Association Between Atopic Disease and Anemia in US Children

Abstract

IMPORTANCE Atopic disease is associated with chronic inflammation, food allergen avoidance, and use of systemic immunosuppressant medications. All these factors have been shown to be associated with anemia. OBJECTIVE To investigate whether atopic disease is associated with increased risk of childhood anemia. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey and laboratory assessment were conducted using data from the 1997-2013 US National Health Interview Survey (NHIS) that included 207 007 children and adolescents and the 1999-2012 National Health and Nutrition Examination Survey (NHANES) that included 30 673 children and adolescents. Analysis of the data was conducted between August 1, 2014, and August 28, 2015. EXPOSURES Caregiver-reported history of eczema, asthma, hay fever, and/or food allergy. MAIN OUTCOMES AND MEASURES Anemia was defined by caregiver report in the NHIS and by hemoglobin levels for age and sex in the NHANES. RESULTS Data were collected on 207 007 children and adolescents from NHIS, representing all pediatric age, sex, racial/ethnic, household educational level, and income groups. The US prevalence was 9.5% (95% CI, 9.4%-9.7%) from all years of the NHIS for health care-diagnosed eczema, 12.8% (95% CI, 12.6%-13.0%) for asthma, 17.1% (95% CI, 16.9%-17.3%) for hay fever, 4.2% (95% CI, 4.1%-4.3%) for food allergy, and 1.1% (95% CI, 1.1%-1.2%) for anemia. In multivariable logistic regression models controlling for age, sex, race/ethnicity, annual household income, highest educational level in the family, insurance coverage, number of persons in the household, birthplace in the United States, and history of asthma, hay fever, and food allergy, anemia was associated with eczema in 14 of 17 studies, asthma in 11, hay fever in 12, and food allergy in 12. In multivariable analysis across the NHIS (with results reported as adjusted odds ratios [95% CIs]), children with any eczema (1.83; 1.58-2.13), asthma (1.31; 1.14-1.51), hay fever (1.57; 1.36-1.81), and food allergy (2.08; 1.71-2.52) had higher odds of anemia (P < .001 for all). In the NHANES, current history of asthma (1.33; 1.04-1.70; P = .02) and eczema (1.93; 1.04-3.59; P = .04) were associated with higher odds of anemia, particularly microcytic anemia (asthma: 1.61; 1.09-2.38; P = .02; eczema: 2.03; 1.20-3.46; P = .009) while history of hay fever was not associated with anemia (0.85; 0.62-1.17; P = .33). CONCLUSIONS AND RELEVANCE The association between atopic disease and anemia was reproducible in multiple cohorts. Future studies are needed to identify the determinants of association between atopic disease and anemia.

Atopic Disease and Anemia in Korean Patients: Cross-Sectional Study with Propensity Score Analysis

“…Even though an association with atopic diseases (allergic rhinitis, atopic dermatitis, and asthma), designated the atopic match (allergic match), was shown [24][25][26], there could be differences in the magnitude of inflammation among the atopic diseases. Two previous studies reported that the more atopic diseases patients have, the higher their risk of anemia [14,15]. Our results were in agreement.…”

“…Drury et al investigated the association between atopic diseases and anemia using a survey of pediatric and adolescent patient caregivers [14]. The present study could better support the results, as it used diagnostic codes for each disease.…”

“…Although the etiology of anemia of inflammation (AI) differs from that of iron deficiency anemia (IDA), differentiating these conditions in the typical clinical setting is difficult, as both types of anemia exhibit low hemoglobin and low iron status in blood tests [13]. Drury et al reported an association between atopic disease and anemia in children [14]. Their study, however, did not evaluate or exclude the effects of other medical conditions correlated with both atopic disease and anemia such as rheumatoid arthritis, irritable bowel diseases, or depression.…”

Circulating CLA+T cells in atopic dermatitis and their possible role as peripheral biomarkers

“…Indeed, our data showed that ~80% of patients with AD who had increased CLA − T‐cell activation suffered from asthma, food allergies, or environmental allergies . Additionally, increased ‘systemic T‐cell activation may also account for the systemic comorbidities that are now becoming increasingly recognized in patients with severe AD .…”

Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults

“…One study has implicated sleep disturbance as a contributing factor, 12 and two studies have implicated AD severity. 4,6 Childhood AD is also associated with multiple allergic and nonallergic comorbidities that might further contribute to the increased risk of ADD/ADHD, including obesity, [13][14][15] anaemia, 16 headaches, 17 asthma 18 and allergic rhinitis. 18 We hypothesized that AD is independently associated with increased risk of ADD/ADHD in children, and that disease severity and sleep disturbance act in concert to increase the risk of ADD/ADHD.…”