The Journal of Allergy and Clinical Immunology
Volume 125, Issue 2 , Pages 404-410, February 2010

Infant-onset eczema in relation to mental health problems at age 10 years: Results from a prospective birth cohort study (German Infant Nutrition Intervention plus)

  • Jochen Schmitt, MD, MPH

      Affiliations

    • Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
    • These authors contributed equally to this work.
    • Corresponding Author InformationReprint requests: Jochen Schmitt, MD, MPH, Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr 74, D-01307 Dresden, Germany.
    • ,
  • Christian Apfelbacher, PhD

      Affiliations

    • Department of Clinical Social Medicine, University Hospital Heidelberg, Heidelberg, Germany
    • These authors contributed equally to this work.
    • ,
  • Chih-Mei Chen, PhD

      Affiliations

    • Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
    • Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany
    • ,
  • Marcel Romanos, MD

      Affiliations

    • Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinic of Wuerzburg, Wuerzburg, Germany
    • ,
  • Stefanie Sausenthaler, PhD

      Affiliations

    • Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
    • ,
  • Sibylle Koletzko, MD

      Affiliations

    • Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany
    • ,
  • Carl-Peter Bauer, MD

      Affiliations

    • Department of Pediatrics, Technical University of Munich, Munich, Germany
    • ,
  • Ute Hoffmann, MD

      Affiliations

    • Department of Pediatrics, Technical University of Munich, Munich, Germany
    • ,
  • Ursula Krämer, PhD

      Affiliations

    • Institut für Umweltmedizinische Forschung, University of Düsseldorf, Düsseldorf, Germany
    • ,
  • Dietrich Berdel, MD

      Affiliations

    • Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
    • ,
  • Andrea von Berg, MD

      Affiliations

    • Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
    • ,
  • H.-Erich Wichmann, MD, PhD

      Affiliations

    • Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
    • Institute of Medical Data Management, Biometrics and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
    • ,
  • Joachim Heinrich, PhD

      Affiliations

    • Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
    • ,
  • German Infant Nutrition Intervention plus Study Group

Received 19 August 2009; received in revised form 25 September 2009; accepted 13 October 2009.

Background

Cross-sectional studies suggest an association between eczema and mental health problems, but the temporal relationship is unclear.

Objective

To assess the association between infant-onset eczema and mental health problems in a prospective study.

Methods

Between 1995 and 1998, a birth cohort study was recruited and followed until age 10 years. Physician-diagnosed eczema, comorbidities, and a broad set of environmental exposures were assessed at age 1, 2, 3, 4, 6, and 10 years. First, we investigated the association between infant-onset eczema (age 1-2 years) and mental health problems at age 10 years according to the Strengths and Difficulties Questionnaire. Second, we analyzed the likelihood of mental health problems at age 10 years in relation to the course of eczema.

Results

A total of 2916 infants were eligible for analysis. Compared with participants never diagnosed as having eczema, children with infant-onset eczema had a significantly increased risk for possible/probable mental health problems (Strengths and Difficulties Questionnaire total score) at age 10 years (odds ratio, 1.49; 95% CI, 1.13-1.96) and for emotional symptoms (odds ratio, 1.62; 95% CI, 1.25-2.09). Eczema limited to infancy predicted a significantly higher risk for conduct problems at age 10 years. The strength of the association between eczema and emotional problems at age 10 years increased with increasing eczema persistence.

Conclusion

Infants with eczema are at increased risk for mental health problems at age 10 years. Even if cleared afterward, eczema at age 1 to 2 years may cause persistent emotional and behavioral difficulties.

Key words: Eczema, cohort study, depression, emotional problems, hyperactivity, infant, risk, Strengths and Difficulties Questionnaire

Abbreviations used: ADHD, Attention-deficit/hyperactivity disorder, GINI, German Infant Nutrition Intervention, OR, Odds ratio, SDQ, Strengths and Difficulties Questionnaire

 

 The German Infant Nutrition Intervention study was funded for 3 years by grants of the Federal Ministry for Education, Science, Research and Technology (grant no. 01 EE 9401-4). The 6-year follow-up of the German Infant Nutrition Intervention plus study was partly funded by the Federal Ministry of Environment (Institut für Umweltmedizinische Forschung, FKZ 20462296). This study was supported in part by Ludwig-Maximilians-Universität's innovative research priority project MC-Health (subproject I).

 Disclosure of potential conflict of interest: S. Koletzko has received speakers' honoraria from Nestle Nutrition and Danone and has received research support from Nestle Nutrition and Mead Johnson. A. von Berg has received a speakers' honorarium from Nestle and has provided legal consultation services or expert witness testimony relevant to Airsonett. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)01632-7

doi:10.1016/j.jaci.2009.10.055

The Journal of Allergy and Clinical Immunology
Volume 125, Issue 2 , Pages 404-410, February 2010