One-Third of Urban Children with Allergic Rhinitis Show Behavioral Issues: Study
China: Urban children aged 6 to 12 years with allergic rhinitis are far more likely to experience behavioral issues, and sleep problems explain a substantial part of this link, a large community-based study published in Annals of Medicine has revealed.
The research showed that children with allergic rhinitis had significantly higher odds of conduct issues, learning difficulties, psychosomatic complaints, impulsive-hyperactive tendencies, anxiety, and hyperactivity, with sleep disturbances mediating 33% to 64% of these associations.
The study, led by Shiyin Yang and colleagues from the Department of Otolaryngology at Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, explored how allergic rhinitis—an inflammatory condition of the nasal passages—affects child behavior. While past evidence hinted at a connection between allergies and behavioral challenges, the role of disrupted sleep had not been clearly defined.
Researchers recruited 18,316 schoolchildren from 34 primary schools across Shanghai, with an average age of nearly eight years. Parents completed detailed online questionnaires capturing demographic information, medical history, sleep habits, and behavioral patterns using validated tools such as the Children’s Sleep Habits Questionnaire and the Conners’ Parent Rating Scale. Statistical models adjusted for potential confounders were then used to evaluate relationships among allergic rhinitis, sleep disturbance, and behavioral outcomes.
The findings were striking and can be summarized as follows:
- About one-third of the children were reported to have allergic rhinitis.
- Nearly one-quarter experienced notable sleep disturbances.
- Eighteen percent showed behavioral problems.
- Children with allergic rhinitis had significantly higher odds of conduct problems (OR 1.77), learning difficulties (OR 1.67), psychosomatic complaints (OR 1.82), impulsive-hyperactive behavior (OR 1.68), anxiety (OR 1.36), and hyperactivity (OR 1.67) compared with those without the condition.
- Sleep disturbance explained roughly one-third to nearly two-thirds of the relationship between allergic rhinitis and each behavioral problem.
- Daytime sleepiness and sleep-disordered breathing were the most influential mediators of these associations.
The authors emphasized that identifying and managing sleep issues in children with allergic rhinitis could be critical to improving both sleep quality and behavioral outcomes. They also noted several limitations, including reliance on parent-reported questionnaires rather than clinical diagnoses or polysomnography, and the cross-sectional design, which prevents conclusions about causality. Additionally, the research did not account for genetic factors, family income, or other allergic conditions such as food allergies or atopic dermatitis.
Despite these caveats, the study’s large sample size and rigorous analysis provide compelling evidence of a strong link between allergic rhinitis, sleep disturbance, and behavioral challenges in urban schoolchildren. The researchers call for future longitudinal studies and interventions aimed at improving sleep to potentially reduce behavioral problems in children affected by allergic rhinitis.
Reference:
Yang, S., Yang, J., Xu, J., Hu, Y., Li, C., Zhang, L., … Liu, Y. (2025). Allergic rhinitis and behaviour problems in urban children aged 6 to 12 years and the mediating role of sleep disturbance. Annals of Medicine, 57(1). https://doi.org/10.1080/07853890.2025.2460771
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