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Medicine (Baltimore). 2015 Jul;94(29):e1211. doi: 10.1097/MD.0000000000001211.

Increased Risk of Chronic Fatigue Syndrome Following Atopy: A Population-Based Study.

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From the Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung (T-YY); Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua (T-YY); Department of Developmental and Behavioral Pediatrics, China Medical University Hospital (H-TK); School of Medicine, China Medical University (H-TK); Management Office for Health Data, China Medical University Hospital (H-JC); Department of Public Health, China Medical University; Asia University (H-JC); Division of Chinese Trauma, China Medical University Hospital, China Medical University, Taichung (C-SC); Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi (W-ML); Chang Gung University, Taoyuan (W-ML); Department of Laboratory Medicine (Clinical Pathology), Mackay Memorial Hospital, Taipei (S-YT); Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (S-YT); Kau-Tang Traditional Medical Hospital (C-NK); Department of Nuclear Medicine and PET Center, China Medical University Hospital (C-HK); and Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK).


Several hypotheses have been proposed to explain the etiopathogenesis of chronic fatigue syndrome (CFS), including immune dysregulation. However, few population-based prospective cohort studies have been conducted on CFS and atopy. We investigated the relationship between atopy and CFS by using a population-based cohort study. In this prospective, population-based cohort study of the National Health Insurance Research Database, we identified 42,558 patients with atopy and 170,232 patients without atopy from 2005 to 2007 with follow-up to 2011. The incidence rates and risks for CFS were estimated using Cox proportion hazards regression. The overall incidence rate of CFS was higher in the atopy cohort compared with the nonatopy cohort (1.37 versus 0.87 per 1000 person-year), with an adjusted hazard ratio of 1.48 (95% confidence interval 1.30-1.69). The risk of CFS in the atopy cohort increased 1.47- to 1.50-fold for each nonexisting comorbidity. Patients with numerous atopic symptoms exhibited a biological gradient of increasing risk for CFS, and the risk changed significantly after adjustment for age, sex, and comorbidities, increasing from 1.46- to 2.59-fold. We revealed that atopy is associated with CFS, particularly in patients with numerous atopic syndromes. The actual mechanism for CFS development in patients with atopy remains unclear and requires further investigation. We recommend researching the subsequent fatigue symptom in patients with atopy, particularly those with multiple atopic syndromes.

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