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Allergies linked to autism spectrum disorder in children

 

Key clinical point: The prevalence of food, respiratory, and skin allergy was greater in children with autism spectrum disorder (ASD).

Major finding: The weighted prevalence of food, respiratory, and skin allergies was 11.25%, 18.73%, and 16.81%, respectively, in children with ASD, compared with 4.25%, 12.08%, and 9.84%, respectively, in children without ASD (P less than .001).

Study details: A population-based study of 199,520 children aged 3-17 years in the National Health Interview Survey.

Disclosures: No conflicts of interest were reported.

Source: Guifeng X et al. JAMA Network Open. 2018 Jun 8. doi: 10.1001/jamanetworkopen.2018.0279.

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Findings support ‘immune-mediated’ ASD subtype

The results of this study add to a “growing body of literature supporting an immune-mediated subtype of autism spectrum disorder (ASD),” Christopher J. McDougle, MD, wrote in an editorial published with the study.

Although prior studies have identified an association between ASD and respiratory and skin allergy, this study is “the first to document the association of food allergy with ASD with confidence, in part based on the large sample size they accessed,” he said (JAMA Network Open. 2018;1[2]:e180280. doi: 10.1001/jamanetworkopen.2018.0280).

Dr. Christopher J. McDougle, Lurie Center for Autism, Massachusetts General Hospital, Boston

Dr. Christopher J. McDougle

“It may be that GI dysfunction, seizures, and sleep disorder, in addition to food, respiratory, and skin allergies, are medical comorbidities that characterize the immune-mediated subtype of ASD,” he added. “Evidence continues to mount that an immune-mediated subtype of ASD should continue to be pursued and defined.”

Dr. McDougle is affiliated with the Lurie Center for Autism at Massachusetts General Hospital.


 

FROM JAMA NETWORK OPEN

The prevalence of food, respiratory, and skin allergy is greater in U.S. children with autism spectrum disorder (ASD) than in U.S. children without the disorder, according to findings published June 8 in JAMA Network Open.

An analysis of data from the National Health Interview Survey found that the weighted prevalence of food, respiratory, and skin allergies was 11.25%, 18.73%, and 16.81%, respectively, in children with ASD, compared with 4.25%, 12.08%, and 9.84%, respectively, in children without ASD (P less than .001).

Survey data were collected between 1997 and 2016, and included patients aged 3-17 years. Allergic conditions were defined by the respondent, usually a parent, answering in the affirmative that the child had any kind of food, digestive, respiratory, or skin allergy in the past 12 months. ASD was defined based on an affirmative response to a question asking whether the child received an ASD diagnosis from a health professional. The question was asked as part of a 10-condition checklist from 1997 to 2013, and as a standalone item from 2014 onward, with revised wording to distinguish autism, Asperger’s disorder, pervasive developmental disorder, and ASD, wrote Guifeng Xu, MD, of the department of epidemiology at the University of Iowa, Iowa City, and her coauthors.

Of the 199,520 children included in the study, 8,734 had food allergy, 24,555 had respiratory allergy, and 19,399 had skin allergy. An ASD diagnosis was reported in 1,868 children. The weighted prevalence was 4.31% for food allergy (95% confidence interval, 4.20%-4.43%), 12.15% for respiratory allergy (95% CI, 11.92%-12.38%), and 9.91% for skin allergy (95% CI, 9.72%-10.10%), the authors said.

Children with ASD were more likely than were children without ASD to have food allergy, respiratory allergy, and skin allergy (P less than .001). After adjustment for factors including age, sex, ethnicity, and family education level, the odds ratio of ASD was more than double among children with food allergy, compared with those without food allergy (odds ratio, 2.72; 95% CI, 2.26-3.28; P less than .001).

Respiratory allergy and skin allergy also were significantly associated with ASD, but to a lesser degree, with an OR of 1.53 (95% CI, 1.32-1.78; P less than .001) for respiratory allergy and 1.80 (95% CI, 1.55-2.09; P less than .001) for skin allergy, Dr. Xu and her colleagues reported.

The findings suggest a “possible presence of shared mechanisms (e.g., immunologic dysfunction) among these allergic conditions in relation to ASD,” though the underlying mechanisms still need to be identified, the authors wrote.

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