Jan 13, 2007

Wegener's Granulomatosis Triggers

Environmental agents have long been suspected of contributing to the development and disease course of the autoimmune vascular disease Wegener's granulomatosis. Wegener's granulomatosis is a chronic autoimmune condition that causes inflammation of blood vessels, resulting in a condition of vasculitis. Vasculitis blocks blood flow to the organs affected by these vessels and eventually leads to destruction of affected tissues. Wegener's granulomatosis primarily involves the respiratory organs and the kidneys.

According to researchers, the sporadic occurrence, lack of familial or genetic associations, and rising incidence of Wegener's granulomatosis suggest possible exposure to environmental agents as causing or contributing to this disease. Researchers from the University of Pennsylvania in Philadelphia have identified a cluster of cases in the Dublin, Pennsylvania region that they are studying in an effort to pinpoint these environmental causes.

By studying hospital records and patient contacts, researchers have located 7 cases that have occurred within a 10-mile radius of an Environmental Protection Agency (EPA) Superfund toxic waste site during a three-year period.

The area under investigation includes approximately 50,000 individuals. Studies of this area have identified several toxins at or above the "action level" including trichloroethylene (TCE), vinyl chloride, methyl tertiary-butyl ether (MTBE), dichloroethane (DCE), and chromic acid from several industrial waste sites within the area.

Interviews with the patients with Wegener's granulomatosis identified in the study showed that these patients reported a total of greater than 30 possible chemicals exposures, including exposures to the chemicals mentioned above. Three of 5 patients had well water exposing them to industrial runoff that required EPA intervention. Additional phone interviews of individuals living in this region showed that mercury and possibly lead exposure were positively associated with Wegener's granulomatosis compared to the control group. A prior history of allergy was also associated with disease development.

The researchers conclude that heavy metal exposure and a prior history of allergy may contribute to Wegener's granulomatosis. Other suspected environmental triggers currently under investigation include aromatic hydrocarbons, silica, farming, prior respiratory infections especially those with Staphylococcus aureus, drug allergy or reaction, and occupational solvent exposures.

In a related study, Ohio researchers postulated that an inhaled agent may be responsible for Wegener's granulomatosis because of its inclination to affect the nasal passages and other respiratory organs. By investigating environmental exposures experienced by patients within the year prior to their diagnosis and comparing them to other people in the region unaffected by Wegener's, the researchers found that there was no seasonal trend to suggest environmental allergens as a cause. However, the patients with Wegener's granulomatosis reported a higher incidence of exposure to particulate materials from construction and occupational exposure to pesticides.

In November 2006 Swedish researchers reported an increased incidence of Wegener's granulomatosis. Whether this increase is related to improved diagnostic tests, particularly the introduction of tests to measure antineutrophilic cytoplasmic antibodies (ANCA) or an increased incidence of disease remains uncertain. In the meantime researchers at the University of Pennsylvania continue to pursue their efforts to confirm the environmental triggers of Wegener's granulomatosis. For more information on ongoing clinical trials or participation see http://www.med.upenn.edu/rheum/clintrials/wegeners/ct1.html.

Resources:

Albert D, Clarkin, C, Komoroski, J, Brensinger CM, and Berlin JA, Wegener's granulomatosis: Possible role of environmental agent in its pathogenesis, Arthritis Rheum 2004 Aug 15;51(4): 656-664.

Albert DA, Albert AN, Vernace M, Sebastian JK, Hsia EC, Analysis of a cluster of cases of Wegener granulomatosis, J Clin Rheumatol, 2005 Aug;11(4): 188-193.

Duna GF, Cotch MF, Galperin C, Hoffman DB, and Hoffman GS, Wegener's granulomatosis: role of environmental exposures, Clin Exp Rheumatol 1998 Nov-Dec; 16(6): 669-674.

Wegener's granulomatosis fact sheet, National Institute of Allergy and Infectious Diseases, http://www3.niaid.nih.gov/healthscience/healthtopics/wegener/default.htm



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Comments

Sep 26, 2008 6:09 PM
Guest :
Yes... Finally, they are looking for triggers that make sense. I was excited to read this article. Now if more research looked into environmental triggers (or even industrial triggers).

Cyn Bagley Wegener's Granulomatosis patient since Jan 2003
Sep 27, 2008 9:09 AM
Guest :
Interesting information, but probably not the case in our particular situation. My daughter was diagnosed with Wegener's in October, 2007, after nearly a year of being very ill. We have researched when or where she might have been exposed to the alleged causal agents listed in this study and come up with nothing. I'm hopeful continued research will eventually narrow the search until a cause can be found and -- mercifully -- eradicated.
Oct 21, 2008 7:44 PM
Guest :
i fine this information interesting, but in my case not true im still suffering from Wegener's since November of 2007. I've had a history of allergies but not of the others
Oct 28, 2008 1:30 PM
Guest :
I was diagnosed with WG December 2003, though symptoms suggest I had an active case as early as March-April of that year. I was exposed to TCE and lead in my job for most of the 1970's. So were many others, usually in higher exposures for longer periods of time. I am unaware of any other WG cases in this town. In fact I'm aware of only two, perhaps three other patients in this end of the state. If these exposures trigger the disease, my question is why only I, out of hundreds of people exposed where we worked, developed the disease? There must be other factors, and I pray and hope they are identified. My WG is in remission, though I continue on Bactrim. I was on CellCept up through last December, but was taken off of it before I had surgery: the doxctors felt my immune system was over-suppressed.
Dec 3, 2008 11:03 AM
Guest :
My work as a textiles millhand and as a potter (in a commercial pottery) -- along with my other exposures to toxic dusts and fumes in electronics factories, while working for the Defense and Aerospace industries -- offer convincing evidence industrial toxins caused my disease, Wegener's Granulomatosis. In my opinion, existing funding for research is misdirected. Study designs having the statistical power to isolate a causal role for infection, have failed. Meanwhile, case-control studies and case histories implicating synthetic agents, toxic solvents, industrial hydrocarbons and silica dust, already part of the literature, are increasing despite an astonishing lack of funding for environmental and occupational triggers. Draw your own conclusions....
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