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Allergic diseases at age 4 predict increased risk for developing internalizing behaviors at age 7

Young patients with allergic diseases such as allergic rhinitis and allergic persistent wheezing are significantly more likely to develop internalizing behaviors by age 7, according to recent research published in Pediatrics.

“The finding of a significant association between early childhood allergic rhinitis, allergic persistent wheezing, and the increasing number of allergic diseases with internalizing behaviors at age 7 years has substantial clinical implications,” Maya K. Nanda, MD, MSc, from the division of asthma, allergy, and immunology at the Children’s Mercy Hospital in Kansas City, Mo., and colleagues wrote. “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.”

Nanda and colleagues evaluated results from 546 pediatric patients in the Cincinnati Childhood Allergy and Air Pollution Study birth cohort who received both skin testing and examination at ages 1 year, 2 years, 3 years, 4 years and 7 years, according to the abstract. The researchers analyzed the relationship between allergic rhinitis, atopic dermatitis, allergic persistent wheezing and allergy sensitization at age 4 as well as anxiety, depression, and Behavioral Assessment System for Children, Second Edition (BASC-2) scores for children aged 7 years.

They found that patients aged 4 years with allergic rhinitis had a significantly higher likelihood of developing internalizing behaviors (adjusted OR = 3.2; 95% CI, 1.8-5.8) at age 7 years, with increased anxiety (adjusted OR = 2.0; 95% CI, 1.2-3.6) and depressive scores (adjusted OR = 3.2; 95% CI, 1.7-6.5), according to the abstract. Internalizing behavior was also significantly associated with an allergic persistent wheeze (adjusted OR = 2.7; 95% CI, 1.2-6.3), with more than one allergic disease (adjusted OR = 3.6; 95% CI, 1.7-7.6) and allergic rhinitis in tandem with comorbid allergic disease (adjusted OR = 4.3; 95% CI, 2.0-9.2) having a dose-dependent relationship with internalizing behaviors.

“Our findings call for improved screening and referral of allergic children, particularly those with multiple allergic diseases,” Nanda and colleagues wrote. “However, the treatment of allergic diseases in the prevention of mental health diseases is unclear and requires further consideration. 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.” – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.