儿童注意缺陷多动障碍伴过敏性鼻结膜炎4例并文献复习

Comorbidity of attention deficit/hyperactivity disorder with allergic rhino-conjunctivitis in children: A report of 4 cases and literature review

目的探讨儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)合并过敏性鼻结膜炎的临床特点。方法回顾2016年5月-2017年9月在外院确诊为ADHD同时伴有过敏性鼻结膜炎、后就诊于首都医科大学附属北京世纪坛医院变态反应科的4例患者的临床资料并做相关文献复习。结果 4例患者,男女各2例,年龄分别为10岁、10岁、11岁、14岁,均有肢体多动、注意力不集中、成绩下降/差等ADHD临床表现,同时还有鼻塞、喷嚏、流涕、挤眼、嗽嗓等过敏性鼻结膜炎症状和咳嗽。经过敏原检查发现患者对尘螨、花粉、真菌以及多种食物严重过敏。治疗:1)食物忌口,并做食物日记;2)进行针对尘螨、真菌、花粉等吸入性变应原的特异性免疫治疗;3)定期随访,随着过敏性疾病症状的好转,ADHD也得到不同程度的控制,且停用药物后ADHD症状无复发。结论对于ADHD患儿应注意询问是否伴发过敏性疾病,且有必要行吸入物和食物等过敏原检测,并针对过敏原进行特异性免疫治疗,ADHD预后良好。

Objective To investigate the clinical features of comorbidity of attention deficit/hyperactivity disorder （ADHD） with allergic rhino-conjunctivitis in children. Methods Medical records of 4 patients who were diagnosed as allergic disease with ADHD and treated in Beijing Shijitan Hospital affiliated to Capital Medical University from May 2015 to September 2017 were retrospectively investigated and its related literatures were reviewed. Results Four children （2 boys and 2 girls） aged 10-14 years went to other hospitals for presentations of extremities hyperactivity, attention-deficit, poor academic performance, etc, and they were diagnosed as ADHD. They went to Beijing Shijitan Hospital for the concurrent nasal obstructive, sneeze, nasal drips and frequent blinking and cough. Allergen tests showed that they were severely allergic to dust mites, pollen, fungi and a variety of food. The diagnosis of allergic rhino-conjunctivitis with ADHD was established. The treatments for these four children were scheduled including： avoiding eating certain foods and keeping a diary for diet, giving specific immunotherapy for major allergens. Regular follow-up revealed that the ADHD symptoms had relieved after the management of allergic rhino-conjunctivitis, and ADHD didn＇t recurred after stopping the drug treatments. Conclusion It is necessary to inquiry the history of allergic disease in children with ADHD （e.g., allergic rhino-conjunctivitis or asthma） and conduct allergen tests for inhalation and foods. The subsequent specific immunotherapy will be beneficial to relieve ADHD.