Childhood Allergies May Predict Internalizing Behaviors

Laurie Barclay, MD

January 07, 2016

Children with allergic rhinitis and allergic persistent wheezing at age 4 years may have increased risk for internalizing behaviors at age 7 years, and the risk appears to be associated with the number of allergic diseases, according to a longitudinal study published in the January 2016 issue of Pediatrics.

"Allergic diseases in childhood have been associated with internalizing disorders, including anxiety and depression, but this is not well characterized in longitudinal studies and the effect of multiple allergic diseases on this relationship is unknown," write Maya K. Nanda, MD, from the Division of Asthma, Allergy, and Immunology, Children's Mercy Hospital in Kansas City, Missouri, and colleagues.

The study goal was to evaluate the association between multiple allergic diseases in early childhood and validated measures of internalizing disorders in school-age children.

At ages 1, 2, 3, 4, and 7 years, 546 children who were enrolled in the Cincinnati Childhood Allergy and Air Pollution Study underwent skin-prick testing and evaluation for the presence of rhinitis, wheezing, and dermatitis. Parents of the children completed the Behavior Assessment System for Children, Second Edition, a validated measure of childhood behavior and emotion, when the children were aged 7 years.

Allergic rhinitis at age 4 years was significantly associated with elevated internalizing scores (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 years, according to logistic and linear regression with adjustment for covariates.

For allergic persistent wheezing, the aOR of elevated internalizing scores was 2.7 (95% CI, 1.2 - 6.3). There were dose-dependent associations between internalizing scores and having more than one allergic disease at age 4 years or allergic rhinitis with comorbid allergic disease or diseases (aOR, 3.6 [95% CI, 1.7 - 7.6] and aOR, 4.3 [95% CI, 2.0 - 9.2], respectively).

"Physicians who care for high-risk children, especially those born to allergic parents, should be aware of the two- to fourfold increased risk of developing internalizing behaviors, especially in children with multiple allergic diseases," the study authors write.

"Our findings call for improved screening and referral of allergic children, particularly those with multiple allergic diseases. However, the treatment of allergic diseases in the prevention of mental health diseases is unclear and requires further consideration."

Limitations of this study include the lack of data from all children on family history of mental health diseases, lack of generalizability to nonurban dwellers, responder bias, and reliance on parental report.

"The impact of mental health disorders on the patient and society is substantial; therefore, screening at-risk patients, including children with allergic disease, and implementing primary prevention activities may be warranted," the authors conclude.

The National Institutes of Health/National Institute of Allergy and Infectious Diseases, the National Institute of Environmental Health Sciences, and an Institutional Clinical and Translational Science Award from the National Institutes of Health/National Center for Research Resources funded and supported this study. The authors have disclosed no relevant financial relationships.

Pediatrics. 2016;137:e20151922. Abstract


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