儿童时期之过敏可预测内化行为


  【24drs.com】根据发表于2016年1月号小儿科期刊的一篇纵向研究,4岁时有过敏性鼻炎和过敏性持续哮喘的儿童,7岁时,内化行为之风险可能会增加,这风险似乎与过敏性疾病类型数量有关。
  
  密苏里州堪萨斯市儿童慈善医院气喘过敏与免疫科的Maya K. Nanda医师等人写道,儿童时期的过敏疾病与焦虑及忧郁等内化行为有关,但是,在纵向研究中并未充分证明这点,且多种过敏疾病对此关联的影响也未知。
  
  研究目标是,评估幼童时期的多种过敏疾病和学龄儿童内化异常之有效测量的关联。
  
  纳入辛辛那提孩童过敏与空气污染研究的546名孩童,在1、2、3、4和7岁时,进行了皮肤点刺试验,以及评估有无出现鼻炎、气喘、和皮肤炎;这些孩童7岁时,家长和孩童完成儿童行为评估系统第二版,这是孩童行为与情绪的一种有效测量。
  
  根据逻辑和线性回归与校正共变项,4岁时的过敏性鼻炎和7岁时的内化分数(校正风险比[aOR]为3.2;95%信赖区间[CI]为1.8 - 5.8)、焦虑(aOR, 2.0;95% CI, 1.2 - 3.6)和忧郁(aOR, 3.2;95% CI, 1.7 - 6.5)分数增加显著有关。
  
  至于过敏性持续哮喘,内化分数增加的aOR为2.7(95% CI, 1.2 - 6.3)。内化分数和4岁时有一种以上过敏疾病、或过敏性鼻炎合并过敏性疾病或其它疾病等,呈现剂量反应关系(分别是aOR, 3.6 [95% CI, 1.7 - 7.6]和aOR, 4.3 [95% CI, 2.0 - 9.2])。
  
  研究作者写道,医师照顾高风险孩童时,特别是家长也有过敏时,应注意这类孩童,特别是多种过敏疾病者,发生内化行为的风险增加2-4倍。
  
  我们的研究结果呼吁,改善过敏孩童的筛检与转诊,特别是那些有多种过敏疾病者,不过,治疗过敏疾病对于心智健康疾病之预防方面,仍尚未清楚且需要更多考量。
  
  研究限制包括,缺乏所有孩童有关心智健康疾病家族史的资料、无法一般化到非城市居民、应答者的偏见、以及依赖父母的报告。
  
  作者们结论表示,心理健康疾病对患者和社会的影响是巨大的;因此,筛检有风险的患者,包括过敏疾病孩童,以及实施初级预防活动是有必要的。
  
  资料来源:http://www.24drs.com/
  
  Native link:Childhood Allergies May Predict Internalizing Behaviors

Childhood Allergies May Predict Internalizing Behaviors

By Laurie Barclay, MD
Medscape Medical News

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.

    
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