Atopy increases vulnerability to affective and anxiety issues?

In a year of impossible things...

I was rather interested to read the recent paper by Renee Goodwin and colleagues [1] observing that: "Atopy appears to be associated with increased vulnerability to affective and anxiety problems, compared to youth without atopy."

Atopy, referring to a predisposition to developing allergic diseases such as eczema, asthma and/or hayfever, is something on the 'up' in research terms when it comes to aspects of psychiatry and/or developmental outcomes (see here for example). Goodwin et al set about further testing the possibility of a link based on data "drawn from the Raine Study (N = 2868) [a favourite initiative on this blog], a population-based birth cohort study in Western Australia."

Looking at signs of atopy - "using parent report and objective biological confirmation (sera IgE)" - at ages 1-5 years and "the range of internalizing and externalizing mental health problems at ages 5-17 years" authors reported on some interesting patterns/correlations in relation to affective and anxiety problems potentially being linked. Authors also described how their results held strong even "after adjusting for a range of potential confounders."

Whilst there are always going to be issues associated with studies linking one or two variables across various years, the Goodwin paper represents yet another example of how further research resources need to be ploughed into the area of immune function and behaviour. Yes, I appreciate that we are entering the era of immunopsychiatry (if I can call it that) and that there is some good science emerging in this area (see here) but questions about the [various] hows and whys still need answering [2].

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[1] Goodwin RD. et al. Childhood atopy and mental health: a prospective, longitudinal investigation. Psychol Med. 2016 Oct 20:1-9.

[2] Hatfield SJ. et al. What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 1. Epidemiology, risk factors and outcomes. Clin Exp Dermatol. 2016 Nov 2.

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Goodwin RD, Robinson M, Sly PD, & Holt PG (2016). Childhood atopy and mental health: a prospective, longitudinal investigation. Psychological medicine, 1-9 PMID: 27762174

ADHD symptoms improved with allergic rhinitis treatment

The findings reported by Ming-Tao Yang and colleagues [1] make for some brief blogging fodder today and the idea that: "Higher ADHD [attention-deficit hyperactivity disorder] scores in children with AR [allergic rhinitis] compared with healthy controls decreased significantly with AR treatment." Said AR treatment consisted of "nonpharmacologic intervention, oral antihistamines, and topical steroids."

I know furrowed brows and eye-rolling might be the response of some people to this work but consider however the [peer-reviewed] data already published on how the presentation of allergy or atopic disease might go well beyond just somatic presentation (see here for example). Given also that Yang et al are based in Taiwan, it is useful to mention how 'big data' from Taiwan has been instrumental in pushing the relationship between immune function and behavioural outcomes (see here).

This time around researchers looked at a small-ish participant group diagnosed with AR; evaluating both their physical AR symptoms and also symptoms scores according to ADHD criteria. After treatment for their AR, their AR symptoms improved (not unexpectedly) but alongside changes to their ADHD scores were noted too. Indeed: "Significant predictors for the improvement of ADHD scores included age, AR drugs, AR subtypes, and multiple atopic diseases." The authors make quite a forthright assertion from their data: "For children with AR and borderline ADHD symptoms, who do not meet full ADHD diagnostic criteria, we recommend initially treating their AR and monitoring improvement of ADHD symptoms."

Just before anyone assumes that I'm pushing oral antihistamines for ADHD, I'm not. Accepting that there are still some research gaps in how ADHD is managed pharmacologically (see here) I do however think that there could be a further research study or two to do on this topic; not least including a placebo element to it. If you need a template for how this might play out, well, there is some mention in the related autism research literature about allergy symptoms potentially affecting autistic symptoms (see here). The case report included in that previous blog post was from Harumi Jyonouchi [2] and went a little further in terms of how AR was treated, but the idea that behaviour could be impacted by such intervention is there and perhaps further stretches the whole 'immune function is related to behaviour' hypothesis.

And yes, autism and ADHD may share a lot more than perhaps previously recognised (see here).

To close, it's news here in Blighty but I'm not so sure elsewhere, but the question 'should I stay or should I go?' will be resolved one way or another today regarding the UK's membership of the European Union. Depending on your point of view, you'll be happy/sad to know we will still be able to take part in Eurovision and the EUROs no matter what...

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[1] Yang MT. et al. Attention-deficit/hyperactivity disorder-related symptoms improved with allergic rhinitis treatment in children. Am J Rhinol Allergy. 2016 May;30(3):209-14.

[2] Jyonouchi H. Marked improvement of neuropsychiatric symptoms following control of allergy symptoms with the use of humanized murine anti-IgE antibody (omalizumab) in 2 patients with severely limited expressive language. Allergy, Asthma & Clinical Immunology. 2015; 11: 38.

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Yang MT, Chen CC, Lee WT, Liang JS, Fu WM, & Yang YH (2016). Attention-deficit/hyperactivity disorder-related symptoms improved with allergic rhinitis treatment in children. American journal of rhinology & allergy, 30 (3), 209-14 PMID: 27216352