AD therapy linked to ADHD

Early antihistamine use in children with atopic dermatitis may be related to attention-deficit-hyperactivity disorder symptoms, researchers report in the journal Allergy.

The study, reported in November, suggests that even in the absence of a clinical ADHD diagnosis, pediatric atopic dermatitis patients have a higher tendency than children without atopic dermatitis to develop ADHD symptoms.

Having atopic dermatitis as a child - even mild forms of the disease - was found to be associated with ADHD symptoms, mental health issues and a diminished quality of life.

Atopic dermatitis, which is the most prevalent chronic condition of infancy, should be viewed by dermatologists and others as a disease that is not limited to the skin, the authors wrote. Instead, as one “that has substantial impact in the general development and morbidity of affected children.

Therefore, early prevention of [atopic dermatitis] and effective treatment of is of utmost relevance,” wrote the researchers who were led by Jochen Schmitt, of the Center for Evidence-Based Healthcare in Germany.

Little is known about the association between atopic dermatitis and ADHD or how to identify atopic dermatitis patients who may be risk for ADHD. Physicians should proceed with caution when considering antihistamines for children.

“Until the safety of exposure to antihistamines that pass the blood-brain barrier early in life is established, newer, non-sedating antihistamines are recommended if indicated,” the authors write.

The study included 154 children ages six to 12 years. The children were divided into four groups: 42 children with atopic dermatitis only; 34 with ADHD only; 31 with atopic dermatitis and ADHD; and, 47 healthy controls. An interdisciplinary group of dermatologists, psychi atrists and psychologists analyzed and compared atopic dermatitis symptoms with behavioral problems, parental stress, quality of life and sleep disturbances.

FINDINGS

All children in the study except for the healthy con trols were found to have “significantly increased” level of behavioral problems and a decreased quality of life. Those with atopic dermatitis only had significantly higher levels of ADHD symptoms.

The previous use of antihistamines in children with atopic dermatitis were found to be significantly associated with increased ADHD symptoms.

ADHD symptoms of attention, hyperactivity and impulse control, were found to be higher in children with atopic dermatitis compared to healthy controls.

Parents reported that their children experienced significant changes in quality of life due to low self-esteem, fractured friendships and learning impairments, compared to healthy controls.

However, during their self-assessment, children rated their quality of life higher than assessments conducted by their parents - a discordance reported in other studies as well, the authors wrote.

Child and parent assessments of sleep problems didn’t reveal an increase in children with atopic dermatitis only, but children in the comorbid group seemed to have more sleeping problems, such as in sleep duration, sleep anxiety, parasomnias and daytime sleepiness.

Researchers found that early-in-life sleeping problems occurred more in the comorbid group and appeared to be related to a greater likelihood of ADHD symptoms in the group of children with atopic dermatitis only. This, the authors wrote, supports an important role of sleeping problems in infancy related to atopic dermatitis and possibly for ADHD development later in life.

FOCUS ON ANTIHISTAMINES

The researchers cited work by Stevenson J et al. that found prolonged use of cetirizine in infants with atopic dermatitis resulted in no adverse effects on behavior or learning processes. But the authors of this study note that many pediatric atopic dermatitis patients take antihistamines that pass the blood-brain barrier in early childhood, leaving questions about the effects of those drugs on the developing brain. Dimetindene is an example of a first-generation antihistamine commonly used to ease itching and sleeping problems in infants with atopic dermatitis.

“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,” researchers wrote. ƒ

REFERENCES

1. Schmitt J, Buske-Kirschbaum A, Tesch F, et al. “Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use.” Allergy. 2017. DOI:10.1111/all.13326

2. Stevenson J, Cornah D, Evrard P, et al. “Long-term evaluation of the impact of the h1-receptor antagonist cetirizine on the behavioral, cognitive, and psychomotor development of very young children with atopic dermatitis.” Pediatric Research. 2002