Potential Autoimmune Association between Benign Paroxysmal Positional Vertigo and Immune-mediated Skin Conditions: Population-based Cohort Study

BackgroundBenign paroxysmal positional vertigo (BPPV), an idiopathic disorder of sudden sensorineural hearing loss and vertigo, shares many similarities with two common skin conditions, atopic dermatitis (AD) and vitiligo. Recent studies have suggested that BPPV may be related to or triggered by autoimmune conditions, notably hypothyroidism and giant cell arteritis (GCA).\n\nObjectiveThese evidences prompted the authors to entertain the possibility of immunological bridge between BPPV and the two skin conditions. The authors have tested this hypothesis with population-based cohort from the National Health Insurance Service Database of Korea.\n\nMethodsA cohort of 1.1 million patients was extracted from the DB. Using{chi} 2 tests, prevalence of the two skin disorders in terms of BPPV status was analysed.\n\nResultsIn AD patients, the prevalence of BPPV was 30% lower, while there was no statistically significant relationship between BPPV prevalence and vitiligo. The relationship between vitiligo and BPPV was significant in younger subgroup only. Socio-economic subgroup analysis revealed the observed patterns are primarily a middle-upper class phenomenon.\n\nLimitationsUncertainty regarding temporal sequence of onset, and lack of detail on disease severity and subtype might have kept the authors from drawing more refined conclusion.\n\nConclusionAD and vitiligo might be linked to BPPV through the action of certain components of cellular immunity, but follow-up studies based on large population cohort would be needed to add more substance to our findings.