Childhood atopy and mental health: a prospective, longitudinal investigation

Maternal mental illness and child atopy: a UK population-based, primary care cohort study

BACKGROUND

The number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy.

AIM

To investigate the association between maternal mental illness and risk of atopy among offspring.

DESIGN AND SETTING

Retrospective cohort study using a UK primary care database (674 general practices).

METHOD

In total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region).

RESULTS

Children exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93).

CONCLUSION

The finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier.

Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls

OBJECTIVE

Several studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017.

METHODS

Self-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma.

RESULTS

Rates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD.

CONCLUSIONS

Rates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.

Allergic diseases do not impair the cognitive development of children but do damage the mental health of their caregivers

This study aimed to investigate whether children with atopic diseases exhibited different neurodevelopment function from healthy controls and whether their caregivers had differential parental stress. In total, we recruited 109 patients with atopic diseases (mean age 6.8 years, 54.1% male) and 82 healthy children (mean age 6.3 years, 54.9% male). Based on the children’s age, they underwent developmental, cognitive evaluations and attention deficit/hyperactivity disorder (ADHD) symptoms. The parenting stress of children’s caregivers was evaluated using the Chinese Health Questionnaire (CHQ-12) and Family APGAR. Of the children with atopic diseases, 87.2%, 74.3%, 29.4%, and 8.3% of them had allergic rhinitis, asthma, atopic dermatitis, and urticaria, respectively. None of these conditions were associated with children’s cognitive profiles or ADHD symptoms. However, the caregivers of patients who had asthma suffered from higher CHQ-12 scores than those of patients without asthma. Furthermore, the number of atopic diseases had a dose–response effect on caregivers’ CHQ-12 scores. In conclusion, allergic diseases did not impair the cognitive development of children. However, caregivers of patients with asthma or multiple atopic diseases may suffer a greater mental health burden with regard to caring for their children. Such caregivers may require support to effectively fulfill their parenting roles.

Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle

BACKGROUND

Approximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease.

OBJECTIVE

This study aimed to describe the perceptions of food allergy-related mental health issues of parents of children with food allergy.

METHODS

Parents of children with pediatric allergist-diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes.

RESULTS

We interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of "accommodation and adaptation." In contrast, parents of children with multiple food allergies described "anxiety and isolation" and spoke of being "depressed" and "terrified" about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt "overwhelmed and alone," especially if they lacked support from extended family and/or their social circle. "Fear for today, fear for the future" was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating "Food allergy management has become our normal." Finally, a small group of parents reported that "Bullying happens, but we are alone to cope with it."

CONCLUSION

Multiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.

Attention deficit-hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin

This study investigated whether common comorbidities or biochemical factors, such as allergic disease, anemia, inflammation, and neurotransmitters, are singly or additively associated with an increased risk of attention deficit–hyperactivity disorder (ADHD). We recruited 216 children diagnosed with ADHD and 216 age-, sex-, height-, weight-, and class-matched controls from 31 elementary schools in Taipei, Taiwan. The International Study of Asthma and Allergies in Childhood questionnaire was used to measure allergic symptoms. Fasting venous blood was collected and analyzed for complete blood count, white blood cell differential count, immunoglobulin (Ig) E level, and serotonin (5-HT) level. The results showed that symptoms of both rhinitis (OR = 2.08, 95% CI = 1.42–3.05) and eczema (OR = 1.72, 95% CI = 1.02–2.88) were significantly associated with increased risk of ADHD. Children with ADHD showed considerably lower levels of hemoglobin (p = 0.001) and 5-HT (p < 0.001) and higher IgE level (p < 0.001) and eosinophil count (p = 0.001) than did control children. ADHD risk increased with the number of aforementioned biochemical risk factors present (one factor: OR = 1.87, 95% CI = 0.87–4.18; two factors: OR = 2.90, 95% CI = 1.29–6.48; three factors: OR = 4.47, 95% CI = 1.97–10.13; four factors: OR = 6.53, 95% CI = 2.43–17.57). Findings suggest that either ADHD’s etiology is multidimensional or the aforementioned conditions have shared etiology with ADHD.