Abstract
The prevalence of autism spectrum disorder (ASD) in US children has increased during the past decades. Immunologic dysfunction has recently emerged as a factor associated with ASD. Although children with ASD are more likely to have gastrointestinal disorders, little is known about the association between food allergy and ASD. To examine the association of food allergy and other allergic conditions with ASD in US children. This population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016. The data analysis was performed in 2018. All eligible children aged 3 to 17 years were included. Food allergy, respiratory allergy, and skin allergy were defined based on an affirmative response in the questionnaire by a parent or guardian. Reported ASD diagnosed by a physician or other health professional. This analysis included 199 520 children (unweighted mean [SD] age, 10.21 [4.41] years; 102 690 boys [51.47%]; 55 476 Hispanic [27.80%], 97 200 non-Hispanic white [48.72%], 30 760 non-Hispanic black [15.42%], and 16 084 non-Hispanic other race [8.06%]). Among them, 8734 (weighted prevalence, 4.31%) had food allergy, 24 555 (12.15%) had respiratory allergy, and 19 399 (9.91%) had skin allergy. A diagnosis of ASD was reported in 1868 children (0.95%). The weighted prevalence of reported food, respiratory, and skin allergies was higher in children with ASD (11.25%, 18.73%, and 16.81%, respectively) compared with children without ASD (4.25%, 12.08%, and 9.84%, respectively). In analyses adjusting for age, sex, race/ethnicity, family highest education level, family income level, geographical region, and mutual adjustment for other allergic conditions, the associations between allergic conditions and ASD remained significant. The odds ratio (OR) of ASD increased in association with food allergy (OR, 2.29; 95% CI, 1.87-2.81), respiratory allergy (OR, 1.28; 95% CI, 1.10-1.50), and skin allergy (OR, 1.50; 95% CI, 1.28-1.77) when comparing children with these conditions and those without. In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular food allergy, with ASD was found. Further investigation is warranted to elucidate the causality and underlying mechanisms.
Highlights
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social interaction, language, and communication, as well as the presence of restricted repetitive behaviors
The odds ratio (OR) of autism spectrum disorder (ASD) increased in association with food allergy (OR, 2.29; 95% CI, 1.87-2.81), respiratory allergy (OR, 1.28; 95% CI, 1.10-1.50), and skin allergy (OR, 1.50; 95% CI, 1.28-1.77) when comparing children with these conditions and those without
Among the 199 520 children aged 3 to 17 years included in this analysis, 8734 had food allergy, 24 555 had respiratory allergy, and 19 399 had skin allergy
Summary
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social interaction, language, and communication, as well as the presence of restricted repetitive behaviors. The prevalence of ASD in US children has steadily increased over the past decades.[1,2,3,4] The Autism and Developmental Disabilities Monitoring Network reported that the estimated prevalence of ASD increased from 0.67% in 2000 to 1.46% in 2012.1 A recent study using data from the National Health Interview Survey (NHIS) found that the prevalence of ASD in US children aged 3 to 17 years was 2.24% in 2014, 2.41% in 2015, and 2.76% in 2016.3 A similar upward trend in ASD prevalence has been observed in many other developed and developing countries worldwide.[5] The etiology of ASD involves both genetic and environmental risk factors,[5,6] and it is estimated that up to 40% to 50% of variance in ASD liability might be attributed to environmental risk factors.[7]. Available evidence has shown that early-life immune activation can adversely influence certain neurodevelopmental processes, such as neuron growth, through multiple pathways, including altered expression of cytokines and chemokines.[12]
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