The relationship between allergic diseases and internalizing and externalizing behaviours in Spanish children: a cross-sectional study

Main Article Content

Mª Pilar Berzosa-Grande
Eduardo González-Fraile
Rocío Sánchez-López
María Soria-Oliver
Santiago Rueda-Esteban


Allergy, behaviour, internalizing and externalizing, child, parent.


Introduction and objectives: The relationship between allergic diseases and behavioural disorders is still unclear. The objective of this study is to describe and compare children’s behaviour (internalising and externalising) across a sample of children between 6 and 11-years-old with and without allergic diseases.
Materials and methods: A cross-sectional, observational case-control study that comprises a survey of 366 families (194 cases and 172 controls) including a Child Behaviour Checklist (CBCL) and a sociodemographic questionnaire with questions related to family, school education, health conditions, and allergy symptoms was administered.
Results: Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD] = 0.47; CI: 0.26–0.68) and in the internalising and externalising factors (SMD = 0.52 and SMD = 0.36, respectively) than non-allergic children. Odds ratio analyses showed a higher risk (OR = 2.76; CI 95% [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appears as modulatory variables.
Conclusions: Children diagnosed with allergies at age 6 to 11 years show larger behavioural problems than non-allergic children, especially in internalising behaviours. These findings suggest the importance of attending to them and treating them in the early stages of the diagnosis to avoid future psychological disorders.

Abstract 47 | PDF Downloads 29 XML Downloads 0 HTML Downloads 0


1. Pawankar R, Canonica GW, Holgate ST, Lockey RF. White book on allergy 2011–2012 executive summary. World Allergy Organization; 2011 .
2. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States: The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up pediatric allergy and immunology in China. Pediatrics. 2011;128:e9–17.
3. Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, et al. The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immunol. 2017;140:145–53.e8.
4. Wong GWK, Li J, Bao YX, Wang JY, Leung TF, Li LL, et al. Pediatric allergy and immunology in China. Pediatr Allergy Immunol. 2018;29:127–32.
5. O’Connell EJ. The burden of atopy and asthma in children. Allergy. 2004;59(Suppl 78):7–11.
6. Loftus PA, Wise SK. Epidemiology and economic burden of asthma. Int Forum Allergy Rhinol. 2015;5(Suppl 1):S7–10.
7. Patel N, Herbert L, Green TD. The emotional, social, and financial burden of food allergies on children and their families. Allergy Asthma Proc. 2017;38:88–91.
8. Fong AT, Katelaris CH, Wainstein B. Bullying and quality of life in children and adolescents with food allergy. J Paediatr Child Health. 2017;53:630–5.
9. Tzeng NS, Chang HA, Chung CH, Kao YC, Chang CC, Yeh HW, et al. Increased risk of psychiatric disorders in allergic diseases: A nationwide, population-based, cohort study. Front Psychiatry. 2018;9:133.
10. Rhee CS, Wee JH, Ahn JC, Lee WH, Tan KL, Ahn S, et al. Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea: The Fifth Korea National Health and Nutrition Examination Survey. Am J Rhinol Allergy. 2014;28:e107–14.
11. Peters TE, Fritz GK. Psychological considerations of the child with asthma. Child Adolesc Psychiatr Clin N Am. 2010;19:319–33, ix.
12. Slim M, Rico-Villademoros F, Calandre EP. Psychiatric comorbidity in children and adults with gluten-related disorders: A narrative review. Nutrients. 2018;10 .
13. Withers AL, Green R. Transition for adolescents and young adults with asthma. Front Pediatr. 2019;7:301.
14. 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;17:120.
15. McGovern CM, Arcoleo K, Melnyk B. COPE for asthma: Outcomes of a cognitive behavioral intervention for children with asthma and anxiety. Sch Psychol. 2019;34:665–76.
16. Goodwin RD, Robinson M, Sly PD, McKeague IW, Susser ES, Zubrick SR, et al. Severity and persistence of asthma and mental health: A birth cohort study. Psychol Med. 2013;43:1313–22.
17. Tajdini M, Effatpanah M, Zaki-Dizaji M, Movahedi M, Parvaneh N, Shariat M, et al. Associations of behavioral disorders with asthma in Iranian children. Iran J Allergy Asthma Immunol. 2019;18:340–5.
18. Teyhan A, Galobardes B, Henderson J. Child allergic symptoms and well-being at school: Findings from ALSPAC, a UK cohort study. PLoS One. 2015;10:e0135271.
19. Nanda MK, LeMasters GK, Levin L, Rothenberg ME, Assa’ad AH, Newman N, et al. Allergic diseases and internalizing behaviors in early childhood. Pediatrics. 2016;137 .
20. Chang HY, Seo JH, Kim HY, Kwon JW, Kim BJ, Kim HB, et al. Allergic diseases in preschoolers are associated with psychological and behavioural problems. Allergy Asthma Immunol Res. 2013;5:315–21.
21. Urrutia-Pereira M, Sole D, Chong Neto HJ, Acosta V, Cepeda AM, Alvarez-Castello M, et al. Sleep disorders in Latin-American children with asthma and/or allergic rhinitis and normal controls. Allergol Immunopathol (Madr). 2017;45:145–51.
22. Topal E, Catal F, Soylu N, Ozcan OO, Celiksoy MH, Babayigit A, et al. Psychiatric disorders and symptoms severity in pre-school children with cow’s milk allergy. Allergol Immunopathol (Madr). 2016;44:445–9.
23. Paller A, Jaworski JC, Simpson EL, Boguniewicz M, Russell JJ, Block JK, et al. Major comorbidities of atopic dermatitis: Beyond allergic disorders. Am J Clin Dermatol. 2018;19:821–38.
24. Xie QW, Dai X, Tang X, Chan CHY, Chan CLW. Risk of mental disorders in children and adolescents with atopic dermatitis: A systematic review and meta-analysis. Front Psychol. 2019;10:1773.
25. Lebovidge JS, Strauch H, Kalish LA, Schneider LC. Assessment of psychological distress among children and adolescents with food allergy. J Allergy Clin Immunol. 2009;124:1282–8.
26. Brew BK, Lundholm C, Gong T, Larsson H, Almqvist C. The familial aggregation of atopic diseases and depression or anxiety in children. Clin Exp Allergy. 2018;48:703–11.
27. Licari A, Ciprandi R, Marseglia G, Ciprandi G. Anxiety and depression in adolescents with severe asthma and in their parents: Preliminary results after 1 year of treatment. Behav Sci (Basel). 2019;9 .
28. Sicouri G, Sharpe L, Hudson JL, Dudeney J, Jaffe A, Selvadurai H, et al. Parent-child interactions in children with asthma and anxiety. Behav Res Ther. 2017;97:242–51.
29. Tully C, Rose M, Breen S, Herrera N, Shelef DQ, Streisand R, et al. Relationship between parent mood and resilience and child health outcomes in pediatric asthma. Fam Syst Health. 2019;37:167–72.
30. Meštrović-Štefekov J, Novak-Bilić G, Kuna M, Pap N, Lugović-Mihić L. Psychological stress in patients with atopic dermatitis. Acta Dermatovenerol Croat. 2018;26:297–303.
31. Yang CJ, Liu D, Xu ZS, Shi SX, Du YJ. The pro-inflammatory cytokines, salivary cortisol and alpha-amylase are associated with generalized anxiety disorder (GAD) in patients with asthma. Neurosci Lett. 2017;656:15–21.
32. Achenbach TM, Edelbrock CS. Manual for the child behavior checklist and revised child behavior profile. T.M. Achenbach; 1983 .
33. Sardinero García E, Pedreira Massa JL, Muñiz J. El cuestionario CBCL de Achenbach: Adaptación española y aplicaciones clínico-epidemiológicas. Clín Salud. 1997;8:447–80.
34. Ogundele MO. Behavioural and emotional disorders in childhood: A brief overview for paediatricians. World J Clin Pediatr. 2018;7:9–26.
35. Cohen J. Statistical power analysis for the behavioral sciences. Academic Press; 2013 .
36. Pawankar R, Canonica GW, Holgate S, Lockey R. WAO white book on allergy: Update 2013. World Allergy Organization; 2013 .
37. Infante M, Slattery MJ, Klein MH, Essex MJ. Association of internalizing disorders and allergies in a child and adolescent psychiatry clinical sample. J Clin Psychiatry. 2007;68:1419–25.
38. Becht AI, Prinzie P, Deković M, van den Akker AL, Shiner RL, Rothenberg WA, et al. Child personality facets and overreactive parenting as predictors of aggression and rule-breaking trajectories from childhood to adolescence cross-cultural effects of parent warmth and control on aggression and rule-breaking from ages 8 to 13. Dev Psychopathol. 2016;28:399–413.
39. Forster M, Grigsby T, Soto DW, Schwartz SJ, Unger JB. The role of bicultural stress and perceived context of reception in the expression of aggression and rule breaking behaviors among recent-immigrant Hispanic youth. J Interpers Violence. 2015;30:1807–27.
40. Garg N, Silverberg JI. Association between childhood allergic disease, psychological comorbidity, and injury requiring medical attention. Ann Allergy Asthma Immunol. 2014;112:525–32.
41. El Hennawi Del D, Ahmed MR, Farid AM. Psychological stress and its relationship with persistent allergic rhinitis. Eur Arch Otorhinolaryngol. 2016;273:899–904.