Association of allergic diseases and attention-deficit/hyperactivity (ADHD) disorder in children a large-scale cohort study
Main Article Content
Keywords
allergy; attention-deficit and hyperactivity disorder; allergic disease; children; prevalence.asthma
Abstract
Background: The burden of attention-deficit/hyperactivity disorder (ADHD) has increased during the last few decades, as in allergic disorders. In some observational studies, ADHD has been linked to allergic diseases, but the evidence remains limited.
Objective: The aim of this study was to investigate whether allergic disorders are associated with ADHD in a large cohort of patients.
Material and Methods: Data from this cohort were retrieved from 860,089 children aged 5–16 years, collected from the pediatric database of Health Services in İzmir, Turkey, between January 1, 2013 and December 31, 2023, and analyzed. The person-years and the association between allergic disorders (including respiratory, skin, and other allergies, such as food and drug allergies as well as anaphylaxis) and ADHD were estimated using relative risks.
Results: The incidence of allergic disorders in the last 11 years was 7.9% (68,351 cases). Respiratory allergies (61,728; 6.8%) were the most common one, followed by skin allergies (7,152; 0.9%). The incidence of ADHD was determined as 5.3% and, as expected, was more common in boys (7.2%). The total number of patients with allergic diseases diagnosed prior to ADHD was 64,137 (7.5%), and the most common were respiratory allergies (57,905; 6.7%) and skin allergies (6,602; 0.8%). The other allergy group comprised 1,878 (0.2%) cases. The relative risk estimations showed a positive association between allergy groups and ADHD (relative risk [RR] 1.99, 95% Confidence Interval [CI] 1.96–2.02) for both genders. Conclusion: An association is observed between allergic disorders and ADHD. Understanding the link and relationship between allergic disorders and the development of ADHD will lead to earlier diagnosis and better treatment of allergic children with neurodevelopmental symptoms. To establish this association more robustly, further population-based cohorts are required.
References
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25. Nirouei M, Kouchekali M, Sadri H, Qorbani M, Montazerlotfelahi H, Eslami N, et al. Evaluation of the fre-quency of attention-deficit hyperactivity disorder in patients with asthma. Clin Mol Allergy. 2023;21(1):4. https://doi. org/10.1186/s12948-023-00185-4
26. Chuang YC, Wang CY, Huang WL, Wang LJ, Kuo HC, Chen YC, et al. Two meta-analyses of the association between atopic diseases and core symptoms of attention-deficit hyper-activity disorder. Sci Rep. 2022;12(1):3377. https://doi. org/10.1038/s41598-022-07232-1
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29. Kaas TH, Vinding RK, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. Association between childhood asthma and attention-deficit hyperactivity or autism spectrum disorders: A systematic review with meta-analysis. Clin Exp Allergy. 2021;51(2):228–52. https://doi.org/10.1111/cea.13750
30. Yuksel H, Sogut A, Yilmaz O. Attention-deficit and hyper-activity symptoms in children with asthma. J Asthma. 2008;45:545–7. https://doi.org/10.1080/02770900801990016
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32. Gambadauro A, Foti Randazzese S, Currò A, Galletta F, Crisafulli G, Caminiti L, et al. Impact of the allergic ther-apeutic adherence in children with allergic rhinitis and ADHD: A pilot study. J Pers Med. 2023;13(9):1346. https://doi. org/10.3390/jpm13091346
33. Cheng Y, Lu JW, Wang JH, Loh CH, Chen TL. Associations of atopic dermatitis with attention-deficit/hyperactivity disor-der and autism spectrum disorder: A systematic review and meta-analysis. Dermatology. 2024;240(1):13–25. https://doi. org/10.1159/000533366
34. Prasad V, Rezel-Potts E, White P, Downs J, Boddy N, Sayal K, Sonuga-Barke E. Use of healthcare services before diagnosis of attention-deficit/hyperactivity dis-order: A population-based matched case-control study. Arch Dis Child. 2023;109(1):46–51. https://doi.org/10.1136/ archdischild-2023-325637
35. Söyler S, Çavmak D. An evaluation of access to healthcare
services in Türkiye. A J Health Sci. 2023;5(2):69–76.
36. Vasiliadis HM, Diallo FB, Rochette L, Smith M, Langille D,
Lin E, et al. Temporal trends in the prevalence and ıncidence of diagnosed ADHD in children and young adults between 1999 and 2012 in Canada: A data linkage study. Can J Psychiatry. 2017;62(12):818–26. https://doi.org/10.1177/0706743717714468
37. Leache L, Arrizibita O, Gutiérrez-Valencia M, Saiz LC, Erviti J, Librero J. Incidence of attention-deficit hyperactiv-ity disorder (ADHD) diagnoses in Navarre (Spain) from 2003 to 2019. Int J Environ Res Public Health. 2021;18(17):9208. https://doi.org/10.3390/ijerph18179208
38. Ilic I, Ilic M. Global ıncidence of attention-deficit/hyper-activity disorder among children. Biol Life Sci Forum. 2022;19(1):6. https://doi.org/10.3390/IECBS2022-12942
39. Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, et al. Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018. BMC Psychiatry. 2021;21(1):229. https://doi.org/10.1186/s12888-021-03235-w
40. Çelik SS, Erkoyun E, Çetinkol AE, et al. Association of allergic diseases and attention-deficit hyperactivity disorder in chil-dren: A large-scale cohort study. Authorea. November 05, 2024. https://doi.org/10.22541/au.173079045.51334118/v1
2. Yang CF, Yang CC, Wang IJ. Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study. J Chin Med Assoc. 2018;81(3):277–83. https://doi.org/10.1016/j.jcma.2017.07.016
3. Gutowska-Ślesik J, Samoliński B, Krzych-Fałta E. The increase in allergic conditions based on a review of literature. Postepy Dermatol Alergol. 2023;40(1):1–7. https://doi. org/10.5114/ada.2022.119009
4. GBD 2021 Asthma and Allergic Diseases Collaborators. Global, regional, and national burden of asthma and atopic dermatitis, 1990–2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Respir Med. 2025;13(5):425–446.
5. Qu X, Lee LC, Ladd-Acosta C, Hong X, Ji Y, Kalb LG, et al. Association between atopic diseases and neurodevelopmen-tal disabilities in a longitudinal birth cohort. Autism Res. 2022;15(4):740–50. https://doi.org/10.1002/aur.2680
6. Miyazaki C, Koyama M, Ota E, Swa T, Mlunde LB, Amiya RM, et al. Allergic diseases in children with attention-deficit hyperactivity disorder: A systematic review and meta-analysis. BMC Psychiatry. 2017;17:1–12. https://doi. org/10.1186/s12888-017-1281-7
7. Schans JV, Çiçek R, de Vries TW, Hak E, Hoekstra PJ. Association of atopic diseases and attention-deficit/hyper-activity disorder: A systematic review and meta-analyses. Neurosci Biobehav Rev. 2017;74:139–48. https://doi. org/10.1016/j.neubiorev.2017.01.011
8. Brew BK, Osvald EC, Gong T, Hedman AM, Holmberg K, Larsson H, et al. Paediatric asthma and non-allergic comor-bidities: A review of current risk and proposed mechanisms. Clin Exp Allergy. 2022;52(9):1035–47. https://doi.org/10.1111/ cea.14207
9. Xu G, Liu B, Yang W, Snetselaar LG, Chen M, Bao W, et al. Association of food allergy, respiratory allergy, and skin allergy with attention-deficit/hyperactivity disorder among children. Nutrients. 2022;14(3):474. https://doi.org/10.3390/ nu14030474
10. Li B, Fuxench ZC. Atopic dermatitis: Disease background and risk factors. Adv Exp Med Biol. 2024;1447:11–9. https://doi. org/10.1007/978-3-031-54513-9_2
11. Tsai SY, Gaffin JM, Hawryluk EB, Ruran HB, Bartnikas LM, Oyoshi MK, et al. Evaluation of dupilumab on the disease burden in children and adolescents with atopic dermatitis: A population-based cohort study. Allergy. 2024;79(10):2748–58. https://doi.org/10.1111/all.16265
12. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al. Comorbidity of allergic and autoimmune diseases among patients with ADHD: A nationwide population-based study. J Atten Disord. 2017;21(3):219–27. https://doi. org/10.1177/1087054712474686
13. Akmatov MK, Ermakova T, Bätzing J. Psychiatric and non-psychiatric comorbidities among children with ADHD: An exploratory analysis of nationwide claims data in Germany. J Atten Disord. 2021;25(6):874–84. https://doi. org/10.1177/1087054719865779
14. Zaitsu M, Mizoguchi T, Morita S, Kawasaki S, Iwanaga A, Matsuo M. Developmental disorders in school children are related to allergic diseases. Pediatr Int. 2022;64(1):e15358. https://doi.org/10.1111/ped.15358
15. Wan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Atopic dermatitis and risk of major neuropsychiatric disorders in children: A population-based cohort study. J Eur Acad Dermatol Venereol. 2023;37(1):114–22. https://doi. org/10.1111/jdv.18564
16. Nemet S, Asher I, Yoles I, Baevsky T, Sthoeger Z. Early childhood allergy linked with development of attention-deficit hyperac-tivity disorder and autism spectrum disorder. Pediatr Allergy Immunol. 2022;33(6):e13819. https://doi.org/10.1111/pai.13819
17. Mallol J, Crane J, von Mutius E, Odhiambo J, Keil U, Stewart A, ISAAC Phase Three Study Group. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergol Immunopathol (Madr). 2013; 41(2):73–85. https://doi.org/10.1016/j.aller.2012.03.001
18. Çelik V, Tanrıverdi H, Kılıç FE, Tutal T. Prevalence of asthma and allergic diseases among children in Adıyaman, Türkiye: A cross-sectional study. J Child. 2023;23(3):279–84. https://doi. org/10.26650/jchild.2023.1353232
19. Tsai MC, Lin HK, Lin CH, Fu LS. Prevalence of attention-deficit/hyperactivity disorder in pediatric allergic rhinitis: A nationwide population-based study. Allergy Asthma Proc. 2011;32(6):41–6. https://doi.org/10.2500/aap.2011.32.3489
20. Zorlu A, Unlu G, Cakaloz B, Zencir M, Buber A, Isildar Y. The prevalence and comorbidity rates of ADHD among school-age children in Türkiye. J Atten Disord. 2020;24(9):1237–45. https://doi.org/10.1177/1087054715577991
21. Xu G, Liu B, Yang W, Snetselaar LG, Chen M, Bao W, et al. Association of food allergy, respiratory allergy, and skin allergy with attention-deficit/hyperactivity disorder among children. Nutrients. 2022;14(3):474. https://doi.org/10.3390/ nu14030474
22. Danielson ML, Claussen AH, Bitsko RH, Katz SM, Newsome K, Blumberg SJ, et al. ADHD prevalence among US children and adolescents in 2022: Diagnosis, severity, co-occurring disorders, and treatment. J Clin Child Adolesc Psychol. 2024;53(3):343–60. https://doi.org/10.1080/15374416.2024.2335625
23. Yamaguchi C, Ebara T, Futamura M, Ohya Y, Asano M. Do allergic clinical manifestations increase the risk of behavioral problems in children? A cross-sectional study. Pediatr Allergy Immunol. 2021;32(8):1646–53. https://doi.org/10.1111/ pai.13542
24. Yang CF, Yang CC, Wang IJ. Association between allergic diseases, allergic sensitization and attention-deficit/hyper-activity disorder in children: A large-scale, population-based study. J Chin Med Assoc. 2018;81(3):277–83. https://doi. org/10.1016/j.jcma.2017.07.016
25. Nirouei M, Kouchekali M, Sadri H, Qorbani M, Montazerlotfelahi H, Eslami N, et al. Evaluation of the fre-quency of attention-deficit hyperactivity disorder in patients with asthma. Clin Mol Allergy. 2023;21(1):4. https://doi. org/10.1186/s12948-023-00185-4
26. Chuang YC, Wang CY, Huang WL, Wang LJ, Kuo HC, Chen YC, et al. Two meta-analyses of the association between atopic diseases and core symptoms of attention-deficit hyper-activity disorder. Sci Rep. 2022;12(1):3377. https://doi. org/10.1038/s41598-022-07232-1
27. Cortese S, Sun S, Zhang J, Sharma E, Chang Z, Kuja-Halkola R, et al.. Association between attention-deficit hyperactivity disorder and asthma: A systematic review and meta-analysis and a Swedish population-based study. Lancet Psychiatry. 2018;5(9):717–26. https://doi.org/10.1016/ S2215-0366(18)30224-4
28. Dai Y, Jin N. Association and ınteracting factors between bronchial asthma and attention-deficit hyperactivity disorder in children: Meta-analysis and systematic review. Actas Esp Psiquiatr. 2023;51(6):262–70.
29. Kaas TH, Vinding RK, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. Association between childhood asthma and attention-deficit hyperactivity or autism spectrum disorders: A systematic review with meta-analysis. Clin Exp Allergy. 2021;51(2):228–52. https://doi.org/10.1111/cea.13750
30. Yuksel H, Sogut A, Yilmaz O. Attention-deficit and hyper-activity symptoms in children with asthma. J Asthma. 2008;45:545–7. https://doi.org/10.1080/02770900801990016
31. Holmberg K, Lundholm C, Anckarsäter H, Larsson H, Almqvist C. Impact of asthma medication and familial factors on the association between childhood asthma and attention-deficit/ hyperactivity disorder: A combined twin- and register-based study: Epidemiology of allergic disease. Clin Exp Allergy. 2015;45(5):964–73. https://doi.org/10.1111/cea.12529
32. Gambadauro A, Foti Randazzese S, Currò A, Galletta F, Crisafulli G, Caminiti L, et al. Impact of the allergic ther-apeutic adherence in children with allergic rhinitis and ADHD: A pilot study. J Pers Med. 2023;13(9):1346. https://doi. org/10.3390/jpm13091346
33. Cheng Y, Lu JW, Wang JH, Loh CH, Chen TL. Associations of atopic dermatitis with attention-deficit/hyperactivity disor-der and autism spectrum disorder: A systematic review and meta-analysis. Dermatology. 2024;240(1):13–25. https://doi. org/10.1159/000533366
34. Prasad V, Rezel-Potts E, White P, Downs J, Boddy N, Sayal K, Sonuga-Barke E. Use of healthcare services before diagnosis of attention-deficit/hyperactivity dis-order: A population-based matched case-control study. Arch Dis Child. 2023;109(1):46–51. https://doi.org/10.1136/ archdischild-2023-325637
35. Söyler S, Çavmak D. An evaluation of access to healthcare
services in Türkiye. A J Health Sci. 2023;5(2):69–76.
36. Vasiliadis HM, Diallo FB, Rochette L, Smith M, Langille D,
Lin E, et al. Temporal trends in the prevalence and ıncidence of diagnosed ADHD in children and young adults between 1999 and 2012 in Canada: A data linkage study. Can J Psychiatry. 2017;62(12):818–26. https://doi.org/10.1177/0706743717714468
37. Leache L, Arrizibita O, Gutiérrez-Valencia M, Saiz LC, Erviti J, Librero J. Incidence of attention-deficit hyperactiv-ity disorder (ADHD) diagnoses in Navarre (Spain) from 2003 to 2019. Int J Environ Res Public Health. 2021;18(17):9208. https://doi.org/10.3390/ijerph18179208
38. Ilic I, Ilic M. Global ıncidence of attention-deficit/hyper-activity disorder among children. Biol Life Sci Forum. 2022;19(1):6. https://doi.org/10.3390/IECBS2022-12942
39. Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, et al. Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018. BMC Psychiatry. 2021;21(1):229. https://doi.org/10.1186/s12888-021-03235-w
40. Çelik SS, Erkoyun E, Çetinkol AE, et al. Association of allergic diseases and attention-deficit hyperactivity disorder in chil-dren: A large-scale cohort study. Authorea. November 05, 2024. https://doi.org/10.22541/au.173079045.51334118/v1