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Relationship Between Behavior and Asthma in Children With Atopic Dermatitis

Center for Research into Psychological Development, Department of Psychology, University of Southampton, United Kingdom, on behalf of the ETAC Study Group.

Address for correspondence and reprint requests to Professor Jim Stevenson, Center for Research into Psychological Development, Department of Psychology, University of Southampton, Highfield, Southampton SO17 1 BJ, UK. E-mail: jsteven{at}soton.ac.uk

OBJECTIVE: The significance of psychological factors in asthma is a subject of considerable dispute. This study addressed the little investigated question of the potential role of psychological factors in the initial onset of asthma.

MATERIALS AND METHODS: Data on the validated, standardized Behavior Screening Questionnaire were obtained prospectively from 35 to 53 months for 150 atopic children who had asthma by age 53 months and for 115 who did not.

RESULTS: At each age, the children who had asthma by 53 months had more behavior problems. There was no evidence that the subsequent behavior of those children who had asthma became more problematic. However, for those children without asthma by 35 months, an elevated behavior problem score at that age was related to the subsequent onset of asthma by age 53 months. The behavior problem score added significantly to the prediction of asthma onset (OR adjusted: 1.15; 95% CI: 1.02–1.29) when known risk factors of asthma and IgE levels for grass pollen and house dust mite at age 17 months were taken into account.

CONCLUSIONS: Behavior problems may precede asthma onset in young atopic children. In this age group, behavior problems are not secondary psychological reactions to asthma onset. They may act as a marker for stress in the child’s life. The presence of behavior problems should alert clinicians that the child may be at increased risk for transition from atopic dermatitis to asthma.

Key Words: atopic dermatitis, • asthma, • child behavior, • cetirizine.

Abbreviations: ETAC = Early Treatment of the Atopic Child study;; BSQ = Behavior Screening Questionnaire;; HDM = house dust mite;; GP = grass pollen;; ITT = intention to treat.

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