Association Between Allergic Diseases and Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Children Aged 6–12 Years Using the Filipino Version of the Vanderbilt ADHD Parent Rating Scale



Over the last decades, the hypothesis that an allergic response could lead to the development of attention-deficit/hyperactivity disorder (ADHD) was raised and clinical studies investigated the co-existence of both. These studies had shown that allergic diseases and neurobehavioral disorders were concurrent and could be associated with genetic factors, neuroimmunity and microbial dysbiosis. To date, this was the first study in the Philippines to evaluate the prevalence and association of allergic diseases, its severity and ADHD symptoms.


The objective of this study was to determine the association of allergic diseases and ADHD symptoms among children aged 6–12 years based on parental report using the Filipino version of the Vanderbilt ADHD Parent Rating Scale.


School-aged children between 6 and 12 years with physician diagnosed allergies (bronchial asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, drug allergy, food allergy and/or acute or chronic urticaria) were randomly selected. Skin prick test (SPT) to aeroallergens was done. The parents completed the Filipino version of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), a screening tool for ADHD.


Among the 415 patients, 135 (32.5%) of them screened positive for ADHD symptoms. Upon assessment of the Vanderbilt parent rating subscale responses, 13.49% of the children were categorized as predominantly inattentive subtype, 6.02% as predominantly hyperactive/impulsive subtype and 13.01% as combined inattention/hyperactivity.

Three hundred and seventy six (91%) children were diagnosed with asthma. Among these asthmatics, 119 (32%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.56%), predominantly hyperactive/impulsive subtype (5.05%) and combined inattention/hyperactivity (13.03%). Combined inattention/hyperactivity subtype had a significant proportion of severe asthmatics, as compared to mild or moderate asthma (p value = 0.026).

Furthermore, 389 (94%) children were diagnosed with allergic rhinitis. Among these patients, 130 (33%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (13.62%), predominantly hyperactive/impulsive subtype (6.43%) and combined inattention/hyperactivity (13.37%). However, evidence was not sufficient to demonstrate an association between ADHD subtypes and allergic rhinitis severity.

Lastly, 206 (50%) children were diagnosed with atopic dermatitis. Among these patients, 71 (34%) had ADHD symptoms with the following subtypes – predominantly inattentive subtype (14.56%), predominantly hyperactive/impulsive subtype (4.85%) and combined inattention/hyperactivity (15.05%). However, there was insufficient evidence to demonstrate a link between ADHD subtypes and atopic dermatitis severity.


Children with allergies, especially those with severe asthma, are more likely to have ADHD symptoms.

Key words: attention deficit hyperactivity disorder, allergic disease, allergic sensitization, asthma

  1. Suwan P, Akaramethathip D, Noipayak P. Association between allergic sensitization and attention deficit hyperactivity disorder (ADHD). Asian Pac J Allergy Immunol. 2011 Mar;29(1):57–65.

  2. Chua RXY, Tay MJY, Ooi DSQ, Siah KTH, Tham EH, Shek LP-C, et al. Understanding the link between allergy and neurodevelopmental disorders: A current review of factors and mechanisms. Front Neurol [Internet]. 2021 Feb 15;11:1—15. Available from:

  3. Schans J van der, Çiçek R, de Vries TW, Hak E, Hoekstra PJ. Association of atopic diseases and attention-deficit/hyperactivity disorder: A systematic review and meta-analyses. Neuroscience & Biobehavioral Reviews [Internet]. 2017 Mar;74:139–48. Available from:

  4. Chang HY, Seo J-H, Kim HY, Kwon J-W, Kim B-J, Kim HB, et al. Allergic diseases in preschoolers are associated with psychological and behavioural problems. Allergy Asthma Immunol Res [Internet]. 2013;5(5):315. Available from:

  5. Chen M-H, Su T-P, Chen Y-S, Hsu J-W, Huang K-L, Chang W-H, et al. Attention deficit hyperactivity disorder, tic disorder, and allergy: is there a link? A nationwide population-based study. Journal of Child Psychology and Psychiatry [Internet]. 2012 Nov 12;54(5):545–51. Available from:

  6. Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol [Internet]. 2016 Aug 28;175(5):920–9. Available from:

  7. Genuneit J, Braig S, Brandt S, Wabitsch M, Florath I, Brenner H, et al. Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder - A prospective birth cohort study. Pediatr Allergy Immunol [Internet]. 2013 Dec 1;25(1):51–6. Available from:

  8. Romanos M, Gerlach M, Warnke A, Schmitt J. Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. Journal of Epidemiology & Community Health [Internet]. 2009 Aug 19;64(3):269–73. Available from:

  9. Melli LCFL, do Carmo-Rodrigues MS, Araújo-Filho HB, Solé D, de Morais MB. Intestinal microbiota and allergic diseases: A systematic review. Allergologia et Immunopathologia [Internet]. 2016 Mar;44(2):177–88. Available from:

  10. Checa-Ros A, Jeréz-Calero A, Molina-Carballo A, Campoy C, Muñoz-Hoyos A. Current evidence on the role of the gut microbiome in ADHD pathophysiology and therapeutic implications. Nutrients [Internet]. 2021 Jan 16;13(1):249. Available from:

  11. Hak E, de Vries TW, Hoekstra PJ, Jick SS. Association of childhood attention-deficit/hyperactivity disorder with atopic diseases and skin infections? A matched case-control study using the General Practice Research Database. Annals of Allergy, Asthma & Immunology [Internet]. 2013 Aug;111(2):102–106.e2. Available from:

  12. Lin Y-T, Chen Y-C, Gau SS-F, Yeh T-H, Fan H-Y, Hwang Y-Y, et al. Associations between allergic diseases and attention deficit hyperactivity/oppositional defiant disorders in children. Pediatr Res [Internet]. 2016 Jun 2;80(4):480–5. Available from:

  13. Yang C-F, Yang C-C, Wang I-J. Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study. Journal of the Chinese Medical Association [Internet]. 2018 Mar;81(3):277–83. Available from:

  14. Yang M-T, Lee W-T, Liang J-S, Lin Y-J, Fu W-M, Chen C-C. Hyperactivity and impulsivity in children with untreated allergic rhinitis: corroborated by rating scale and continuous performance test. Pediatrics & Neonatology [Internet]. 2014 Jun;55(3):168–74. Available from:

  15. Jiang X, Shen C, Dai Y, Jiang F, Li S, Shen X, et al. Early food allergy and respiratory allergy symptoms and attention-deficit/hyperactivity disorder in Chinese children: A cross-sectional study. Pediatr Allergy Immunol [Internet]. 2018 Apr 15;29(4):402–9. Available from:

  16. Brawley A, Silverman B, Kearney S, Guanzon D, Owens M, Bennett H, et al. Allergic rhinitis in children with attention-deficit/hyperactivity disorder. Annals of Allergy, Asthma & Immunology [Internet]. 2004 Jun;92(6):663–7. Available from:

  17. Biederman J, Milberger S, Faraone SV, Guite J, Warburton R. Associations between childhood asthma and ADHD: Issues of psychiatric comorbidity and familiality. Journal of the American Academy of Child & Adolescent Psychiatry [Internet]. 1994 Jul;33(6):842–8. Available from:

  18. Gaitens T, Kaplan BJ, Freigang B. Absence of an association between IgE-mediated atopic responsiveness and ADHD symptomatology. J Child Psychol Psychiatry. 1998 Mar;39(3):427–31.

  19. McGee R, Stanton WR, Sears MR. Allergic disorders and attention deficit disorder in children. J Abnorm Child Psychol [Internet]. 1993 Feb;21(1):79–88. Available from:

  20. Schmitt J, Buske-Kirschbaum A, Roessner V. Is atopic disease a risk factor for attention-deficit/hyperactivity disorder? A systematic review. Allergy [Internet]. 2010 Aug 17;65(12):1506–24. Available from:

  21. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2018 [Internet]. [updated 2021; cited 2018 May 2]. Available from:

  22. Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical & Experimental Allergy [Internet]. 2007 Dec 7;38(1):19–42. Available from:

  23. Lewis-Jones S, Mugglestone MA. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ [Internet]. 2007 Dec 13;335(7632):1263–4. Available from:

  24. Kliegman R,Kliegman R, Stanton B, St Geme JW III, Schor NF, Behrman RE, Nelson W, et al. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier, 2016.

  25. Cabral MDI, Liu S, Soares N. Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Transl Pediatr [Internet]. 2020 Feb;9(S1):S104–13. Available from:

  26. Diaz, LY, Pacifico, R, Sosa MG. Validation of the Filipino translation of the Vanderbilt ADHD Parent Rating Scale in the diagnosis of ADHD in Filipino children. [Unpublished]. Department of Pediatrics – De La Salle Health Sciences Institute; June 2014.

  27. NICHQ Vanderbilt Assessment Scales [Internet]. 2002 [cited 2018 July 1]. Available from:

  28. Miyazaki C, Koyama M, Ota E, Swa T, Mlunde LB, Amiya RM, et al. Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis. BMC Psychiatry [Internet]. 2017 Mar 31;17(1). Available from:

  29. Blackman JA, Gurka MJ. Developmental and behavioral comorbidities of asthma in children. Journal of Developmental & Behavioral Pediatrics [Internet]. 2007 Apr;28(2):92–9. Available from:

  30. Holmberg K, Lundholm C, Anckarsäter H, Larsson H, Almqvist C. Impact of asthma medication and familial factors on the association between childhood asthma and attention-deficit/hyperactivity disorder: a combined twin- and register-based study. Clin Exp Allergy [Internet]. 2015 Apr 16;45(5):964–73. Available from:

  31. Chen M-H, Su T-P, Chen Y-S, Hsu J-W, Huang K-L, Chang W-H, et al. Asthma and attention-deficit/hyperactivity disorder: a nationwide population-based prospective cohort study. J Child Psychol Psychiatr [Internet]. 2013 Jun 3;54(11):1208–14. Available from:

  32. Mogensen N, Larsson H, Lundholm C, Almqvist C. Association between childhood asthma and ADHD symptoms in adolescence - a prospective population-based twin study. Allergy [Internet]. 2011 May 21;66(9):1224–30. Available from:

  33. Cortese S, Sun S, Zhang J, Sharma E, Chang Z, Kuja-Halkola R, et al. Association between attention deficit hyperactivity disorder and asthma: a systematic review and meta-analysis and a Swedish population-based study. The Lancet Psychiatry [Internet]. 2018 Sep;5(9):717–26. Available from:

  34. Wang L-J, Yu Y-H, Fu M-L, Yeh W-T, Hsu J-L, Yang Y-H, et al. Attention deficit–hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin. Sci Rep [Internet]. 2018 Jul 6;8(1). Available from:

  35. Tsai J-D, Chang S-N, Mou C-H, Sung F-C, Lue K-H. Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study. Annals of Epidemiology [Internet]. 2013 Apr;23(4):185–8. Available from:

  36. Jiang X, Shen C, Hu Y, Li F. Reply to Khosravi Shadmani F. et al. Pediatr Allergy Immunol [Internet]. 2018 Jun 22;29(5):572–572. Available from:

Articles related to the one you are viewing

There are currently no results to show, please try again later

CC BY: Open Access Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit