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Purpose: In a previous study it was established that children with attention deficit hyperactive disorder (ADHD) and autistic spectrum disorders (ASD) had regressed during pollen seasons. The purpose of this study was to determine if these children regressed on direct nasal pollen challenge. Design: A double‐blind crossover placebo‐controlled nasal challenge study. Materials and Methods: Twenty‐nine children with ASD and 18 with ADHD comprised the population. The study was a double‐blind crossover with nasal instillation of a pollen extract or placebo on alternate weeks during the winter. The pollens used were oak tree, timothy grass and ragweed. The dose insufflated into each nostril was 25 mg (±15%) of each pollen. Results: Sixteen of 29 (55%) children with ASD and 12 of 18 (67%) children with ADHD or a total of 28 of 47 (60%) children regressed significantly (p<0.01) from their baseline. Nasal pollen challenge produced significant neurobehavioral regression in these children. This regression occurred in both allergic and non‐allergic children and was not associated with respiratory symptoms. There was no correlation to the child's IgE level, positive RAST pollen tests, or skin tests.
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... We know that children with autism tend to have a history of recurrent upper respiratory infections, otitis media, and allergic rhinitis . This would correlate with the factors seen in OSA, as described above. ...
... Interestingly, while the author does not make a connection to OSA, both patients had significant behavioral improvements after adenotonsillectomy , consistent with the idea that airway obstruction is the primary problem in autism. It has been demonstrated that pollen exposure may trigger regression in autistic children, however the authors state this was not associated with respiratory symptoms and hypothesize an effect on inflammatory cytokines which then can affect the brain . Regardless, their data was collected by questionnaires and it may be that there were subtle changes in the airway that were not appreciated which may have increased SDB in these children. ...
The ASD/OSA hypothesis as proposed in this paper will incorporate over 90 pieces of the "autism puzzle". It is suggested that the cause of autism is four-fold, requiring that: 1) the mother has sleep disordered breathing (SDB) during her pregnancy, 2) the infant is born with sleep disordered breathing, 3) both mother and infant have polymorphisms of the methylation pathway which are then triggered by the SDB, and 4) the infant is prone to intracranial hypertension. This theory can explain many, if not most, of the pieces of information that we currently know about the biology of autism. The fact that the sleep disordered breathing (SDB) in autism and in the mothers of autistic children has not been previously noted is due to flaws in the current methods for detecting SDB. Esophageal manometry is much more sensitive for detecting SDB but is not used routinely, however it may be more accurate than the apnea hypopnea index in terms of correlation with disruptive behavior disorders. There is evidence that SDB is much more common than previously believed. Apneas are known to increase intracranial pressure, and intracranial hypertension can be caused by obstructive sleep apnea. Recent studies showing behavioral problems and special needs correlated with SDB urge further evaluation of autistic children for SDB. The ASD/OSA hypothesis suggests that autism might be primarily prevented by detecting and treating SDB in women prior to conception, and in infants shortly after birth.
... 107 The presentation of core ASD symptoms -impaired social communication and repetitive and/or stereotyped behaviours -are seemingly connected to allergic manifestations, alongside other neuropsychiatric symptoms such as anxiety, hyperactivity, and irritability.  The assumption is that the pain and discomfort following allergic conditions exacerbate challenging behaviours and cognitive dysfunction in individuals with ASD. In some cases, the treatment of allergies has been reported to result in improvements in challenging behaviours and cognitive function. ...
Regina Sala,1 Lorene Amet,2 Natasa Blagojevic-Stokic,3 Paul Shattock,4 Paul Whiteley5 1Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK; 2Autism Treatment Plus, Edinburgh, UK; 3Thinking Autism, London, UK; 4Education & Services for People with Autism, Sunderland, UK; 5Education & Services for People with Autism Research, Sunderland, UKCorrespondence: Dr Regina SalaCentre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UKEmail firstname.lastname@example.orgAbstract: Autism spectrum disorder (ASD) is a highly complex and heterogeneous developmental disorder that affects how individuals communicate with other people and relate to the world around them. Research and clinical focus on the behavioural and cognitive manifestations of ASD, whilst important, have obscured the recognition that ASD is also commonly associated with a range of physical and mental health conditions. Many physical conditions appear with greater frequency in individuals with ASD compared to non-ASD populations. These can contribute to a worsening of social communication and behaviour, lower quality of life, higher morbidity and premature mortality. We highlight some of the key physical comorbidities affecting the immune and the gastrointestinal systems, metabolism and brain function in ASD. We discuss how healthcare professionals working with individuals with ASD and parents/carers have a duty to recognise their needs in order to improve their overall health and wellbeing, deliver equality in their healthcare experiences and reduce the likelihood of morbidity and early mortality associated with the condition.Keywords: autism spectrum disorder, ASD, physical health, comorbidity, inequality
... Maternal stress and maternal smoking have been demonstrated to increase the risk of both ADHD and atopic diseases in the offspring [4,7,37]. Pollen and certain foods have been recognized to be triggers of ADHD, suggesting an immunoallergic background of ADHD [17,26,38]. A strict elimination diet could improve the symptoms of ADHD in a subset of patients . ...
Increasing evidence suggests a positive association between attention-deficit hyperactivity disorder (ADHD) and atopic diseases. However, the risk of atopic diseases in unaffected siblings of patients with ADHD has not been investigated.
To investigate the risk of developing atopic diseases among unaffected siblings of ADHD probands.
Using data from the Taiwan National Health Insurance Research Database, 20,170 unaffected siblings of patients with ADHD born between 1980 and 2000 and 80,680 age-, birth time-, and residence-matchedcontrols were included in this study. Diagnoses of atopic diseases, including asthma, atopic dermatitis, allergic rhinitis, and allergic conjunctivitis, were ascertained from 1996 or the birth time until the end of 2011.
Breslow-Cox proportional hazard regression analyses with adjustment for demographic data showed that compared with the controls, unaffected siblings of patients with ADHD had a higher risk of developing asthma (relative risk [RR], 1.19; 95% confidence interval [CI], 1.15-1.24), atopic dermatitis (RR, 1.10; 95% CI, 1.04-1.16), allergic rhinitis (RR, 1.17; 95% CI, 1.14-1.21), allergic conjunctivitis (RR, 1.13; 95% CI, 1.09-1.17), and any of these atopic diseases (RR, 1.13; 95% CI, 1.10-1.15).
The unaffected siblings of ADHD probands were more likely to develop atopic diseases compared with the controls, suggesting shared risk factors for both diseases.
... Several epidemiological studies have reported that children with ADHD have a high risk of developing allergic diseases, such as asthma and atopic dermatitis, while other studies have reported no evidence of a link between allergy and ADHD . Given such conflicting evidence on the association, it is suspected that a sizeable proportion of the ADHD population experiencing comorbidities with various allergic diseases may have been overlooked. ...
Background: Reports of frequent manifestation of allergic diseases in children with attention deficit hyperactivity disorder (ADHD) have been the subject of mounting clinical interest. However, evidence supporting the association between ADHD and allergies is inconsistent and has yet to be systematically reviewed. The objective of this study was to compile and assess available studies on the association between ADHD and allergic diseases in children.
Methods: A comprehensive search using MEDLINE, EMBASE, the Cochrane library, and CINAHL databases was completed in 23 November 2015. The inclusion criteria for studies were that the research assessed allergic diseases in children, 18 years of age and younger, with a diagnosis of ADHD and that a distinct comparison group was incorporated. Any comparative studies, encompassing both randomized controlled trials and observational studies, were considered for inclusion. Two review authors independently assessed the quality of the selected studies by the use of validated assessment tools, performed data extraction and conducted meta-analysis according to Cochrane Collaboration guidelines.
Results: Five eligible studies were included in this systematic review. Of these studies, three were case-control and two were cross sectional studies. A majority of information from the five studies was classified as having low or unclear risk of bias. The meta-analysis showed an association between children with ADHD and asthma compared with the control groups (OR: 1.80, 95% CI: 1.57 - 2.07; five studies, low quality of evidence), but did not indicate an association between food allergy and ADHD (OR: 1.13, 95% CI: 0.88 - 1.47; three studies very low quality of evidence). The odds of experiencing allergic rhinitis, atopic dermatitis, and allergic conjunctivitis were slightly higher in children with ADHD compared with control groups, though a substantial statistical heterogeneity was notable in the overall effect estimates.
Conclusions: The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial.
Keywords: Allergic conjunctivitis, Allergic disease, Allergic rhinitis, Asthma, Atopic dermatitis, Attention deficit hyper disorder, Coexisting condition, Food allergy, Meta-analysis
... On the other hand, in some recently published studies, a significant link between the presence of allergic diseases-such as eczema, allergic rhinitis and asthma-and ADHD was established . While some children affected by ADHD exhibit more pronounced symptoms after consuming certain foods, artificial colors or a sodium benzoate preservative , or after pollen exposure , it is likely that this reaction is due to their hypersensitivity. A better understanding of the relationship between AD prevalence and the development of ADHD is of significant public health relevance, as it may lead to the development of targeted treatments and improved preventive measures. ...
... Food and inhalant allergies, including frank atopic diseases and food intolerances are common in autism (Schieve et al., 2012). It has been demonstrated that a challenge with nasal allergens results in increase of autism symptoms in over half of the studied children (Boris and Goldblatt, 2004) while treatment of allergies often results in improvement in behaviors such as anxiety, hyperactivity, and irritability, commonly attributed to " being autistic " (Chen et al., 2013). In previous study we examined specific IgA, IgG, and IgE antibodies to food antigens in 35 participants with autistic disorder and 21 of their siblings. ...
Attention-deficit hyperactivity disorder (ADHD) etiology is not completely understood, but common comorbid dysfunction of the gastrointestinal and immune system suggests that these systems may be affected by a common genetic background and molecular mechanisms. For example, increased levels of specific cytokines were observed in ADHD. Moreover, ADHD has a high comorbidity with both Th1- and Th2-mediated disorders like ear infections, eczema and asthma. A common pathophysiological mechanism was suggested to underlie both asthma and ADHD, while several genes that are linked to ADHD have immune functions. Furthermore, immunological recognition of food provoking ADHD-like behavior was suggested. An immune imbalance, probably requiring a predisposing genetic background, is therefore suggested to contribute to ADHD etiology, with immune dysregulation being more likely than a single subcellular defect. However, next to allergic mechanisms, also pharmacological mechanisms (especially in case of food additives) might be involved. In addition, though cellular (cytokine-related) rather than antibody-mediated immune mechanisms seem involved, specific immune-inflammatory markers other than antibodies have not been systematically studied in ADHD. Substantial alterations implicated in ADHD apparently occur in the immune system and epigenetic regulation of gene expression. As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation. If immune pathways contribute to ADHD, both its diagnosis and treatment should be reconsidered. Modulation of immune system activity might have potential in ADHD treatment, for example by nutritional approaches providing safe and low-cost ADHD therapy, but further research in these fields is implicated.
... Challenge with nasal allergens during the low pollen winter months resulted in regression in 55% of children with autism as measured by the Aberrant Behavior Checklist . Children with autism have been reported to have fewer aberrant behaviors particularly speech during fever as reported in a prospective study . ...
Autism is the fastest growing developmental disorder in the world today. The prevalence of autism in the US has risen from 1 in 2500 in 1970 to 1 in 88 children today. People with autism present with repetitive movements and with social and communication impairments. These impairments can range from mild to profound. The estimated total lifetime societal cost of caring for one individual with autism is $3.2 million US dollars. With the rapid growth in this disorder and the great expense of caring for those with autism, it is imperative for both individuals and society that techniques be developed to model and understand autism. There is increasing evidence that those individuals diagnosed with autism present with highly diverse set of abnormalities affecting multiple systems of the body. To this date, little to no work has been done using a whole body systems biology approach to model the characteristics of this disorder. Identification and modelling of these systems might lead to new and improved treatment protocols, better diagnosis and treatment of the affected systems, which might lead to improved quality of life by themselves, and, in addition, might also help the core symptoms of autism due to the potential interconnections between the brain and nervous system with all these other systems being modeled. This paper first reviews research which shows that autism impacts many systems in the body, including the metabolic, mitochondrial, immunological, gastrointestinal and the neurological. These systems interact in complex and highly interdependent ways. Many of these disturbances have effects in most of the systems of the body. In particular, clinical evidence exists for increased oxidative stress, inflammation, and immune and mitochondrial dysfunction which can affect almost every cell in the body. Three promising research areas are discussed, hierarchical, subgroup analysis and modeling over time. This paper reviews some of the systems disturbed in autism and suggests several systems biology research areas. Autism poses a rich test bed for systems biology modeling techniques.
... Challenge with nasal allergens during the low pollen winter months resulted in regression in 55% of children with autism as measured by the Aberrant Behavior Checklist . Children with autism have been reported to have fewer aberrant behaviors particularly speech during fever as reported in a prospective study . ...
Autism is the fastest growing developmental disorder in the world today. People with autism present with stereotypy and with social and communication impairments. Research has shown that autism has roots in many systems in the body, including the metabolic, mitochondrial, immunological, gastrointestinal and the neurological. These systems interact in complex and highly interdependent ways. Autism poses a rich test bed for systems biology modeling techniques. This paper reviews some of the systems disturbed in autism and suggests several systems biology research areas.
Many individuals on the autism spectrum experience depressive symptoms. These symptoms contribute to poor quality of life and may have a more negative impact than core autistic features. However, identifying depressive symptoms among individuals on the spectrum is a real challenge. In this study, we investigate the psychometric qualities of a French scale for evaluating depressive symptoms among youth on the autism spectrum. Participants were 153 autistic children and adolescents aged between 3 and 17 years. The majority of the sample was male (73.86%). One of their parents completed the scale for evaluating depressive symptoms among youth on the autism spectrum during an interview with a psychologist. Overall, the findings indicate the scale may be reliably used with children and adolescents on the autism spectrum. Experts deemed the items as being representative of depressive symptoms. The scale is composed of two factors: behavioral changes on one hand and cognitive and emotional changes on the other. The results are encouraging and show the scale is a promising instrument for assessing Major Depressive Disorder symptomatology among youth on the spectrum. Future studies should focus on testing this scale among adults and developing an auto-evaluative section.
Background. Attention deficit hyperactivity disorder (ADHD) is commonly present worldwide, causing serious problems to those affected. ADHD was suggested to be secondary to allergic disorder or its medication. Both ADHD and allergy depend on complex environmental and genetic interaction, and they meet the hypersensitivity criteria. Objective. Detect the percentage of allergy in ADHD children, the common allergic disorders and allergens, and the effect of allergy on symptom and severity of ADHD. Material and methods. 100 children with ADHD were subjected to psychiatric assessment for ADHD type and severity, history of allergy, skin prick test to common environmental allergens, serum total IgE levels and open food challenge. Co-morbid neuropsychiatric disorders, below average intelligence quotient (IQ), and chronic illnesses were excluded. A control of 60 healthy children was chosen to compare the results of skin prick test and serum total IgE levels. Results. 35 ADHD children (35%) were allergic. Most cases had combined allergic rhinitis and bronchial asthma (25%). Common allergens were hay dust (43%) followed by different pollens (37.5%). There were statistical significant differences between coexistence of allergy, type of ADHD, early onset and severity of symptoms. Conclusion. Children with ADHD had an increased prevalence of allergic diseases. Evaluation of allergy in ADHD is mandatory, to decrease the burden of the condition.
The impact of pollen on human health is primarily evident in allergic diseases. Sensitized patients can respond to pollen by symptoms of nose, eyes and bronchi. Pollen threshold levels for sensitization are unknown; instead most studies focus on the prevalence of sensitization for different pollen species. The pollen thresholds for symptom development vary among the different studies. Factors that influence the threshold level of a pollen species for symptom development are discussed. (i) Differences in response are observed among individual patients, but also among (ii) ethnic populations, (iii) changes in response to pollen concentrations during the pollen season occur, (iv) the amount of allergens carried by the pollen grains can differ in per region, from day to day and from year to year, and finally (v) threshold levels are affected by environmental factors, like weather conditions (temperature, pressure and storms), and air pollutants.The diversity of factors that influence the health impact of pollen has hampered the definition of a straight forward relationship between pollen and the severity of symptoms. However, within the public, the policymakers and the pharmaceutical industry there is a need for a definition of threshold pollen levels. A first approach to meet this need could be to define preliminary threshold values for different regions, followed by a validation of these preliminary threshold levels with patient symptom scores that can be collected by using new information and communication technology (ICT). Finally, the possible role of pollen in non allergic diseases is discussed, especially non-allergic respiratory diseases, cardio- and cerebrovascular diseases, and psychiatric diseases, including suicide and suicide attempt.
Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear.
To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months.
Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months.
Infants with a maternal history of allergic disease (n=324).
Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development.
Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p=.016), and this was most apparent for a diagnosis of eczema (p=.007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p=.010), along with a trend for effects on the Social-Emotional composite score for IgE-Mediated food allergies (p=.052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes.
This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.
Recent observations suggest that pollen do not only interacts with the human immune system to elicit an allergic response in susceptible individuals. It would have a much broader impact on human health. This applies more especially, yet not exclusively, to three groups of diseases: non-allergic respiratory conditions, cardio- and cerebrovascular accidents, and psychiatric disorders including suicide and suicide attempt. At present, the reasons for these unexpected connections are only hypothetical, and require further exploration in larger samples, but there is perhaps a multitude of them. One must therefore favour a holistic approach of pollen and its impact on human health.
The increase in prevalence and burden of allergic diseases, i.e., eczema, asthma, and rhinitis, has been matched by parallel trends in a worldwide increase in attention deficit hyperactivity disorder (ADHD) diagnoses. Research data concerning the causal association between ADHD and allergies are conflicting. Allergic sensitization is the most important risk for development of allergic diseases.
We investigated the relationship between allergic sensitization in patients with physician-diagnosed ADHD.
Eighty patients were enrolled in the study. Forty patients were allocated into the ADHD group who presented with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of ADHD to an outpatient pediatric developmental and behavioral clinic and the other 40 were enrolled in the control group. All patients were performed skin prick testing to common allergens and were evaluated for allergic diseases with focused history and physical examination.
The prevalence of any positive skin prick test (SPT) in ADHD patients was higher than the control, 67.5% and 45.0%, respectively. (p = 0.043) The five most common sensitizing allergens were as follows: D. farinae, 42.5 %, D. pteronyssinus 40.0%, Bermuda grass 37.5%, American cockroach 35.0%, German cockroach 30.0% and Johnson grass 30.0% in ADHD children D.farinae 32.5 %, D. pteronyssinus, 32.5%, German cockroach 22.5%, American cockroach 20.0% and Bermuda grass 20.0% in control children. No significant differences were detected between the groups on type of allergen except Johnson grass. Sensitization to Johnson grass was significantly higher in the ADHD group, 30.0% in ADHD cases and 10.0% in control cases. (p = 0.048) The frequency of allergic rhinitis was higher in the ADHD group. (p = 0.008) No differences between groups were observed regarding other allergic diseases, asthma, eczema, allergic conjunctivitis, food allergy and urticaria. (p > 0.05)
Our results suggest that there were increased rates of allergic sensitization and allergic rhinitis in ADHD children. Therefore, assessment of allergic sensitization may be beneficial in children diagnosed with ADHD.
Onderzoeksresultaten naar het causale verband tussen ‘Attention-deficit hyperactivity disorder’ (ADHD) en allergieën zijn niet eenduidig. Allergieën zoals astma en eczeem zijn klinische syndromen waarbij zowel genetische aanleg als omgevingsfactoren (huisdieren, huisstofmijten, pollen en voeding) kunnen bijdragen tot de ontwikkeling ervan. De hypothese dat ADHD bij sommige kinderen ook een allergie kan zijn, wordt onderbouwd aan de hand van de verschillende mechanismen die ten grondslag liggen aan zowel ADHD als allergische aandoeningen. Volgens de geaccepteerde terminologie voor allergie voldoet ADHD aan de criteria van overgevoeligheid, allergie en atopie. Deze hypothese zal in gerandomiseerd gecontroleerd onderzoek getoetst moeten worden. Hierbij moet niet alleen gebruik gemaakt worden van immunologisch onderzoek, maar ook van genetisch onderzoek. Dit omdat genen die gerelateerd worden aan het immuunsysteem met ADHD geassocieerd kunnen worden. Immunotherapeutische benaderingen, zoals immunotherapie en probiotica, zouden betrokken kunnen worden bij de behandeling van ADHD. Wanneer overgevoeligheid voor omgevingsfactoren, zoals voedingsmiddelen, bijdraagt aan het manifest worden van ADHD, zal de diagnostiek en de behandeling van ADHD herzien moeten worden, om zo de kwaliteit van zorg voor deze patiënten te verbeteren.
The Aberrant Behavior Checklist (ABC) is a 58-item rating scale that was developed primarily to measure the effects of pharmacological intervention in individuals living in residential facilities. This study investigated the use of the ABC in a sample of community children with mental retardation. Teacher ratings on the ABC were collected on 666 students attending special classes. The data were factor analyzed and compared with other studies using the ABC. In addition, subscales were analyzed as a function of age, sex, and classroom placement, and preliminary norms were derived. A four-factor solution of the ABC was obtained. Congruence between the four derived factors and corresponding factors from the original ABC was high (congruence coefficients ranged between .87 and .96). Classroom placement and age had significant effects on subscale scores, whereas sex failed to affect ratings. The current results are sufficiently close to the original factor solution that the original scoring method can be used with community samples, although further studies are needed to look at this in more detail.
Recent research suggests that anxiety disorders are more common in asthmatic patients than in the population as a whole. There are a variety of biologic, psychologic, and social factors that suggest that the disorder of asthma may in itself be anxiogenic and that simply having asthma may give patients an increased vulnerability toward the development of anxiety disorders. These issues are reviewed and emphasis is placed on the need for further research into the apparent biologic areas of overlap between psychiatric disorders and asthma. It is hypothesized that a "lactate challenge test" may be used in asthmatics to see if they are predisposed to panic and suggested that a therapeutic trial of tricyclic antidepressants in anxious asthmatics is indicated. Research into the psychobiologic aspects of asthma is likely to clarify the role of "emotional" factors in asthma and may well have significant implications for the management of this disorder.
Parent symptom ratings of 316 psychiatric clinic patients and 365 normal children were factor analyzed. Factor scores discriminate between patients and normals and between neurotic and hyperkinetic diagnostic groups, but the same basic factor structure appears in the groups. Age, social class, and race effects were slight. Symptom prevalence rates were higher in clinic patients than in a representative normal sample. It is concluded that there are few qualitative differences between normal and psychiatrically ill children, though they differ in the severity of symptomatology.
Purpose: To determine whether children with autistic spectrum disorders (ASD) or attention deficit hyperactive disorder (ADHD) exhibit neurobehavioral regressive changes during pollen seasons.
Design: A behavioral questionnaire‐based survey, with results matched to pollen counts; an uncontrolled, open non‐intervention study.
Materials and Methods: Twenty‐nine children identified with ASD and 18 children with ADHD comprised the study population. The parents of the study children completed the Allergic Symptom Screen for 2 weeks during the winter prior to the pollen allergy season under investigation. The parents of the ASD children also completed the Aberrant Behavior Checklist and the parents of the ADHD children completed Conners' Revised Parent Short Form for the same periods. The parents completed the respective forms weekly from 1 March to 31 October 2002. Pollen counts from the geographical area of study were recorded on a daily basis during this period.
Results: During natural pollen exposure, 15 of 29 (52%) children with ASD and 10 of 18 (56%) children with ADHD demonstrated neurobehavioral regression. There was no correlation with the child's allergic status (IgE, skin tests and RAST) or allergy symptoms.
Conclusions: Pollen exposure can produce neurobehavioral regression in the majority of children with ASD or ADHD on a non‐IgE‐mediated mechanism. Psychological dysfunction can be potentiated by environmental exposures.
The possible association between depression and type I allergies (i.e. immunoglobulin E-mediated hay fever, asthma, eczema, hives) was examined in a nonclinical sample of 379 college students. Measures included self-reports of depression, tiredness, fearfulness, allergic disorders, and environmental allergens and irritants. Seventy-one percent of the subjects who had ever received a professional diagnosis of depression also indicated a history of allergy: those with greater self-rated current depression overall reported a significantly higher prevalence of asthma (p less than 0.05). Type I allergic (43%) and nonallergic subjects did not differ in self-rated frequency of depression, fatigue, or anxiety. However, type I subjects reported significantly worse mood after the flu than did nonallergic subjects (p less than 0.001). The data support the hypothesis that individuals prone to clinical depression have more allergies than nondepressives. Allergics may experience more postflu mood worsening but not current depression in comparison with nonallergics.
Fifty consecutive patients with chronic airflow obstruction who were admitted to a respiratory unit were assessed medically and psychiatrically. A high rate of psychiatric morbidity (58%) was detected with panic and other anxiety disorders (34%) being particularly prevalent. Various physiological and psychological reasons for the high rate of anxiety disorders are discussed.
The purposes of this project were to study the relationship of allergies and allergy treatment to school behavior. Parents of allergic and nonallergic children (grades K-12 and from different socioeconomic status) completed a survey form. The 400 parent respondents reported no significant difference between allergic and nonallergic children in terms of academic and language performance, retention, diagnosis as handicapped, or behavior problems; allergic children were absent from school more. Eustachian tube dysfunctions were significantly related to academic and behavior problems. Certain medications were related to overactive types of behavior. Parents who considered their children's behavior as inappropriate tended to contribute a portion of it to side effects of medication. 65% of the parents reported positive results from treatment on behavior at home; they tended to be unsure of the impact on school behavior. Direct relationship of allergy and allergy treatment on academic performance is questionable, except for the impact of upper respiratory problems on listening and attention. Use of certain medications with already behavior disordered children requires caution. Better communication among physicians, teachers and parents is advised.
The personal and family history of bronchial asthma and/or hay fever was obtained from a series of 82 psychiatric patients. We report a significantly higher incidence of atopic disorders in affective patients (16/48) than in schizophrenic patients (2/34) (chi-square = 8.754, P less than 0.005). There was also a significantly higher incidence of atopic disorders among the first-degree relatives of patients with affective disorders (48/356) than among the first-degree relatives of patients with schizophrenia (10/182) (chi-square 8.501, P less than 0.005).
We reexamined the ability of inhaled ragweed pollen to induce bronchoconstriction in ragweed-sensitive asthmatic patients using a turbo-inhaler to administer pollen quantitatively. Adult subjects were selected for study on the basis of fall season asthmatic attacks, positive skin test, histamine release, RAST, and bronchial challenge responses to ragweed extract. Not one of 12 such subjects had any bronchial response to oral inhalation of whole pollen grains even when the dose was increased to 7640 pollen grains (more than the estimated maximum daily exposure in season), whereas nasal challenge by the same method produced brisk hay fever responses without bronchospasm. On the other hand, when the pollen was ground to fragments with a size range of 1 to 8 micrometers, oral inhalation produced a 35% fall in airways conductance in six of seven subjects in doses ranging from 59 to 20,000 pollen grain equivalents. Atropine pretreatment did not modify the response to pollen fragments, making an irritant response unlikely. These data, coupled with earlier observations that no more than a few pollen grains penetrate further than the larynx, raise further questions about the role of whole ragweed pollen in fall asthma in allergic patients. In addition, ragweed-allergic asthmatics appear not to have their symptoms at the time of maximum pollen load in the air. We believe that small-particle allergens other than ragweed pollen should be considered in most cases of fall seasonal asthma.
A study was undertaken to compare IgG, IgA, IgM, IgE and IgD antibodies in adult alcoholic, depressive and schizophrenic patients with healthy, adult controls. Total IgG, -IgA, -IgM, -IgE, and -IgD and specific-IgE antibodies were assessed using 33 allergens: 12 inhalant and 21 foods. There was no significant difference observed in the total immunoglobulin results between the patients and controls. There were, however, significant differences between the groups for allergen specific-IgE with the depressive patients exhibiting the greatest number of positive test results. The depressives had an over-all t-test value of 10.080 (5% = 1.960), the alcoholics t = 6.800 and the schizophrenics t = 6.015. The most often positive allergens were those from the perennial/mold group, although the most frequently positive single allergen was egg white and 100% of the depressives were sensitive to it. The data in this investigation suggest that psychiatric patients with alcohol dependence, depression and schizophrenia be studied further so that information on a causal relationship between allergen specific-IgE antibodies and these mental disorders can be evaluated.
The aim of this study was to explore relationships among perennial allergic rhinitis and personality traits in a nonpsychiatric female population of proven allergic status. Female subjects were assigned to the allergic (N = 22) or nonallergic group (N = 18) on the basis of skin prick test and self-reported allergic status. Analysis of MMPI profiles showed that allergic subjects scored significantly higher on the Hypochondriasis (Hs) and Social Introversion (Si) scales and significantly lower on the Correction (K) and Ego Strength (Es) scales. The results suggested that women with perennial allergic rhinitis show poorer psychological functioning than nonallergic women. In addition, the number of allergies was positively correlated with T scores on the Hs, Depression (D), Hysteria (Hy), Psychasthenia (Pt), Schizophrenia (Sc), Si, and Conscious Anxiety (A) scales, and negatively correlated with T scores on the K and Es scales. Skin reactivity to house dust mite and grass pollen allergens were positively correlated with scores on Si, whereas skin reactivity to grass pollen and mold allergens was positively correlated with D and Pt (grass) and Pd and Sc (grass and mold). Two possible mechanisms explaining the link between psychological factors and allergic rhinitis include (1) the effect of cortisol on IgE production or (2) the production of mediators during an allergic reaction which travel from the nose to the brain.
The purpose of this study was to test the hypothesis that learning ability is impaired in patients with seasonal allergic rhinitis relative to untreated individuals and to evaluate a combination compound (acrivastine 8 mg + pseudoephedrine 60 mg) for attenuation of the learning impairment in these patients.
In a previous study employing the same method it was shown that young children (10 to 12 yrs) suffering from seasonal allergic rhinitis performed significantly worse on tests of learning and using knowledge after acute treatment with a sedating antihistamine (diphenhydramine 50 mg) or placebo as compared with nontreated healthy controls. This effect was partially reversed by treatment with loratadine.
Sixty-seven young adults suffering from seasonal allergic rhinitis and 28 matched controls were trained on didactic simulation for three consecutive days. Atopic subjects were treated differentially during training according to a double-blind, randomized, parallel group design with either diphenhydramine hydrochloride 50 mg, a combination compound (acrivastine 8 mg + pseudoephedrine 60 mg, A + P), or placebo, administered qd. After training, all atopic subjects were maintained on A + P treatment for 14 days at which time all groups returned for examination.
Mean performance at the end of training was worse for all atopic subjects combined compared with normal subjects. Subjects treated with diphenhydramine performed significantly worse than either normals (P < .001) or those treated with A + P (P < .001). At the examination, the diphenhydramine group's performance differed significantly from those of the normal (P < .001) and A + P groups (P < .001).
The study supports our previous finding that allergy symptoms reduce learning ability which is further reduced learning ability which is further reduced by diphenhydramine. Atopic subjects with allergies treated with acrivastine + pseudoephedrine learned as well as normal subjects.
Allergic rhinitis is underestimated as a cause of suffering and diminished quality of life in children and adolescents. If nasal symptoms such as itching, sneezing, rhinorrhea, and congestion are not well controlled during the day, they may contribute to learning problems during school hours. If these symptoms are not well controlled during the night, they may contribute to nocturnal sleep loss, secondary daytime fatigue and learning impairment. Even uncomplicated seasonal allergic rhinitis may be associated with reduced ability to learn, and the likelihood of learning problems may increase in severe perennial rhinitis or in rhinitis associated with complications such as sinusitis or eustachian tube dysfunction and conductive hearing loss. Also, many of the medications used to treat allergic rhinitis may cause central nervous system adverse effects and contribute to learning impairment. For some medications, such as inhaled glucocorticoids and decongestants, the potential effect on central nervous system function and learning has not been tested. For others such as H1-receptor antagonists (antihistamines), well-designed, prospective studies have been performed. The newer relatively nonsedating medications such as terfenadine, astemizole, loratadine, cetirizine, and fexofenadine have less potential to impair central nervous system function and learning than their predecessors.
We studied the relation between the presence versus the absence of sleep deprivation or allergy symptoms and the rate and function of problem behavior. Three students whose problem behavior was negatively reinforced by escape form instruction were studied across several weeks using analogue functional analyses. Our results indicated that the extraexperimental events were associated with (a) termination of instruction functioning as a negative reinforcer, (b) increased rates of negatively reinforced problem behavior, or (c) increased rates of problem behavior across all conditions.
To examine the prevalence and comorbidity of posttraumatic stress disorder (PTSD) in an adolescent inpatient population. A 2-year retrospective chart study was conducted.
Computer-registered data of discharge records from 1993 and 1994 were recovered. Patients were grouped by diagnosis; frequency and chi-square statistical analyses were performed to ascertain the prevalence and the comorbidity of various diagnoses with PTSD.
A total of 187 patients, 114 females and 73 males, with a mean age of 15 years were reviewed, and 42% (79) of all patients had a diagnosis of PTSD using DSM-III-R criteria. There were 54 females and 25 males with PTSD; however, gender effect was not clinically significant. Associated comorbidity reaching clinical significance included other anxiety disorders (P = 0.008) and depressive disorders (P = 0.003). Asthma was diagnosed as a significant clinical disorder (P = 0.05) comorbid with PTSD. PTSD diagnoses correlated strongly with a history of abuse (P = 0.0001).
PTSD occurs frequently in adolescent inpatients and is commonly comorbid with other diagnostic presentations. These findings may affect the management of PTSD and prognosis for this population.
There are mixed research results in the literature regarding a possible association between Attention Deficit Hyperactivity Disorder (ADHD) and atopic disorders. If such an association were supported, the implications for underlying pathophysiology would be significant. We evaluated level of atopic responsiveness (based on IgE-mediated response to skin prick tests) in 312 referrals to a pediatric allergist. Based on the atopy code, children were categorized as non-atopic, or moderately or severely atopic. Parents completed the Child Behavior Checklist (CBCL). Univariate analyses on the eight CBCL subscales revealed no differences between the atopic groups. Our results do not support an association between IgE-Mediated atopic responsiveness and ADHD, but they do not rule out an association between allergic symptoms and ADHD based on some other mechanism.
Levels of psychological distress, social support factors, and emotional adjustment to illness were measured in a sample of patients with severe asthma. These were then examined in terms of their interrelationships and their ability to predict self-management knowledge.
A sample of 80 patients was recruited from a hospital-based asthma clinic designed for patients with severe asthma. Thirty-four percent of consecutive attenders approached took part. Morbidity and asthma management were recorded from case records. Anxiety, depression, social support, emotional adjustment to asthma and asthma knowledge were measured using self-report instruments selected for their acceptability and ease of administration.
Twenty-five percent of the sample had possible or definite caseness for anxiety; 10.3% had possible or definite caseness for depression. Twenty-five percent had inadequate social support in some way. Three independent attitudinal factors were found: emotional maladjustment to asthma, the doctor-patient relationship, and asthma-related stigma. Level of asthma knowledge was very low. None of the measures of psychosocial function chosen were predictive of asthma knowledge.
Levels of asthma knowledge were dangerously low, despite apparently adequate educational initiatives. In addition, patients with severe asthma have high levels of distress, particularly of anxiety, even between attacks. Their attitudes to their illness are multifactorial, and are significantly correlated with emotional distress, morbidity indices and some demographic factors. While this may point the way to interventions designed to relieve patients' distress, the hypothesis that this might in turn relate to practical asthma knowledge was not confirmed.
Although low-back pain and depression are common comorbidities, the mechanisms responsible for their association remain unclear. The effects of proinflammatory cytokines on the hypothalamic-pituitary-adrenal (HPA) axis lead to the hypothesis that allergic reactions, as markers for inflammation-associated activation of the HPA axis, result in aberrant responses to subsequent stressors. Data from 6,836 US adults 20-39 years old from the Third National Health and Nutrition Examination Survey (1988-1994) were used. Subjects responded to questions regarding low-back pain in the past 12 months and history of asthma, hay fever, and other allergies. The history and onset of major depression were obtained from the Diagnostic Interview Schedule. Logistic regression modeling was used to estimate the associations between allergies and depression and low-back pain. Subjects with a history of any allergy were more likely to report low-back pain (odds ratio = 1.51; 95% confidence interval: 1.16, 1.96), to be diagnosed with major depression (odds ratio = 1.58; 95% confidence interval: 1.13, 2.21), and much more likely to have both major depression and low-back pain (odds ratio = 3.03; 95% confidence interval: 1.32, 6.92). Hypersensitivity reactions may prime the HPA axis to respond aberrantly to stressors, resulting in physical and behavioral consequences.
Clinical studies have shown a relationship between allergic disorders and depression, panic disorder, attention deficit/hyperactivity disorder, and social anxiety for a significant subset of patients with these disorders. The nature of the relationship, whether due to shared environmental or biologic vulnerabilities or as a result of the stress of chronic illness, has been less clear. By examining the covariance of atopic disorders and depressive symptoms in a community sample of monozygotic (MZ) and dizygotic (DZ) twins, the contribution of genetic and/or shared environmental etiological factors can be established. A Finnish sample of 1337 MZ and 2506 DZ twin pairs, ages 33-60 years, was sent questionnaires inquiring about history of asthma, eczema, and atopic rhinitis, as well as the Beck Depression Inventory (BDI). The nature of the covariation between twins of these symptoms was investigated by fitting competing genetic and environmental models. Within-person correlation between atopic symptoms and BDI was 0.103 (P < 0.001) for the total sample. Using the Mx statistical modeling program to fit the data to competing quantitative genetic models, the best fitting model estimated that 64% of the association between atopy and BDI was due to shared familial vulnerability, primarily additive genetic influences. Although the measures for allergic disorders and depression are crude, this study supports the hypothesis that there is a small shared genetic risk for atopic and depressive symptoms, and if replicated, may open research for common mechanisms between allergic and depressive disorders. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:146-153, 2000.
The goal of this study is to determine the prevalence of 23 common diseases in subjects with a chronic airway obstruction and in controls. All subjects with a known diagnosis by their general practitioner of asthma or chronic obstructive pulmonary disease (COPD), and who were 40 years and older were selected (n = 1145). Subjects who were willing to participate (n = 591) and who appeared to have an irreversible airway obstruction (n = 290) were included. To recruit controls, a random sample was taken of 676 individuals who were 40 years and older and who were not diagnosed as having asthma or COPD by their general practitioner. Of these 676 individuals 421 were willing to participate. The presence of diseases was determined by using a questionnaire. One hundred and ninety-four subjects (73%) and 229 controls (63%) were shown to be suffering from one or more (other) diseases. In both groups, locomotive diseases, high blood pressure, insomnia and heart disease were most common. Locomotive diseases, insomnia, sinusitis, migraine, depression, stomach or duodenal ulcers and cancer were significantly more common in the subject group than in the control group. For both clinical and research purposes, it is important to consider the presence of diseases in patients with a chronic airway obstruction.
The objective of this study was to determine the relationship between self-reported hay fever and common mental disorders among adults in the general population.
Data were drawn from the Midlife Development in the United States Survey, a representative household survey of the adult US population (25 to 74 years old; n = 3,032). Multivariate logistic regression analyses were used to determine the relationship between self-reported hay fever and current major depression, panic attacks, generalized anxiety disorder, and alcohol/substance use disorders.
Self-reported hay fever was associated with a significantly increased odds of panic attack (odds ratio = 1.8 [1.2, 2.6]), which persisted after adjusting for differences in sociodemographic characteristics and comorbid mental disorders. Self-reported hay fever was not associated with a significantly increased likelihood of major depression, generalized anxiety disorder, or alcohol/substance use disorders.
Consistent with previous findings, these data show a relationship between self-reported hay fever and increased likelihood of panic attacks among adults in the general population. The mechanism of the observed association remains unknown. Future work that examines the relationship between hay fever and panic attacks, as well as other mental disorders using both self-report and objective measurement of allergic response in prospective, longitudinal, epidemiologic data may be useful in improving our understanding of this observed link.
: The hypotheses that certain personality traits are associated with allergic disorders, and that these traits resemble those discovered in investigations of specific allergic disorders, were tested and supported by comparing the performance of allergic and normal individuals on a standard personality inventory. The Minnesota Multiphasic Personality Inventory was administered to 36 allergic and an equal number of nonallergic individuals. The two groups were equally divided as to sex, and each allergic subject was matched with a nonallergic control subject in regard to age, sex, educational level, socio-economic status, and marital status. Comparisons were made of the two groups as a whole, according to sex, and according to allergy types--single or multiple. Statistical analysis of the results showed significant differences between allergies and nonallergics on 5 of the scales: F, Hs, Pt, Sc, and Ma. The D scale approached significance. Comparison of female allergies with female nonallergics showed only the Ma scale significantly elevated. The Hs scale approached significance. An analysis of the performance of allergic and nonallergic males showed four scales significantly elevated: F, Pt, Sc, and Ma. The Pd scale approached significance. A large portion of the differences shown between the total allergic and total control groups was due to weighting by the male allergic subjects. Comparison of the single-type with the multiple-type allergies failed to show a significant difference on any of the scales. Trends toward higher scores for the multiple allergies occurred on the L, Pa, Hs, Hy, and K scales, and toward lower scores on the F, Pd, Pt, and Sc scales. Since the chances of a true difference are so small, little reliance can be placed on these tendencies. Copyright (C) 1962 by American Psychosomatic Society
Effects of semorex D and diphenhydramine on learning in young adults with seasonal allergies
Sanders Rl Lm
O Muntjewerff Nd
Vuurman EF, van Veggel LM, Sanders RL, Muntjewerff ND, O'Hanlon JF. Effects of semorex D and diphenhydramine on learning in young adults with seasonal allergies. Ann Allergy Asthma Immunol 1996; 76: 247–52.
Psychiatric morbidity in patients with chronic airflow obstruction
P M Yellowless
J H Alpers
J J Bowden
Effects of semorex D and diphenhydramine on learning in young adults with seasonal allergies
E F Vuurman
L M Van Veggel
R L Sanders
N D Muntjewerff
A study of antibody levels in alcoholic and schizophrenic patients