodine excess as an environmental risk factor for autoimmune thyroid disease, nt J Mol Sci 2014; 15: 12895-912.
Duntas L.H.: The Role of Iodine and Selenium in Autoimmune Thyroiditis, Horm Metab Res 2015; 47(10):721-726.
Teng X., Shan Z., Chen Y. et al.: More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels, Eur J Endocrinol 2011; 164(6):943-950.
Palaniappan S., Shanmughavelu L., Prasad H.K. et al.: Improving odine nutritional status and increasing prevalence of autoimmune thyroiditis in children, Indian J Endocrinol Metab 2017; 21(1): 85-89.
Landrigan P.J., Fuller R.: Global health and environmental pollution, Int J Public Health. 2015; 60(7):761-762.
Parks C.G, Walitt B.T., Pettinger M. et al: Insecticide use and risk of rheumatoid arthritis and systemic lupus erythematosus in the Women’s HealthInitiative Observational Study. Arthritis Care Res (Hoboken) 2011; 63(2):184-194.
Kharrazian D.: The Potential Roles of Bisphenol A (BPA) Pathogenesis in Autoimmunity, Autoimmune Dis. 2014; 2014:743616.
Jochmanová, I., Lazúrová, Z., Rudnay M. et al: Environmental estrogen bisphenol A and autoimmunity. Lupus 2014, 24 (4-5), 392-399.
Somers E.C., Richardson B.C.: Environmental exposures, epigenetic changes and the risk of lupus. Lupus 2014; 23; 568- 576.
Calafat A.M., Ye X., Wong L.Y. et al: Exposure of the U.S. population to Bisphenol A and 4-tertiaryoctylphenol:2003- 2004. Environmental Health Perspectives 2008; 116(1): 39- 44.
Chighizola C., Meroni P.L.: The role of environmental estrogens and autoimmunity. Autoimmun Rev 2012; 11: A493- A501.
Buyon J.P., Petri M.A., Kim M.Y. et al: The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial. Ann Intern Med 2005; 142: 953-962.
Rowley B., Monestier M.: Mechanisms of heavy metal-induced autoimmunity. Molecular Immunology 2005; 42: 833- 838.
Silbergeld E.K., Silva I.A., Nyland J.F.: Mercury and autoimmunity: implications for occupational and environmental health. Toxicology and Applied Pharmacology 2005; 207: 282 -292.
Marie I’ Gehanno J.F., Bubenheim M., Duval-Modeste A.B. et al.: Systemic sclerosis and exposure to heavy metals: A case control study of 100 patients and 300 controls. Autoimmun Rev 2017; 16(3): 223-230.
Gallagher C.M., Meliker J.R.: Mercury and thyroid autoantibodies in U.S. women, NHANES 2007-2008. Environ Int 2012; 40: 39-43.
Silva I.A., Nyland J.F., Gorman A. et al.: Mercury exposure, malaria, and serum antinuclear/antinucleolar antibodies in Amazon populations in Brazil: a cross-sectional study. Environ Health Glob 2001; 3:11.
Madeddu R., Forte G., Bocca B. et al.: Heavy metals and multiple sclerosis in Sardinian population (Italy). Analytical Letters 2011; 44(9): 1699-1712.
Gorman J.D.: Smoking and Rheumatoid Arthritis: Another Reason to Just Say No. Arthritis Rheum 2006; 54(1):10-13.
Chang K., Yang S.M., Kim S.H. et al: Smoking and rheumatoid arthritis. Int J Mol Sci. 2014; 15(12):22279-95.
Di Giuseppe D., Discaccati A., Orsini N. et al: Cigarette smoking and risk of rheumatoid arthritis: a dose-response metaanalysis. Arthritis Res Ther 2014; 16(2):R61.
Costenbader K.H., Kim D.J., Peerzada J. et al: Cigarette smoking and the risk of systemic lupus erythematosus: a metaanalysis. Arthritis Rheum 2004; 50(3): 849-857.
Hardy C., Palmer B., Muir K. et al: Smoking history, alcohol consumption, and systemic lupus erythematosus: a casecontrol study. Ann Rheum Dis 1998; 57(8): 451-455.
Rodríguez Huerta M.D., Trujillo-Martín M.M., Rúa-Figueroa Í. et al: Healthy lifestyle habits for patients with systemic lupus erythematosus: A systemic review. Semin Arthritis Rheum 2016; 45(4): 463-470.
Barbhaiya M., Costenbader K.H.: Environmental exposures and the development of systemic lupus erythematosus. Curr Opin Rheumatol 2016; 28(5 ):497-505.
Ekblom-Kullberg S., Kautiainen H., Alha P. et al: Smoking and the risk of systemic lupus erythematosus. Clin Rheumatol 2013; 32(8): 1219-1222.
Bertelsen J.B., Hegedüs L.: Cigarette smoking and the thyroid. Thyroid 1994; 4(3):327-331.
Prummel M.F., Wiersinga W.M.: Smoking and risk of Graves’ disease. JAMA 1993; 269(4): 479-482.
Vestergaard P., Rejnmark L., Weeke J.: et al: Smoking as a risk factor for Graves’ disease, toxic nodular goiter, and autoimmune hypothyroidism. Thyroid 2002; 12(1):69-75.
Holm I.A., Manson J.E., Michels K.B. et al: Smoking and other lifestyle factors and the risk of Graves’ hyperthyroidism. Arch Intern Med 2005; 165(14):1606-1611.
Vestergaard P.: Smoking and thyroid disorders-a meta-analysis. Eur J Endocrinol 2002; 146(2):153-161.
Asvold B.O., Bjřro T., Nilsen T.I. et al: Tobacco smoking and thyroid function: a population-based study. Arch Intern Med 2007; 167(13):1428-1432.
Journals System - logo
Scroll to top