Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.
University Allergy Center, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Allergy. 2018 Mar;73(3):615-626. doi: 10.1111/all.13326. Epub 2017 Nov 20.
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.
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.
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.
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.
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.
流行病学证据表明特应性皮炎（AD）与注意力缺陷/多动障碍（ADHD）之间存在相关关联。潜在机制以及如何最好地识别有患 ADHD 风险的 AD 患者亚组的方法尚不清楚。
比较患有 AD、ADHD、AD/ADHD 共病和年龄匹配的健康对照组的儿童的社会人口统计学、临床和心理社会特征，并探讨与 ADHD 症状相关的 AD 相关方面。
应用因子设计，我们调查了 4 组年龄在 6-12 岁的儿童：仅 AD（即无 ADHD）、仅 ADHD（即无 AD）、AD+ADHD 和健康对照组（即无 AD/无 ADHD）。使用经过验证的工具，比较各组之间 ADHD 症状和其他行为问题、生活质量、养育压力和睡眠问题。在仅 AD 的儿童中，评估了临床体征（客观 SCORAD）、症状（POEM、瘙痒 VAS、睡眠问题 VAS）和 AD 的既往治疗，以调查与 ADHD 症状相关的疾病模式。
与健康对照组（n=47）相比，仅 AD 儿童（n=42）、仅 ADHD 儿童（n=34）和共病 AD+ADHD 儿童（n=31）的行为问题明显增加，生活质量下降。仅 AD 的儿童的 ADHD 症状明显高于健康对照组。在仅 AD 的儿童中，既往使用抗组胺药与 ADHD 症状增加显著相关（OR 1.88；95%CI 1.04-3.39）。当前的临床体征和 AD 症状与 ADHD 症状的水平无关。
即使排除 ADHD 的临床诊断，患有 AD 的儿童也会出现 ADHD 症状水平升高。进一步的研究需要确定早期抗组胺药暴露是否是 ADHD 的主要危险因素，还是过去 AD 严重程度和/或相关睡眠问题的替代指标。
