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Originalarbeit/Original article

Assoziation von Neurodermitis und Aufmerksamkeits-Defizit/Hyperaktivitäts-Syndrom

Meta-Analyse aktueller epidemiologischer Studien

Published Online:December 21, 2012https://doi.org/10.1024/1422-4917/a000208

Abstract

Fragestellung: Die Aufmerksamkeits-Defizit/Hyperaktivitäts-Störung (ADHS) und Neurodermitis sind häufige Erkrankungen des Kindes- und Jugendalters von fächerübergreifender Versorgungsrelevanz. Seit Jahren wird ein möglicher Zusammenhang von Erkrankungen des atopischen Formenkreises und ADHS diskutiert. Methodik: Anhand von je zwei Querschnittsstudien und Geburtskohortenstudien analysierten wir den Zusammenhang von Neurodermitis und ADHS unter Berücksichtigung von Umwelt- und Lifestylefaktoren sowie atopischen Komorbiditäten. Zur Quantifizierung der Assoziation von aktueller oder früherer Neurodermitis und ADHS wurden eine Meta-Analyse durchgeführt unter Verwendung für Alter, Geschlecht und atopische Komorbidität adjustierter Odds Ratios (OR). Ergebnisse: Unsere Daten deuten konsistent auf eine von Umweltexpositionen, soziodemographischen Faktoren und Komorbiditäten unabhängige Assoziation von Neurodermitis und ADHS (OR [95 %] 1.43 [1.25–1.64]) hin, wobei insbesondere die frühkindliche Neurodermitis mit einer späteren Manifestation von ADHS-Symptomen assoziiert zu sein scheint. Schlafstörungen aufgrund der Neurodermitis scheinen für die Assoziation relevant zu sein. Diskussion: Neue epidemiologische Studien deuten konsistent auf eine Assoziation von Neurodermitis und ADHS hin. Die Wahrscheinlichkeit, dass ein Kind mit früherer oder aktueller Neurodermitis die Diagnose ADHS oder klinische ADHS-Symptome aufweist, ist um etwa 43 % erhöht. Nun gilt es die Mechanismen zu erforschen, die der Assoziation von Neurodermitis und ADHS zugrunde liegen. In der Perspektive könnten darauf aufbauend gezielt Therapie- und Präventionsstrategien entwickelt werden.


Association of atopic eczema and attention-deficit/hyperactivity disorder – meta-analysis of epidemiologic studies

Background: Atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD) are frequent paediatric conditions with high medical relevance. A possible relationship between atopic diseases (i.e., AD, asthma, and allergic rhinitis) has long been discussed, but convincing evidence is still missing. Methods: We investigated the relationship between AD and ADHD in two cross-sectional studies and in two birth cohort studies considering lifestyle factors, environmental factors, and atopic comorbidities as potential confounders. To quantify the strength of association between AD and ADHD, data from the four epidemiologic studies were summarized by means of a meta-analysis. Odds ratios (OR) were pooled for the association between prevalent or previous AD and prevalent ADHD from the four studies adjusted for age, sex, and atopic comorbidity (allergic rhinitis, asthma). Results: The epidemiologic studies conducted consistently indicate an association between AD and ADHD which is independent of environmental exposures and other comorbidities. Particularly infant AD appears to be associated with later development of ADHD symptoms. Sleeping problems due to AD are suggested as playing an important role for the observed association between AD and ADHD. The pooled OR (95 % confidence interval (95 %CI)) for the association between AD and ADHD was 1.43 (1.25–1.64). Discussion: Four new epidemiologic studies consistently indicate a positive association between AD and ADHD. Compared to children without AD, children with previous or prevalent AD have an approximately 43 % increased risk to be diagnosed with ADHD or to display clinical ADHD symptoms. Following our findings, the biological mechanisms underlying the observed comorbidity between AD and ADHD require further investigation in order to subsequently develop targeted therapeutic and preventive strategies.

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