Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Atopic Dermatitis and Asthma in Child Behavior

Children with atopic dermatitis (AD) symptoms are at higher risk for concomitant hyperactivity and emotional disorder, and children with asthma symptoms were at higher risk of having concomitant emotional problems, a new study found. The secondary cohort analysis enrolled 17,046 infants at birth and followed them up at 6.5 years (n=13,889). Researchers estimated the magnitude of associations of AD in infancy, and symptoms of asthma and AD at 6.5 years, with child behavior at 6.5 years. They found:

  • Physician-diagnosed AD in the first year of life was not associated with increased risk for behavioral problems at 6.5 years.
  • Emotional problems at 6.5 years were more common among children with AD symptoms and asthma symptoms during the past year at 6.5 years.
  • Odd ratios for children with symptoms of more severe AD and asthma were also higher.
  • AD in the past year was also associated with probable hyperactivity/inattention disorder at 6.5 years.

Citation:

Ballardini N, et al. Associations of atopic dermatitis and asthma with child behavior: Results from the PROBIT cohort. [Published online ahead of print May 13, 2019]. doi:10.1111/cea.13417.

Commentary:

We know that earlier onset of AD predicts increased severity and persistence of AD. This report, somewhat surprisingly, did not confirm that infantile onset of AD makes one more likely to show behavioral problems at age 6.5 years. However, those who had atopic symptoms within the past year did have an increase in emotional problems and hyperreactivity. The risk for those with asthma was elevated but not as greatly. Unfortunately, this study relied on parent reporting and did not require diagnoses to be made by allergists or dermatologists. It seems possible that some of the infants diagnosed with AD actually had another type of dermatitis, most likely seborrheic dermatitis, as it would be quite unusual for infants with AD to be free of disease at age 6.5. In any case, this report does give more data from a large, if uncontrolled, cohort showing that children with AD suffer from emotional problems as well.— Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY