Allergic rhinitis, atopic dermatitis, and asthma are associated with differences in school performance among Korean adolescents

Abstract

Several studies have reported negative relations between allergic diseases and school performance but have not simultaneously considered various allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, and only examined a limited number of participants. The present study investigated the associations of allergic rhinitis, asthma, and atopic dermatitis with school performance in a large, representative Korean adolescent population. A total of 299,695 7th through 12th grade students participated in the Korea Youth Risk Behaviour Web-based Survey (KYRBWS) from 2009 to 2013. The subjects’ history of allergic rhinitis, asthma, and atopic dermatitis and number of school absences due to these diseases in the previous 12 months were examined and compared. School performance was classified into 5 levels. The relations between allergic disorders and school performance were analyzed using multiple logistic regressions with complex sampling and adjusted for the subjects’ durations of sleep, days of physical activity, body mass indexes (BMIs), regions of residence, economic levels, parents’ education levels, stress levels, smoking status, and alcohol use. A subgroup analysis of the economic groups was performed. Allergic rhinitis was positively correlated with better school performance in a dose-dependent manner (adjusted odds ratios, AOR, [95% confidence interval, CI] = 1.50 [1.43–1.56 > 1.33 [1.28–1.38] > 1.17 [1.13–1.22] > 1.09 [1.05–1.14] for grades A > B > C > D; P < 0.001). Asthma was negatively correlated with better school performance (AOR [95% CI] = 0.74 [0.66–0.83], 0.87 [0.79–0.96], 0.83 [0.75–0.91], 0.93 [0.85–1.02] for performance A, B, C, and D, respectively; P < 0.001). Atopic dermatitis was not significantly correlated with school performance. The subgroup analysis of the students’ economic levels revealed associations between allergic diseases and school performance. Compared to other allergic disorders, the asthma group had more school absences due to their symptoms (P < 0.001). School performance was positively correlated with allergic rhinitis and negatively correlated with asthma in Korean adolescents, even after adjusting for other variables. The asthma group had an increased number of school absence days, which presumably contributes to these students’ poor school performance.

Academic achievement of adolescents with asthma or atopic disease

“…The results for asthma support a 2005 review investigating asthma in children and academic performance concluding that any association was weak or nonexistent, as well as the null findings of two subsequent studies: a Swedish study on adolescents, and a US study on children aged 8‐17 . However, two more recent studies have found an association between ever, school age and diagnosed asthma with worse academic performance. The larger of these studies by Kim et al included 299 695 children from years 7‐12, and although this is the largest study in this field to date, the limitation of this study was that the participants were voluntary and self‐reported on both exposures and academic performance, hence increasing the risk for selection and measurement bias.…”

“…Although asthma has been shown to be associated with increased absenteeism and in turn absenteeism has been shown to be associated with reduced academic performance, the direct association between asthma and academic performance is unclear. Several studies have found a negative association between asthma and academic performance, while others have found none . This could be because of the heterogeneity of asthma and that most cases are mild and controlled which may not influence learning and cognition, where as other phenotypes of asthma such as uncontrolled, severe or late onset asthma may have a more obvious impact on learning and performance .…”

“…Furthermore, despite the fact that hayfever, eczema and food allergy are also common childhood diseases, affecting quality of life for the sufferers and their families, very little has been studied to date on the effects of these diseases on academic performance …”

The impact of dyspnea and threat of dyspnea on error processing

“…In this regard, Hirsh and Inzlicht (2010) showed that reduced error processing was related to worse academic performance. Given that dyspnea could potentially impair error processing, this might subsequently relate to reduced academic success, for example, in students with asthma who have been demonstrated to show impaired academic performance (Kim, Kim, Park, Kim, & Choi, 2017;Krenitsky-Korn, 2011;Moonie, Sterling, Figgs, & Castro, 2008). In view of these potential negative consequences that reduced error processing caused by dyspnea could have, we aimed at testing the effect of dyspnea on error processing.…”

Nasal obstruction during adolescence induces memory/learning impairments associated with BDNF/TrkB signaling pathway hypofunction and high corticosterone levels

“…A recent study found that children who do not use mouth breathing exhibit better reading comprehension, arithmetic skills, and working memory function when compared with children who use mouth breathing (Kuroishi et al, 2015). Moreover, adenoidal hypertrophy and allergic rhinitis were found to lead to poor academic ability (Fensterseifer, Carpes, Weckx, & Martha, 2013;Walker et al, 2007) and high stress levels (Kim, Kim, Park, Kim, & Choi, 2017) during adolescence. Furthermore, a previous study showed that stress induces hippocampal atrophy and memory loss (Sapolsky, 2000).…”