Miyazaki Celine, Koyama Momoko, Ota Erika, Swa Toshiyuki, Mlunde Linda B, Amiya Rachel M, Tachibana Yoshiyuki, Yamamoto-Hanada Kiwako, Mori Rintaro
Department of Health Policy, National Center for Child Health and Development, 10-1-2 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8654, Japan.
BMC Psychiatry. 2017 Mar 31;17(1):120. doi: 10.1186/s12888-017-1281-7.
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.
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.
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.
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.
注意缺陷多动障碍（ADHD）患儿中过敏性疾病频繁发作的报道已成为临床日益关注的焦点。然而，支持ADHD与过敏之间关联的证据并不一致，且尚未得到系统评价。本研究的目的是汇总并评估关于儿童ADHD与过敏性疾病之间关联的现有研究。
2015年11月23日，使用MEDLINE、EMBASE、Cochrane图书馆和CINAHL数据库完成了全面检索。纳入研究的标准为：研究评估18岁及以下诊断为ADHD的儿童的过敏性疾病，且纳入一个明确的对照组。纳入任何比较性研究，包括随机对照试验和观察性研究。两位综述作者使用经过验证的评估工具独立评估所选研究的质量，进行数据提取，并根据Cochrane协作网指南进行荟萃分析。
五项符合条件的研究纳入了本系统评价。其中，三项为病例对照研究，两项为横断面研究。五项研究中的大多数信息被归类为偏倚风险低或不明确。荟萃分析显示，与对照组相比，ADHD患儿与哮喘之间存在关联（比值比：1.80，95%置信区间：1.57 - 2.07；五项研究，证据质量低），但未表明食物过敏与ADHD之间存在关联（比值比：1.13，95%置信区间：0.88 - 1.47；三项研究，证据质量极低）。与对照组相比，ADHD患儿患过敏性鼻炎、特应性皮炎和过敏性结膜炎的几率略高，尽管总体效应估计中存在显著的统计学异质性。
本综述和荟萃分析的结果表明，ADHD患儿比对照组更易患哮喘、过敏性鼻炎、特应性皮炎和过敏性结膜炎。包括ADHD患儿过敏管理策略在内的干预措施将是有益的。
