Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use

J Schmitt; A Buske-Kirschbaum; F Tesch; K Trikojat; V Stephan; S Abraham; A Bauer; K Nemat; F Plessow; V Roessner

doi:10.1111/all.13326

Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use

Allergy. 2018 Mar;73(3):615-626. doi: 10.1111/all.13326. Epub 2017 Nov 20.

Authors

J Schmitt^{1

2}, A Buske-Kirschbaum³, F Tesch¹, K Trikojat³, V Stephan¹, S Abraham^{2

4}, A Bauer^{2

4}, K Nemat², F Plessow^{5

6}, V Roessner⁷

Affiliations

¹ Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.
² University Allergy Center, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
³ Department of Biopsychology, TU Dresden, Dresden, Germany.
⁴ Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
⁵ Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Medicine, Harvard Medical School, Boston, MA, USA.
⁷ Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.

PMID: 28975640
DOI: 10.1111/all.13326

Abstract

Background: Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify subgroups of AD patients at risk for ADHD are poorly understood.

Aims of the study: To compare sociodemographic, clinical and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD and age-matched healthy controls and to investigate aspects of AD related to ADHD symptoms.

Methods: Applying a factorial design, we investigated 4 groups of children aged 6-12 years: AD-only (ie, without ADHD), ADHD-only (ie, without AD), AD + ADHD and healthy controls (HC; ie, no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress and sleeping problems were compared between groups. In children with AD-only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems) and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms.

Results: Compared to HC (n = 47), children with AD-only (n = 42), ADHD-only (n = 34) and comorbid AD + ADHD (n = 31) had significantly increased behavioural problems and decreased quality of life. Children with AD-only had significantly higher levels of ADHD symptoms than HC. In children with AD-only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95% CI 1.04-3.39). Current clinical signs and AD symptoms were unrelated to the level of ADHD symptoms.

Conclusions: Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.

Keywords: antihistamines; atopic dermatitis; attention-deficit/hyperactivity disorder; comorbidity; epidemiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attention Deficit Disorder with Hyperactivity / epidemiology
Attention Deficit Disorder with Hyperactivity / etiology*
Child
Dermatitis, Atopic / complications*
Dermatitis, Atopic / drug therapy
Female
Histamine Antagonists / therapeutic use*
Humans
Male
Problem Behavior*

Substances

Histamine Antagonists