pp 1–10 | Cite as

How the Frequency and Phenotype of Sarcoidosis is Driven by Environmental Determinants

  • Manuel Ramos-CasalsEmail author
  • Belchin Kostov
  • Pilar Brito-Zerón
  • Antoni Sisó-Almirall
  • Robert P. Baughman
  • the Autoimmune Big Data Study Group



Sarcoidosis is a systemic disease in which the personal environment seems to drive a differentiated disease frequency and clinical expression. The main epidemiological studies suggest a key influence of potential environmentally linked exposures related to the type of occupation, the household, life style, socioeconomic status, and region of residence.


To provide an update on how sarcoidosis may be modulated by environmental factors.

Data Sources

We searched PubMed for epidemiological studies.


The risk of sarcoidosis is enhanced in people working in jobs related to agriculture, water, construction, metal machining, education, and health, and reduced in those working in jobs mainly centered on personal care. Studies have confirmed seasonal-related peaks of sarcoidosis incidence that follow geographical North–South and West–East gradients. Other personal factors include smoking, personal household exposures, and leisure activities. The evidence pointing to the crucial role of the environment in the etiopathogenesis of sarcoidosis is mounting rapidly. Few diseases so strongly combine geography, environment, gender, and ethnicity as key etiopathogenic factors, with susceptibility to any putative agent being modulated by the individual exposome and genome.


Geoepidemiological research should focus on evaluating the combined effects of environmental and genetic factors, the identification of clusters of geographically driven exposures, and more precise measurement of all personal exposures (degree of combination, length, and level of exposure).


Sarcoidosis Occupational disease Geolocation Environment Seasonality 



The members of the Autoimmune Big Data Study Group involved in this project (serving as scientific advisors, critically reviewing the study proposal, helping to collect data, and participating in writing or technical editing of the manuscript) are Pilar Brito-Zerón1,2,17, Roberto Pérez-Alvarez3,17, Daphne Superville4, Belchin Kostov5, Nihan Acar-Denizli6, Antoni Sisó-Almirall5, Alejandra Flores-Chavez2,8, Courtney Grant15, Soledad Retamozo16, Xavier Bosch7, Lucio Pallarés9,17, David Buss2, Yehuda Shoenfeld12, Munther A. Khamashta11, Robert P. Baughman14, Manuel Ramos-Casals2,13,17 (coordinator). (1) Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain; (2) Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain; (3) Department of Internal Medicine, Hospital Alvaro Cunqueiro, Vigo, Spain; (4) University of California San Francisco, San Francisco, CA, USA; (5) Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CAPSBE, Barcelona, Spain; (6) Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, Istanbul, Turkey; (7) Department of Internal Medicine, ICMiD, Hospital Clínic, Barcelona, Spain; (8) Biomedical Research Unit 02, Clinical Epidemiology Research Unit, UMAE, Specialties Hospital, Western Medical Center, Mexican Institute for Social Security (IMSS), Guadalajara, Mexico; Postgraduate Program of Medical Science, University Center for Biomedical Research (CUIB), University of Colima, Colima, Mexico; (9) Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital de Son Espases, Palma de Mallorca, Spain; (11) Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College University, London, UK; (12) Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; (13) Department of Medicine, University of Barcelona, Barcelona, Spain; (14) University of Cincinnati Medical Center, Department of Medicine, Cincinnati, OH, USA; (15) Glasgow University, UK; (16) Instituto De Investigaciones En Ciencias De La Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - CORDOBA - Argentina; (17) SarcoGEAS Study Group, Grupo de Estudio de Enfermedades Autoinmunes Sistémicas (GEAS) de la Sociedad Española de Medicina Interna (SEMI).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

408_2019_243_MOESM1_ESM.pdf (216 kb)
Supplementary material 1 (PDF 216 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
  2. 2.Primary Healthcare Transversal Research GroupInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CAPSBEBarcelonaSpain
  3. 3.Autoimmune Diseases Unit, Department of MedicineHospital CIMA- SanitasBarcelonaSpain
  4. 4.Department of MedicineUniversity of Cincinnati Medical CenterCincinnatiUSA

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