Asthma, Atopic Dermatitis May Predispose to Behavioral and Emotional Problems

child with asthma, eczema
Although atopic dermatitis in infancy was not associated with later behavioral problems, at 6.5 years old, children who experienced asthma or atopic dermatitis symptoms within the past year were at increased risk for concomitant emotional problems.

Although atopic dermatitis (AD) in infancy was not associated with later behavioral problems, at 6.5 years old, children who experienced asthma or AD symptoms within the previous year were at increased risk for concomitant emotional problems or concomitant emotional problems and hyperactivity/inattention, respectively, according to a report published in Clinical & Experimental Allergy.

Allergic diseases such as AD and asthma are thought to be associated with behavioral problems such as attention-deficit/hyperactivity disorder, but research has offered mixed evidence and conflicting findings. Investigators sought to characterize and quantify these relationships, hypothesizing that behavioral problems at 6.5 years of age would correlate with AD and asthma symptoms at the same age, as well as with AD during infancy.

The investigators conducted a secondary analysis of the cluster-randomized, controlled Promotion of Breastfeeding Intervention Trial (PROBIT; ISRCTN Registry Number: 37687716; n=17,046). Participants were initially recruited between June 1996 and December 1997, with a total of 13,889 Belarusian children followed from birth through 6.5 years, and 11,668 patients (47.7% female) with complete data were included in the final assessment.

During the initial year of life, participants were followed at 1, 2, 3, 6, 9, and 12 months, and diagnoses of AD were documented. At 6.5 years, all patients were examined and given skin prick tests (SPTs) for 5 common allergens, and patients/parents reported AD and asthma symptoms occurring during the previous year, using the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire. At the same time, parents and/or teachers filled out the Strength and Difficulties Questionnaire (SDQ), which assesses behavioral issues using subscales on emotional problems, hyperactivity/inattention, peer problems, conduct problems, and prosocial behaviors. Logistic regression with multiple adjustments was performed.

In fully adjusted models, there was no association detected between infant AD diagnoses and subsequent behavioral problems at 6.5 years, on any SDQ subscale. However, at 6.5 years, the children who reported asthma symptoms (wheeze) or AD symptoms (rash) during the past year demonstrated a concomitant increased risk for emotional problems, with odds ratios (ORs) and 95% CIs of 1.45 (95% CI, 1.07-1.96; P =.02) and 2.24 (95% CI, 1.62-3.12; P <.001), respectively. More severe symptoms were correlated with higher risk and increased ORs for emotional issues in both diseases.

In a sensitivity analysis, there was also a greater risk for probable hyperactivity/inattention at 6.5 years in patients who reported AD symptoms throughout the prior year (OR, 2.05; 95% CI, 1.09-3.84). No other SDQ subscales appeared to be associated with asthma or AD symptoms during the past year. There was no effect of SPT results on childhood behavioral problems.

Study strengths included a prospective design, large sample size, multiple first year follow-up visits, wide geographic spread, background data collection, reduced recall bias risk, adjustment for AD during asthma/behavioral explorations, ISAAC-based disease definitions, combined parent/teacher behavioral assessments for most children, use of SPT, and first year skin examination for AD by a pediatrician.

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Study limitations included behavioral assessment at only 1 time point, possible lack of full behavioral issue development, lack of parental psychopathology information, nonassessment of food allergies/sensitization, and the possibility of behavioral issues preceding AD or asthma symptomatology.

“Based on our findings we think that physicians taking care of children with AD and asthma, especially when severe, should consider screening for emotional problems,” the authors concluded.


Ballardini N, Kramer MS, Oken E, et al. Associations of atopic dermatitis and asthma with child behaviour: results from the PROBIT cohort [published online May 13, 2019]. Clin Exp Allergy. doi:10.1111/cea.13417