title: Risk of bipolar disorder among adolescents with allergic rhinitis: A nationwide longitudinal study.
abstract: BACKGROUND
  Previous studies have suggested an immunological dysfunction in bipolar disorder, but none has investigated the temporal association between allergic rhinitis (AR) and bipolar disorder.
  
  
  METHODS
  Using Taiwan National Health Insurance Research Database, 9506 adolescents aged 12-18 years with allergic rhinitis were enrolled between 2000 and 2008 and compared to 38,024 age-and gender-matched (1:4) control groups. Subjects of bipolar disorder that occurred up to the end of follow-up (December 31, 2011) were identified.
  
  
  RESULTS
  Adolescents with AR had a significantly higher incidence of developing bipolar disorder (0.77 vs. 0.18 per 1000 person-years, p<0.001) during the follow-up period than the controls. Adolescents with AR had an increased risk (hazard ratio [HR]: 4.62, 95% confidence interval [CI]: 3.17-6.75) of developing bipolar disorder in their later life compared to the control group after adjusting for demographic data and comorbid allergic diseases.
  
  
  CONCLUSIONS
  This is the first study showing a temporal association between AR and bipolar disorder, in that patients who had AR in adolescence exhibited an increased risk of developing bipolar disorder in later life. Further study would be required to investigate the underlying mechanism about this association.
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Hsuan
authors.initials: WH
authors.lastname: Lan
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ju-Wei
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Sheue
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Han
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Tai-Long
authors.initials: TL
authors.lastname: Pan
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: tpsu@vghtpe.gov.tw.
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ymbi@mail2000.com.tw.
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Bai
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D065631:Rhinitis, Allergic / Q000150:complications* / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D014505:Urban Population
keywords: Adolescence; Allergic rhinitis; Bipolar disorder