Karim Hanna, Lundholm Cecilia, Gong Tong, Brew Bronwyn, Silverman Michael, Almqvist Catarina
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Clin Exp Allergy. 2025 Feb;55(2):175-186. doi: 10.1111/cea.14619. Epub 2025 Jan 15.
Evidence suggests a link between food allergy and poor mental health, however, this may be explained by shared genetic and environmental factors. We aimed to investigate the association between food allergy of different severity and mental health in children, and the role of familial factors.
This population-based, longitudinal cohort study is based on the Child and Adolescent Twin Study in Sweden with questionnaire data reported by parents and/or children. Food allergy 'ever' and doctor's diagnosis were reported at age 9-12 years, and ≥ 1 recent dispensation of adrenaline was used as a marker for current severe food allergy. Outcomes were identified using validated questionnaires for anxiety; Screen for Child Anxiety Related Disorders (SCARED); Strength and Difficulties Questionnaire (SDQ) and depression; Short Mood and Feelings Questionnaire (SMFQ), Center for Epidemiological Studies Depression Scale (CES-D) and Diagnostic and Statistical manual of Mental Disorders (DSM-IV-MDE) and reported at 9-12, 15 and 18 years of age. Multivariate linear and logistic modelling was applied to the whole cohort and a co-twin control approach to remove confounding by familial factors.
In total, 3039 (8.9%) children had a parent-reported food allergy. Among these, 1292 (43.5%) had non-severe food allergy without diagnosis, 1490 (49%) had non-severe food allergy with diagnosis and 257 (8.5%) had severe food allergy. Compared to children with no food allergy, non-severe food allergy with diagnosis by 9-12 years was associated with parent-reported anxiety/depression; SCARED (adjOR 2.10, 95% CI 1.48-2.98), SMFQ (adjOR 1.92, 95% CI 1.19-3.10) at 9-12 years and SDQ (adjβ 0.2, 95% CI 0.0-0.4) at 15 years. All other associations were null including for those with severe food allergy. All positive estimates in the full cohort were attenuated using co-twin controls.
Evidence associating paediatric food allergy severity and poor mental health was weak, and positive associations observed were likely due to familial confounding.
有证据表明食物过敏与心理健康不佳之间存在联系，然而，这可能由共同的遗传和环境因素来解释。我们旨在研究不同严重程度的食物过敏与儿童心理健康之间的关联，以及家族因素的作用。
这项基于人群的纵向队列研究基于瑞典儿童和青少年双胞胎研究，数据通过父母和/或孩子报告的问卷收集。在9至12岁时报告“曾经有过”食物过敏和医生诊断情况，并且将近期至少一次肾上腺素配给作为当前严重食物过敏的标志。使用经过验证的焦虑问卷来确定结果；儿童焦虑相关障碍筛查量表（SCARED）；优势与困难问卷（SDQ）以及抑郁问卷；简短情绪与情感问卷（SMFQ）、流行病学研究中心抑郁量表（CES-D）和精神疾病诊断与统计手册（DSM-IV-MDE），并在9至12岁、15岁和18岁时报告结果。对整个队列应用多变量线性和逻辑模型，并采用双胞胎对照方法以消除家族因素的混杂影响。
总共有3039名（8.9%）儿童有父母报告的食物过敏。其中，1292名（43.5%）有未确诊的非严重食物过敏，1490名（49%）有确诊的非严重食物过敏，257名（8.5%）有严重食物过敏。与无食物过敏的儿童相比，9至12岁时确诊的非严重食物过敏与父母报告的焦虑/抑郁相关；9至12岁时的SCARED（调整后的比值比为2.10，95%置信区间为1.48至2.98）、SMFQ（调整后的比值比为1.92，95%置信区间为1.19至3.10）以及15岁时的SDQ（调整后的β值为0.2，95%置信区间为0.0至0.4）。所有其他关联均无统计学意义，包括那些有严重食物过敏的儿童。使用双胞胎对照后，全队列中的所有阳性估计值均减弱。
将儿童食物过敏严重程度与心理健康不佳联系起来的证据薄弱，观察到的阳性关联可能是由于家族混杂因素导致的。
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