Allergic Diseases and Internalizing Behaviors in Early Childhood

Abstract

BACKGROUND AND OBJECTIVES The relationship between allergic diseases and internalizing disorders has not been well characterized with regard to multiple allergic diseases or longitudinal study. The objective of this study was to examine the association between multiple allergic diseases in early childhood with validated measures of internalizing disorders in the school-age years. METHODS Children enrolled in the Cincinnati Childhood Allergy and Air Pollution Study underwent skin testing and examinations at ages 1, 2, 3, 4, and 7 years. At age 7, parents completed the Behavior Assessment System for Children, Second Edition (BASC-2), a validated measure of childhood behavior and emotion. The association between allergic diseases at age 4, including allergic rhinitis, allergic persistent wheezing, atopic dermatitis, and allergic sensitization, and BASC-2 internalizing, anxiety, and depression T scores at age 7 was examined by logistic and linear regression, adjusting for covariates. RESULTS The cohort included 546 children with complete information on allergic disease and BASC-2 outcomes. Allergic rhinitis at age 4 was significantly associated with elevated internalizing (adjusted odds ratio [aOR]: 3.2; 95% confidence interval [CI]: 1.8–5.8), anxiety (aOR: 2.0; 95% CI: 1.2–3.6), and depressive scores (aOR: 3.2; 95% CI: 1.7–6.5) at age 7. Allergic persistent wheezing was significantly associated with elevated internalizing scores (aOR: 2.7; 95% CI: 1.2–6.3). The presence of >1 allergic disease (aOR: 3.6; 95% CI: 1.7–7.6) and allergic rhinitis with comorbid allergic disease(s) (aOR: 4.3; 95% CI: 2.0–9.2) at age 4 had dose-dependent associations with internalizing scores. CONCLUSIONS Children with allergic rhinitis and allergic persistent wheezing at age 4 are at increased risk of internalizing behaviors at age 7. Furthermore, multiple allergic diseases had a dose-dependent association with elevated internalizing scores.

Associations of atopic dermatitis and asthma with child behaviour: Results from the PROBIT cohort

“…In a German birth cohort study including 770 children from the general population, information on AD before age 4 years was obtained by questionnaires to parents and physicians. AD was strongly associated with parental reports of doctor‐diagnosed ADHD or ADHD medication up to age 8 years (adjusted relative risk, 5.17; 95% CI: 2.18‐12.3) . Another German birth cohort study including 2916 individuals evaluated with parental SDQ at age 10 years found that children with parental reports of AD during infancy had an increased risk of emotional symptoms (adjusted OR: 1.62; 95% CI: 1.25‐2.09) and AD limited to infancy was associated with conduct problems (adjusted OR: 1.75; 95% CI: 1.18‐2.60) .…”

“…The findings are in line with the theory of a neuro-immunologic pathway, and the important question whether TA B L E 4 OR estimates calculated by logistic regression for child behaviour at 6.5 years in relation to AD and asthma in the past year (n = 11 668) targeted preventive measures for infants with AD could reduce behavioural problems has been raised. 23 In contrast to previous studies that defined AD based on questionnaires, [27][28][29][30] we used clinical examinations by a physician at several follow-up visits during the first year of life to evaluate AD in infancy. The only significant association with behaviour was reduced odds of hyperactivity/inattention at 6.5 years.…”

“…Longitudinal cohorts include prospectively collected data on background factors and potential confounders and allow stronger causal inference, based on the temporal sequence between exposure and outcome. Findings from longitudinal studies evaluating allergic diseases in relation to child behaviour are inconsistent . In longitudinal studies from Germany, AD early in life was associated with conduct problems, emotional problems and ADHD at school age, while no association was found between AD and ADHD in a larger birth cohort including 3000 Swedish children .…”

“…Findings from longitudinal studies evaluating allergic diseases in relation to child behaviour are inconsistent. [27][28][29][30][31] In longitudinal studies from Germany, AD early in life was associated with conduct problems, emotional problems and ADHD at school age, 27,28 while no association was found between AD and ADHD in a larger birth cohort including 3000 Swedish children. 29 In the British ALSPAC birth cohort, child behaviour was reported by teachers for a subpopulation (n = 4366) at age 8 years; late-onset AD was associated with a higher risk of internalizing behaviours (emotional problems and peer problems), persistent rash increased the risk for externalizing behaviours (conduct problems and hyperactivity/inattention), while no association was observed between wheeze and behaviour.…”

Activation of Dopamine D2 Receptor Alleviates Neuroinflammation and Neuronal Injury in Mice Model of Allergic Rhinitis With Olfactory Dysfunction

“…Endothelin-1 produced by in ammatory tissue may increase BBB permeability and activate microglia expressing endothelin receptor B through the damaged BBB [38]. Other hypotheses cite the role of IL-1β in allergic reactions, which activates the hypothalamic-pituitary-adrenal (HPA) axis, stimulates the release of cortisol and serotonin, and leads to mood disorders [39]. This study also showed that AR-induced OD was closely related to neuroin ammation of the olfactory bulb.…”