兒童時期之過敏可預測內化行為


  【24drs.com】根據發表於2016年1月號小兒科期刊的一篇縱向研究,4歲時有過敏性鼻炎和過敏性持續哮喘的兒童,7歲時,內化行為之風險可能會增加,這風險似乎與過敏性疾病類型數量有關。
  
  密蘇里州堪薩斯市兒童慈善醫院氣喘過敏與免疫科的Maya K. Nanda醫師等人寫道,兒童時期的過敏疾病與焦慮及憂鬱等內化行為有關,但是,在縱向研究中並未充分證明這點,且多種過敏疾病對此關聯的影響也未知。
  
  研究目標是,評估幼童時期的多種過敏疾病和學齡兒童內化異常之有效測量的關聯。
  
  納入辛辛那提孩童過敏與空氣污染研究的546名孩童,在1、2、3、4和7歲時,進行了皮膚點刺試驗,以及評估有無出現鼻炎、氣喘、和皮膚炎;這些孩童7歲時,家長和孩童完成兒童行為評估系統第二版,這是孩童行為與情緒的一種有效測量。
  
  根據邏輯和線性回歸與校正共變項,4歲時的過敏性鼻炎和7歲時的內化分數(校正風險比[aOR]為3.2;95%信賴區間[CI]為1.8 - 5.8)、焦慮(aOR, 2.0;95% CI, 1.2 - 3.6)和憂鬱(aOR, 3.2;95% CI, 1.7 - 6.5)分數增加顯著有關。
  
  至於過敏性持續哮喘,內化分數增加的aOR為2.7(95% CI, 1.2 - 6.3)。內化分數和4歲時有一種以上過敏疾病、或過敏性鼻炎合併過敏性疾病或其他疾病等,呈現劑量反應關係(分別是aOR, 3.6 [95% CI, 1.7 - 7.6]和aOR, 4.3 [95% CI, 2.0 - 9.2])。
  
  研究作者寫道,醫師照顧高風險孩童時,特別是家長也有過敏時,應注意這類孩童,特別是多種過敏疾病者,發生內化行為的風險增加2-4倍。
  
  我們的研究結果呼籲,改善過敏孩童的篩檢與轉診,特別是那些有多種過敏疾病者,不過,治療過敏疾病對於心智健康疾病之預防方面,仍尚未清楚且需要更多考量。
  
  研究限制包括,缺乏所有孩童有關心智健康疾病家族史的資料、無法一般化到非城市居民、應答者的偏見、以及依賴父母的報告。
  
  作者們結論表示,心理健康疾病對患者和社會的影響是巨大的;因此,篩檢有風險的患者,包括過敏疾病孩童,以及實施初級預防活動是有必要的。
  
  資料來源: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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