Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people worldwide. Based on the concept of central sensitization, we conducted a population-based cohort analysis to investigate the risk of IBS in children with atopic dermatitis (AD) as one of the first steps in the atopic march. From 2000 to 2007, 1 20 014 children with newly diagnosed AD and 1 20 014 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of IBS in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and CIs were measured. The incidence of IBS during the study period was 1.45-fold greater (95% CI: 1.32 to 1.59) in the AD cohort than in the non-AD cohort (18.8 vs 12.9 per 10 000 person-years). The AD to non-AD HR of IBS was greater for girls (1.60, 95% CI: 1.39 to 1.85) and children≥12 years (1.59, 95% CI: 1.23 to 2.05). The HR of IBS in AD children increased from 0.84 (95% CI: 0.75 to 0.94) for those with ≤3 AD related visits to 16.7 (95% CI: 14.7 to 18.9) for those with >5 visits (P<0.0001, by the trend test). AD children had a greater risk of developing IBS. Further research is needed to clarify the role of allergy in the pathogenesis of IBS.
WilsonA, LongstrethGF, KnightK, . Quality of life in managed care patients with irritable bowel syndrome. Manag Care Interface2004;17:24–8.
2.
QuigleyEM. Changing face of irritable bowel syndrome. World J Gastroenterol2006;12:1–5.doi:10.3748/wjg.v12.i1.1
3.
MayerEA, CollinsSM. Evolving pathophysiologic models of functional gastrointestinal disorders. Gastroenterology2002;122:2032–48.doi:10.1053/gast.2002.33584
4.
MieleE, SimeoneD, MarinoA, . Functional gastrointestinal disorders in children: an Italian prospective survey. Pediatrics2004;114:73–8.doi:10.1542/peds.114.1.73
5.
ReshetnikovOV, KurilovichSA, DenisovaDV, . Prevalence of dyspepsia and irritable bowel syndrome among adolescents of Novosibirsk, western Siberia. Int J Circumpolar Health2001;60:253–7.
6.
DongL, DingguoL, XiaoxingX, . An epidemiologic study of irritable bowel syndrome in adolescents and children in China: a school-based study. Pediatrics2005;116:e393–6.doi:10.1542/peds.2004-2764
7.
DoshiJA, CaiQ, BuonoJL, . Economic burden of irritable bowel syndrome with constipation: a retrospective analysis of health care costs in a commercially insured population. J Manag Care Spec Pharm2014;20:382–90.doi:10.18553/jmcp.2014.20.4.382
8.
BelliniM, GambacciniD, StasiC, . Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy. World J Gastroenterol2014;20:8807–20.doi:10.3748/wjg.v20.i27.8807
9.
StefaniniGF, SaggioroA, AlvisiV, . Oral cromolyn sodium in comparison with elimination diet in the irritable bowel syndrome, diarrheic type. Multicenter study of 428 patients. Scand J Gastroenterol1995;30:535–41.doi:10.3109/00365529509089786
10.
TanTK, ChenAC, LinCL, . Preschoolers with allergic diseases have an increased risk of irritable bowel syndrome when reaching school age. J Pediatr Gastroenterol Nutr2017;64:26–30.doi:10.1097/MPG.0000000000001219
11.
PetitpierreM, GumowskiP, GirardJP. Irritable bowel syndrome and hypersensitivity to food. Ann Allergy1985;54:538–40.
12.
MagnussonJ, LinXP, Dahlman-HöglundA, . Seasonal intestinal inflammation in patients with birch pollen allergy. J Allergy Clin Immunol2003;112:45–51.doi:10.1067/mai.2003.1604
13.
GuiXY. Mast cells: a possible link between psychological stress, enteric infection, food allergy and gut hypersensitivity in the irritable bowel syndrome. J Gastroenterol Hepatol1998;13:980–9.doi:10.1111/j.1440-1746.1998.tb00558.x
14.
UndemBJ, Taylor-ClarkT. Mechanisms underlying the neuronal-based symptoms of allergy. J Allergy Clin Immunol2014;133:1521–34.doi:10.1016/j.jaci.2013.11.027
15.
WilliamsH, RobertsonC, StewartA, . Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol1999;103:125–38.doi:10.1016/S0091-6749(99)70536-1
16.
BoguniewiczM, LeungDY. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev2011;242:233–46.doi:10.1111/j.1600-065X.2011.01027.x
17.
de BenedictisFM, FranceschiniF, HillD, . The allergic sensitization in infants with atopic eczema from different countries. Allergy2009;64:295–303.doi:10.1111/j.1398-9995.2008.01779.x
18.
AtkinsonW, SheldonTA, ShaathN, . Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut2004;53:1459–64.doi:10.1136/gut.2003.037697
19.
SimrénM, MånssonA, LangkildeAM, . Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion2001;63:108–15.doi:10.1159/000051878
20.
ZhengT, YuJ, OhMH, . The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res2011;3:67–73.doi:10.4168/aair.2011.3.2.67
21.
SampsonHA, BroadbentKR, Bernhisel-BroadbentJ. Spontaneous release of histamine from basophils and histamine-releasing factor in patients with atopic dermatitis and food hypersensitivity. N Engl J Med1989;321:228–32.doi:10.1056/NEJM198907273210405
22.
CaffarelliC, CosciaA, BaldiF, . Characterization of irritable bowel syndrome and constipation in children with allergic diseases. Eur J Pediatr2007;166:1245–52.doi:10.1007/s00431-006-0410-y
23.
JonesMP, WalkerMM, FordAC, . The overlap of atopy and functional gastrointestinal disorders among 23,471 patients in primary care. Aliment Pharmacol Ther2014;40:382–91.doi:10.1111/apt.12846
24.
WeiCC, TsaiJD, LinCL, . Increased risk of idiopathic nephrotic syndrome in children with atopic dermatitis. Pediatr Nephrol2014;29:2157–63.doi:10.1007/s00467-014-2835-2
25.
WeiCC, LinCL, ShenTC, . Neonatal jaundice and risks of childhood allergic diseases: a population-based cohort study. Pediatr Res2015;78:223–30.doi:10.1038/pr.2015.89
26.
WeiCC, LinCL, ShenTC, . Risk of idiopathic nephrotic syndrome among children with asthma: a nationwide, population-based cohort study. Pediatr Res2015;78:212–7.doi:10.1038/pr.2015.80
27.
WeiCC, LinCL, ShenTC, . Occurrence of common allergic diseases in children with idiopathic nephrotic syndrome. J Epidemiol2015;25:370–7.doi:10.2188/jea.JE20140167
28.
WeiCC, YuIW, LinHW, . Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology2012;17:681–8.doi:10.1111/j.1440-1797.2012.01650.x
29.
DevanarayanaNM, RajindrajithS, PathmeswaranA, . Epidemiology of irritable bowel syndrome in children and adolescents in Asia. J Pediatr Gastroenterol Nutr2015;60:792–8.doi:10.1097/MPG.0000000000000714
30.
LovellRM, FordAC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol2012;10:712–21.doi:10.1016/j.cgh.2012.02.029
31.
KayJ, GawkrodgerDJ, MortimerMJ, . The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol1994;30:35–9.doi:10.1016/S0190-9622(94)70004-4
32.
KapoorR, MenonC, HoffstadO, . The prevalence of atopic triad in children with physician-confirmed atopic dermatitis. J Am Acad Dermatol2008;58:68–73.doi:10.1016/j.jaad.2007.06.041
33.
WalkerMM, TalleyNJ, PrabhakarM, . Duodenal mastocytosis, eosinophilia and intraepithelial lymphocytosis as possible disease markers in the irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther2009;29:765–73.doi:10.1111/j.1365-2036.2009.03937.x
34.
WalkerMM, WarwickA, UngC, . The role of eosinophils and mast cells in intestinal functional disease. Curr Gastroenterol Rep2011;13:323–30.doi:10.1007/s11894-011-0197-5
35.
WoodJD. Enteric neuroimmunophysiology and pathophysiology. Gastroenterology2004;127:635–57.
36.
WrightRJ. Stress and atopic disorders. J Allergy Clin Immunol2005;116:1301–6.doi:10.1016/j.jaci.2005.09.050
37.
PearsonJS, NivenRM, MengJ, . Immunoglobulin E in irritable bowel syndrome: another target for treatment? A case report and literature review. Therap Adv Gastroenterol2015;8:270–7.doi:10.1177/1756283X15588875
38.
ChanMC, CherkSWW, KwokKL, . Prevalence and risk factors for symptoms of attention deficit and hyperactivity in primary snoring children. Pediatr Respir and Criti Care Med2017;1:59.
39.
BarbaraG, StanghelliniV, De GiorgioR, . Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology2004;126:693–702.doi:10.1053/j.gastro.2003.11.055
40.
LeeH, ParkJH, ParkDI, . Mucosal mast cell count is associated with intestinal permeability in patients with diarrhea predominant irritable bowel syndrome. J Neurogastroenterol Motil2013;19:244–50.doi:10.5056/jnm.2013.19.2.244
41.
CroweSE, PerdueMH. Functional abnormalities in the intestine associated with mucosal mast cell activation. Reg Immunol1992;4:113–7.
42.
LillestølK, HelgelandL, Arslan LiedG, . Indications of ‘atopic bowel’ in patients with self-reported food hypersensitivity. Aliment Pharmacol Ther2010;31:1112–22.doi:10.1111/j.1365-2036.2010.04261.x
43.
KlookerTK, BraakB, KoopmanKE, . The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut2010;59:1213–21.doi:10.1136/gut.2010.213108
44.
DjukanovićR, WilsonS, KraftM, . Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med2004;170:583–93.doi:10.1164/rccm.200312-1651OC
45.
LaneJE, CheyneyJM, LaneTN, . Treatment of recalcitrant atopic dermatitis with omalizumab. J Am Acad Dermatol2006;54:68–72.doi:10.1016/j.jaad.2005.09.030
