Emotional and behavioral problems in adolescents and young adults with food allergy

Psychosocial Mediators of Change and Patient Selection Factors in Oral Immunotherapy Trials

Health-related quality of life (HRQL) is influenced by physiological, psychological, and environmental variables and can be best understood by considering the interactions of factors that cut across multiple levels. One of the most important issues relating to treatment in food allergy is to identify, describe, and define predictors that may contribute to modify HRQL outcomes. The research presented demonstrates that measures of HRQL are able to distinguish key features of known groups (e.g. relating to reaction severity, treatment, allergen type/number, expectation of outcome) and delineate impact on hitherto unknown groups (e.g. relating to personality types and coping styles). This heterogeneity may explain why HRQL or other patient-related outcomes may differ in individuals during, or following any treatment or intervention. Patient-reported outcomes are relatively poorly defined to date. Since HRQL has only been studied in relatively few oral immunotherapy trials to date, primarily looking at caregiver HRQL, it is unclear which factors, measures, or subscales are most predictive of short- and/or long-term treatment outcomes for which type of patient, and which time points for measurement are most informative. A standardised protocol that incorporates HRQL and other relevant patient-related outcome measures and agreed definitions of outcomes would allow for the comparison of efficacy of food allergy treatments between centres, trials, or countries. Further evidence-based research aimed at exploring the effects of interventions on outcomes in food allergy is needed, including the influence of patient and parent factors on protocol design. To this end, it is vital that patient-related outcomes such as improved HRQL are seen as a primary outcome and are measured at multiple intervals during the trial duration and beyond. The creative use of methods and designs (both qualitative and quantitative) to better understand the role of HRQL in immunotherapy treatment trials will enable improved modelling of the costs, risks, and benefits of any treatment. Systematic analysis and modelling of antecedent factors, mediators, and outcomes will be important to boost intervention effects and to maximise the overall benefits of treatment.

Student and Parent Perspectives on Severe Food Allergies at College

INTRODUCTION

Constant vigilance to manage severe food allergies (FAs) can lead to high stress. Additional stress may develop during life-course transitions, such as the transition to college. However, few studies have evaluated everyday and FA-related stress in college students with FA and their parents. This analysis examined experiences of 26 college students with FA and their parents.

METHODS

Students and parents completed online surveys in a mixed-methods exploratory study of everyday and FA-related stressors, potential contributing factors, and FA management.

RESULTS

FA affected nearly all areas of students' lives. Management required constant vigilance because of issues of trust in others. However, nearly 40% of students did not consistently carry emergency medication to counteract reactions. Parents worried from a distance while learning to trust their child's FA management capabilities.

DISCUSSION

Additional preparation and support for college students with severe FA and their parents may help improve stress and FA management.

Early food allergy and respiratory allergy symptoms and attention-deficit/hyperactivity disorder in Chinese children: A cross-sectional study

BACKGROUND

The relationship between food allergy and respiratory allergy and attention-deficit/hyperactivity disorder (ADHD) in children is rarely investigated. The objective of this study was to determine whether early food allergy and respiratory allergy symptoms are associated with the prevalence of ADHD in Chinese school-age children.

METHODS

This cross-sectional study was conducted in school-age children using cluster-stratified methods from 9 cities across China between November and December 2005. A family and social environmental questionnaire including the diagnosis history of ADHD and allergic diseases (food allergy, allergic rhinitis, and bronchial asthma), as well as general information, was completed by parents.

RESULTS

The prevalence of both allergic rhinitis (20.4%) and asthma (11.6%) in the food allergy group was significantly higher than in the non-food allergy group (9.0% and 2.8%, respectively; both P < .001). The multivariable analysis showed that single food allergy (OR = 1.53, 95% CI: 1.13-2.05, P = .005), food allergy complicated with allergic rhinitis or asthma (OR = 3.36, 95% CI: 2.19-5.14, P < .001), and food allergy complicated with allergic rhinitis and asthma simultaneously (OR = 4.08, 95% CI: 2.05-8.11, P < .001) were independently associated with the increased risk of ADHD.

CONCLUSIONS

Early food allergy is associated with ADHD in school-age children. Early food allergy and respiratory allergy symptoms independently and synergistically contributed to higher risk of ADHD. Monitoring food allergy in early life could help in the early prediction and intervention for the consequent allergy march and ADHD in children.

Oral sensitization to whey proteins induces age- and sex-dependent behavioral abnormality and neuroinflammatory responses in a mouse model of food allergy: a potential role of mast cells

BACKGROUND

Growing evidence has strengthened the association of food allergy with neuropsychiatric symptoms such as depression, anxiety, and autism. However, underlying mechanisms by which peripheral allergic responses lead to behavioral dysfunction are yet to be determined. Allergen-activated mast cells may serve as mediators by releasing histamine and other inflammatory factors that could adversely affect brain function. We hypothesized that eliciting food allergy in experimental animals would result in behavioral changes accompanied by mast cell accumulation in the brain. Our hypothesis was tested in a mouse model of milk allergy using bovine milk whey proteins (WP) as the allergen.

METHODS

Male and female C57BL/6 mice at 4 weeks (young) and 10 months (old) of age underwent 5-week WP sensitization with weekly intragastric administration of 20 mg WP and 10 μg cholera toxin as an adjuvant. Age-matched sham animals were given the vehicle containing only the adjuvant. All animals were orally challenged with 50 mg WP in week 6 and their intrinsic digging behavior was assessed the next day. Animals were sacrificed 3 days after the challenge, and WP-specific serum IgE, intestinal and brain mast cells, glial activation, and epigenetic DNA modification in the brain were examined.

RESULTS

WP-sensitized males showed significantly less digging activity than the sham males in both age groups while no apparent difference was observed in females. Mast cells and their activities were evident in the intestines in an age- and sex-dependent manner. Brain mast cells were predominantly located in the region between the lateral midbrain and medial hippocampus, and their number increased in the WP-sensitized young, but not old, male brains. Noticeable differences in for 5-hydroxymethylcytosine immunoreactivity were observed in WP mice of both age groups in the amygdala, suggesting epigenetic regulation. Increased microglial Iba1 immunoreactivity and perivascular astrocytes hypertrophy were also observed in the WP-sensitized old male mice.

CONCLUSIONS

Our results demonstrated that food allergy induced behavioral abnormality, increases in the number of mast cells, epigenetic DNA modification in the brain, microgliosis, and astrocyte hypertrophy in a sex- and age-dependent manner, providing a potential mechanism by which peripheral allergic responses evoke behavioral dysfunction.

Association of allergic diseases with children's life satisfaction: population-based study in Finland

OBJECTIVE

To assess the impact of allergic diseases on the subjective well-being and life satisfaction of primary-school children.

DESIGN

Population-based cohort.

SETTING

Finnish sample of children ages 10 and 12 from the International Survey of Children's Well-Being.

PARTICIPANTS

Nationally representative sample of 1947 school children.

MAIN OUTCOME MEASURE

Two different instruments to assess the child's own perception of well-being, the short version of the Student Life Satisfaction Scale (SLSS) and the Brief Multidimensional Student Life Satisfaction Scale (BMSLSS).

RESULTS

Altogether, 51.4% of children reported having at least one allergic condition (10.1% asthma, 23.8% eczema and 40.3% seasonal allergic rhinitis). A statistically significant distinction in life satisfaction emerged between non-allergic and allergic children (inferior in the latter). In particular, children with eczema were more likely to report a reduction in life satisfaction compared with non-allergic children (SLSS β=-128.220; BMSLSS β=-90.694; p<0.01). Apart from freedom from eczema, good life satisfaction was associated with a physically active lifestyle.

CONCLUSIONS

Active allergic disease reduces the child's own perception of well-being. During clinical visits, more attention should be paid to the child's psychosocial status and impairments, which may differ substantially from those of parents or medical authorities.

Rationale for Dietary Antioxidant Treatment of ADHD

Increasing understanding arises regarding disadvantages of stimulant medication in children with ADHD (Attention-Deficit Hyperactivity Disorder). This review presents scientific findings supporting dietary antioxidant treatment of ADHD and describes substantial alterations in the immune system, epigenetic regulation of gene expression, and oxidative stress regulation in ADHD. As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation, as well as by neuronal oxidative damage and loss of normal cerebral functions. Therefore, modulation of immune system activity and oxidant-antioxidant balance using nutritional approaches might have potential in ADHD treatment. The use of natural antioxidants against oxidative conditions is an emerging field in the management of neurodegenerative diseases. Dietary polyphenols, for example, have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy. This review can stimulate the development and investigation of dietary antioxidant treatment in ADHD, which is highly desired.

Mental disorder in children with physical conditions: a pilot study

OBJECTIVES

Methodologically, to assess the feasibility of participant recruitment and retention, as well as missing data in studying mental disorder among children newly diagnosed with chronic physical conditions (ie, multimorbidity). Substantively, to examine the prevalence of multimorbidity, identify sociodemographic correlates and model the influence of multimorbidity on changes in child quality of life and parental psychosocial outcomes over a 6-month follow-up.

DESIGN

Prospective pilot study.

SETTING

Two children's tertiary-care hospitals.

PARTICIPANTS

Children aged 6-16 years diagnosed in the past 6 months with one of the following: asthma, diabetes, epilepsy, food allergy or juvenile arthritis, and their parents.

OUTCOME MEASURES

Response, participation and retention rates. Child mental disorder using the Mini International Neuropsychiatric Interview at baseline and 6 months. Child quality of life, parental symptoms of stress, anxiety and depression, and family functioning. All outcomes were parent reported.

RESULTS

Response, participation and retention rates were 90%, 83% and 88%, respectively. Of the 50 children enrolled in the study, the prevalence of multimorbidity was 58% at baseline and 42% at 6 months. No sociodemographic characteristics were associated with multimorbidity. Multimorbidity at baseline was associated with declines over 6 months in the following quality of life domains: physical well-being, β=-4.82 (-8.47, -1.17); psychological well-being, β=-4.10 (-7.62, -0.58) and school environment, β=-4.17 (-8.18, -0.16). There was no association with parental psychosocial outcomes over time.

CONCLUSIONS

Preliminary evidence suggests that mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time. Based on the strong response rate and minimal attrition, our approach to study child multimorbidity appears feasible and suggests that multimorbidity is an important concern for families. Methodological and substantive findings from this pilot study have been used to implement a larger, more definitive study of child multimorbidity, which should lead to important clinical implications.

Food allergy in EAACI journals (2016)

Over the last years we have observed considerable progress in the area of food allergy, particularly in children. This review article focusses on important contributions which have lately been published in the three journals of the European Academy of Allergy and Clinical Immunology. A better understanding of allergens as well as the mechanisms of sensitization and tolerance induction may hopefully lead to a more targeted management of food allergy in the near future.

Changes in patient quality of life during oral immunotherapy for food allergy

BACKGROUND

Quality of life (QOL) is impaired in patients with food allergy and improves following oral immunotherapy (OIT). However, the treatment itself is prolonged and demanding. We examined changes in patient QOL during OIT for food allergy.

METHODS

The FAQLQ-PF was administered to children aged 4-12 years undergoing OIT for milk, peanut, or egg allergy, at the beginning and after 4 months of treatment. Patients were categorized as improved, unchanged, or diminished FAQLQ-PF (>0.5 point decrease, a change of ≤0.5 points, or >0.5 increase, respectively) and compared. Food-allergic patients not undergoing OIT served as controls.

RESULTS

The Food Anxiety, Social and Dietary Limitation, and total FAQLQ-PF scores improved significantly during the study period (P=.001, P=.018, and P=.01, respectively) in treated but not in control patients, while the Emotional Impact did not. The change in the FAQLQ-PF was independent of the maximal tolerated dose at baseline or following four months of treatment, the pace of dose increase, or the number or severity of reactions experienced. The total FAQLQ-PF score was inversely associated with the score at baseline on multivariate analysis (regression coefficient=-0.56, P<.001). That was driven primarily by improvement in QOL scores in patients with high score (worse QOL) at baseline. Some patients with low FAQLQ-PF score (better QOL) at baseline deteriorated.

CONCLUSIONS

QOL of patients with food allergy improves in some but deteriorates in others during OIT. Patients with impaired QOL at baseline improve significantly despite the treatment burden. Some patients with better QOL at baseline might deteriorate during OIT.

Food Allergy in Patients Seeking Mental Health Care: What the Practicing Psychiatrist Should Know

PURPOSE OF REVIEW

This review provides an overview of food allergy among children and adolescents in the context of its impact on psychosocial functioning, and quality of life (QoL).

RECENT FINDINGS

The prevalence of food allergy is increasing. The burden of day to day management of food allergy is significant and can have a negative impact on QoL for both parents of those with food allergy, and the children themselves. This can impact social functioning, academic functioning, and mental health. Children with food allergy experience more bullying than peers. Greater internalizing of symptoms has been identified in adolescents with food allergy. Typical developmental considerations in the transition from adolescence to adulthood can be impacted significantly. Those caring for children with food allergy should consider the impact of food allergy on the individual and family level within the context of social and emotional development.

An update on the impact of food allergy on anxiety and quality of life

PURPOSE OF REVIEW

Food allergies have become more common, and management involves dietary avoidance that can impair quality of life. Patients and families must manage the daily risk of anaphylaxis at each meal. The purpose of this review is to describe the impact of food allergies on quality of life and to provide an update on new developments in food allergy management, particularly peanut allergy.

RECENT FINDINGS

Food allergy requires careful avoidance of common and ubiquitous dietary allergens. Living with food allergy is associated with annual economic costs in excess of $4000 per child, in addition to risks of anxiety and depressive symptoms. An expert panel sponsored by the 2017 National Institute of Allergy and Infectious Diseases published addendum guidelines for the prevention of peanut allergy, which suggest three separate approaches to peanut protein introduction for infants at various levels of risk.

SUMMARY

Clinicians must be aware of underappreciated burdens faced by children and families with food allergies. Management involves a partnership between primary and specialty care. Mitigation strategies to improve quality of life for patients include efforts to avoid overdiagnosis in synergy with balanced counseling about the risks of food allergies. Experimental food allergen desensitization can improve quality of life but remains investigational at this time. For patients with significant anxiety, interdisciplinary management involving professional counseling may be helpful. Risk stratification and early introduction of peanut protein can help prevent the development of peanut allergy.

Food allergy and attitudes to close interpersonal relationships: An exploratory study on attachment

BACKGROUND

Food allergy is a common immunologic disease that includes potentially fatal reactions. It impacts considerably on patients' social life including close interpersonal relationships. Attachment theory provides a theoretic framework to evaluate the quality of close interpersonal relationships in chronic disorders. Attachment insecurity, mainly characterized by attachment avoidance, has been found in a variety of health conditions, but still needs to be investigated in food allergy. The study aimed to investigate attachment, as attitude to close interpersonal relationships, among food-allergic young patients, compared to healthy controls.

METHODS

This is a cross-sectional study involving patients suffering from IgE-mediated food allergy sequentially recruited and matched to healthy controls for age and gender. The Attachment Style Questionnaire (ASQ) was used to assess five factors and two attachment dimensions (Anxiety-Avoidance). Associations with anaphylaxis and adrenaline prescription were explored among patients.

RESULTS

174 participants were assessed (female=45%; mean age=17.51; SD=4.26). Food-allergic patients reported significantly higher levels of Discomfort with Closeness (P<.05), Relationships as Secondary (P<.05) and Attachment Avoidance (P<.0001) compared to controls.

CONCLUSIONS

Clinicians should be aware of implications of insecure attachment for health and illness. They should support patients in limiting social impairment finding a balance between safety and psychologic well-being.

Coping strategies, alexithymia and anxiety in young patients with food allergy

BACKGROUND

Food allergy is major public health concern affecting nearly 15 million Americans and 80 million Europeans. Risk of anaphylaxis and implications for social activities affect patients' quality of life and psychological well-being. We previously found that young patients reported higher levels of alexithymia (difficulty in recognizing and expressing emotions) compared with healthy peers and may influence affect, management style and clinical outcomes. This study aimed to explore links between coping strategies, alexithymia and anxiety among food-allergic adolescents and young adults.

METHODS

Ninety-two patients with IgE-mediated food allergy (mean age 18.6 years) completed Coping Orientation to Problems Experienced Inventory, Toronto Alexithymia Scale and Trait Anxiety subscale of State-Trait Anxiety Inventory. Multivariate analyses of variance assessed differences and associations between subgroups on the scales.

RESULTS

Significant differences found between alexithymia levels in coping style were explained by Avoidance strategies. 'Avoidance' had the highest contribution in explaining alexithymia, followed by trait anxiety, age, anaphylaxis and social support. Respondents with higher alexithymia use avoidance as coping strategy over and above other coping strategies such as problem-solving and positive thinking, are younger, will have experienced anaphylaxis and will have lower social support.

CONCLUSIONS

Recognizing the specific role of affect regulation in health behaviours may constitute an important step in supporting patients to explore more adaptive strategies.

Transitioning the Allergy/Immunology Patient from Childhood to Adulthood

Allergic disorders and immunodeficiencies are generally chronic and even lifelong conditions, often changing over time, making the cautious transition of care from childhood to adulthood particularly important. Many, but not all, patients can continue to receive their care from the same physician as they transition through adolescence and emerging adulthood, made possible because allergy/immunology training programs require cross-training in the care of both pediatric and adult patients. Although keeping the same physician makes the transition easier for many allergy/immunology patients, even these patients face psychosocial issues unique to adolescents and emerging adults, including increased autonomy, risk-taking behavior, and medical self-management. Successful transition for patients with chronic allergic and immunologic conditions involves an understanding of the natural history of these conditions by patients and physicians alike, a gradual increase in self-management depending on individual readiness, and careful communication between pediatric and adult specialists as care is transitioned. [Pediatr Ann. 2017;46(6):e229-e234.].

Child- and parent-reported quality of life trajectories in children with epilepsy: A prospective cohort study

OBJECTIVE

To describe the developmental trajectories of quality of life (QoL) in a large cohort of children with epilepsy, and to assess the relative contribution of clinical, psychosocial, and sociodemographic variables on QoL trajectories.

METHODS

Five assessments during a 28-month prospective cohort study were used to model trajectories of QoL. Participants were recruited with their parents from six Canadian tertiary centers. A convenience sample of 506 children aged 8-14 years with epilepsy and without intellectual disability or autism spectrum disorder were enrolled. A total of 894 children were eligible and 330 refused participation. Participating children were, on average, 11.4 years of age, and 49% were female. Nearly one third (32%) had partial seizures. At baseline, 479 and 503 child- and parent-reported questionnaires were completed. In total, 354 children (74%) and 366 parents (73%) completed the 28-month follow-up. QoL was measured using the child- and parent-reported version of the Childhood Epilepsy QoL scale (CHEQOL-25).

RESULTS

Child-reported QoL was fitted best by a six-class model and parent-reported QoL by a five-class model. In both models, trajectories remained either stable or improved over 28 months. Of these children, 62% rated their QoL as high or moderately high, defined as at least one standard deviation above the average CHEQOL-25 score. Greater family, classmate, and peer social support, fewer symptoms of child and parent depression, and higher receptive vocabulary were identified as the most robust predictors of better QoL (all p < 0.001).

SIGNIFICANCE

Most children with epilepsy and their parents reported relatively good QoL in this first joint self- and proxy-reported trajectory study. Findings confirm the heterogeneous QoL outcomes for children with epilepsy and the primary importance of psychosocial factors rather than seizure and AED-specific factors in influencing QoL. These predictors that are potentially amenable to change should now be the focus of specific intervention studies.

Association of Pediatric Allergic Rhinitis with the Ratings of Attention-Deficit/Hyperactivity Disorder

Background

Allergic rhinitis (AR) is currently the most prevalent allergic disease in children and adolescents.

Objective

Surveys conducted by population-based studies of East Asia revealed an increased prevalence of behavioral disorders in patients with AR. Thus, in this study, we explored the prevalence of attention-deficit/hyperactivity disorder (ADHD) in pediatric patients with AR.

Methods

A total of 333 children (6–12 years of age) with AR and a total of 322 age-matched controls were included in this study. An otorhinolaryngologist diagnosed all AR cases and evaluated the severity of the disease. Skin-prick test results for 18 major allergens, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), Child Behavior Checklist (CBCL), and Swanson, Nolan, and Pelham version IV (SNAP-IV) scores were recorded.

Results

In total, 320 age-matched controls and 323 children with AR completed the study. With respect to the Total Nasal Symptom Score and the PRQLQ, the condition of the experimental group was more serious than that of the controls. The scores on the hyperactivity/impulsivity and inattention subscales, which evaluate ADHD symptoms, and those on the CBCL subscales were significantly higher in patients with AR than in the controls (all p values were <0.01). From the results of the Pearson correlation, we deduced that there were significant positive correlations between the AR-related data and each subscale of the CBCL and SNAP-IV in the AR group. Moreover, two basic characteristics (males and environmental exposure to tobacco smoke) present significant positive and age showed a significant negative correlations affect ADHD symptom in both the AR group and the control group. Also, in the “pure AR” group, hierarchical regression analyses were performed to determine the subtests of the PRQLQ, which are significant predictors of SNAP-IV and CBCL.

Conclusions

Apart from AR per se, the possible comorbidities of impulsivity and inattention are important when managing children with AR. It is essential to evaluate the symptoms of ADHD in children and adolescents with AR.

IgE-associated allergic disorders: recent advances in etiology, diagnosis, and treatment

IgE-associated allergic diseases belong to the most common inflammatory conditions. Their clinical manifestation ranges from mild symptoms to life-threatening episodes. Often patients experience a reduction in physical and psychologic well-being and suffer from a decreased quality of life due to disease activity. The continuously rising number of people that are affected by an allergic condition indicates an urgent need for better diagnostics and more efficient treatment options. Recent progress in the understanding of pathophysiologic mechanisms underlying IgE-associated allergic disorders has led to the identification of novel therapeutic targets and the development of drug candidates that are currently under evaluation. In this review, we highlight studies and clinical trials, which have helped to gain further insight in the etiology of IgE-associated allergic conditions as well as advances in the development of diagnostic tools and therapeutic approaches recently published in Allergy (European Journal of Allergy and Clinical Immunology).

Attention Deficit Disorder and Allergic Rhinitis: Are They Related?

The association between ADHD and allergy remains controversial. Our previous findings suggest that nerve growth factor may link the nervous and immune systems. The primary objective of this study was to determine if a combination of cetirizine + methylphenidate is effective in children with comorbid ADHD and allergic rhinitis. We also examined the role of nerve growth factor in these comorbidities. Our randomized, double-blind, placebo-controlled, crossover study enrolled 38 children diagnosed with comorbid ADHD and allergy using cetirizine (n = 12), sustained-release methylphenidate (n = 12), or cetirizine + methylphenidate (n = 14). Endpoints compared baseline to posttreatment evaluations for allergic rhinitis and ADHD scores. Serum nerve growth factor levels were measured using ELISA. For allergy endpoints, combination therapy produced results superior to individual therapy. For ADHD, similar scores were achieved for individual therapy; however, combination therapy resulted in improved scores. Nerve growth factor levels were downregulated following this trend. We conclude that ADHD and allergic rhinitis may have common mechanism and represent a comorbid condition that links the nervous system to the immune system. Further studies are needed.

Psychiatric disorders and symptoms severity in pre-school children with cow's milk allergy

BACKGROUND

Psychiatric disorders are seen frequently in atopic diseases. The present study aims to evaluate the frequency of psychiatric disorders and the severity of psychiatric symptoms in pre-school children with cow's milk allergy.

METHODS

The parents of the pre-school children with cow's milk allergy were interviewed in person and asked to fill out the Early Childhood Inventory-4 form.

RESULTS

The cow's milk allergy group included 40 children (27 male, 13 female) with mean age, 44.5±14.7 months, and the control group included 41 children (25 male, 16 female) with mean age, 47.6±15.2 months. It was established that 65% of the group with cow's milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference (p=0.02). Within the psychiatric disorders, attention deficit hyperactivity disorders (odds ratio: 4.9, 95% CI: 1.472-16.856, p=0.006), oppositional defiant disorder (odds ratio: 5.6, 95% CI: 1.139-28.128, p=0.026), and attachment disorder (odds ratio: 4.8, 95% CI: 1.747-13.506, p=0.004) were found significantly higher compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores, calculated by using the Early Childhood Inventory-4 form, attention deficit hyperactivity disorders severity (p=0.006) and oppositional defiant disorder severity (p=0.037) were found to be higher in the cow's milk allergy group.

CONCLUSION

Psychiatric disorders are frequent and severe in pre-school children with cow's milk allergy.

Association between medication prescription for atopic diseases and attention-deficit/hyperactivity disorder

BACKGROUND

Data on the association between atopic diseases and attention-deficit/hyperactivity disorder (ADHD) have been inconclusive.

OBJECTIVE

To assess whether children with drug-treated ADHD are more likely to receive treatment for asthma, allergic rhinitis, or eczema before the start of ADHD medication use compared with controls and to examine the effect of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring.

METHODS

We conducted a retrospective nested case-control study among children (6-12 years of age) using the Groningen University prescription database. Cases were defined as children with at least 2 prescriptions of methylphenidate within 12 months. For each case, 4 controls were matched on age, sex, and regional area code. Parental prescription data were linked to cases and controls to assess the influence of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring.

RESULTS

We identified 4257 cases and 17,028 matched controls. Drug treatment for asthma, allergic rhinitis, and eczema was more common in cases than controls (adjusted odds ratios [aORs], 1.4 [95% confidence interval (CI), 1.3-1.6], 1.4 [95% CI, 1.1-1.8], and 1.3 [95% CI, 1.1-1.5], respectively). Medication for allergic rhinitis and asthma among parents was associated with ADHD treatment in their children (aORs, 1.3 [95% CI, 1.1-1.5] and 1.2 [95% CI, 1.1-1.3], respectively).

CONCLUSION

This study provides further evidence to support the hypothesis that atopic diseases are associated with ADHD. The parental-offspring association suggests a possible genetic and/or environmental component.