Quality of life, salivary cortisol and atopic diseases in young children

Abstract

Background Children with atopic disease may have reduced health-related quality of life (QoL) and morning cortisol. Possible links between QoL, morning cortisol and atopic disease are unclear. We aimed to determine if QoL was associated with morning salivary cortisol at two years of age, and if asthma, atopic dermatitis and/or allergic sensitisation influenced this association. Secondarily, we aimed to determine if QoL at one year of age was associated with salivary cortisol one year later. Methods and findings The Bronchiolitis All SE-Norway study included infants during hospitalisation for acute bronchiolitis in infancy (bronchiolitis group) and population-based control infants (controls). The present study included all 358 subjects with available Infant Toddler Quality of Life Questionnaire (ITQOL) from parents, consisting of 13 domains and morning salivary cortisol at two years of age. Answers from the same 0–100 score questionnaire, with optimal score 100 nine months after enrolment, was also available for 289 of these children at about one year of age. Recurrent bronchial obstruction was used as an asthma proxy. Atopic dermatitis was defined by Hanifin and Rajka criteria and allergic sensitisation by a positive skin prick test. Due to different inclusion criteria, we tested possible interactions with affiliation groups. Associations between QoL and cortisol were analysed by multivariate analyses, stratified by bronchiolitis and control groups due to interaction from affiliation grouping on results. At two years of age, QoL decreased significantly with decreasing cortisol in 8/13 QoL domains in the bronchiolitis group, but only with General health in the controls. The associations in the bronchiolitis group showed 0.06–0.19 percentage points changes per nmol/L cortisol for each of the eight domains (p-values 0.0001–0.034). The associations remained significant but diminished by independently including recurrent bronchial obstruction and atopic dermatitis, but remained unchanged by allergic sensitisation. In the bronchiolitis group only, 7/13 age and gender adjusted QoL domains in one-year old children were lower with lower cortisol levels at two years of age (p = 0.0005–0.04). Conclusions At two years, most QoL domains decreased with lower salivary cortisol among children who had been hospitalised for acute bronchiolitis in infancy, but for one domain only among controls. Recurrent bronchial obstruction and to a lesser extent atopic dermatitis, weakened these associations that nevertheless remained significant. After bronchiolitis, lower QoL in one-year old children was associated with lower salivary cortisol at two years.

Chronic, Elevated Maternal Corticosterone During Pregnancy in the Mouse Increases Allergic Airway Inflammation in Offspring

“…Another goal of this study was to examine sex as a biological variable in the prenatal programming of allergic immune function by stress hormone. Epidemiological studies examining the effect of maternal stress on atopic disease in offspring have conflicting results (12,20,(37)(38)(39)(40)(41)(42). Lee et al (38) examined 765 mother-child dyads and found an association between prenatal stress and asthma risk in 6 year old boys, while postnatal stress was associated with asthma in 6 years old girls, tendencies that were also observed in another cohort study of Mexican children by Rosa et al (39), Lee et al (38).…”

Early Adverse Experiences and Repeated Wheezing From 6 to 30 Months of Age: Investigating the Roles of Hypothalamic–Pituitary–Adrenal Axis Functioning, Child Sex, and Caregiving Sensitivity

“…Chronic downregulation of HPA axis activity and a disrupted pattern of diurnal cortisol variation may therefore place individuals at higher risk for inflammatory diseases such as asthma (Buske-Kirschbaum, 2009;Chrousos, 1995). Disturbances in HPA axis functioning have been described in children with asthma and related allergic disorders, suggesting a role of HPA axis in the early development of repeated wheeze and later asthma, although results have been largely crosssectional and mixed (Buske-Kirschbaum et al, 2003;Dreger, Kozyrskyj, HayGlass, Becker, & MacNeil, 2010;Rolfsjord et al, 2019;Stenius et al, 2011). While some studies have found lower basal salivary cortisol, a blunted diurnal rhythm, and reduced reactivity to stressors in those with a family history of asthma or asthma diagnosis (Bakkeheim, Mowinckel, Carlsen, Burney, & Lødrup Carlsen, 2010;Ball, Anderson, Minto, & Halonen, 2006;Wamboldt, Laudenslager, Wamboldt, Kelsay, & Hewitt, 2003), others fail to support an association between dysregulated cortisol and asthma or wheeze (Vink, Boezen, Postma, & Rosmalen, 2013;Wolf, Nicholls, & Chen, 2008).…”