Seasonal Allergies and Psychiatric Disorders in the United States

VINDICATE-P: A Mnemonic for the Many Comorbidities of Atopic Dermatitis

Patients with atopic dermatitis (AD) are at increased risk of atopic and non-atopic comorbidities. In fact, the Hanifin and Rajka criteria include allergic and infectious comorbidities as a minor criterion. Despite the well-recognized list of comorbidities, the past 15 years greatly expanded the list of recognized comorbidities of AD. This narrative review focuses on comorbidities of AD using a mnemonic, VINDICATE-P: vascular/cardiovascular, infectious, neoplastic and neurologic, degenerative, iatrogenic, congenital, atopic and autoimmune, traumatic, endocrine/metabolic, and psychiatric. The comorbidities of AD vary by age. More research is needed into the mechanisms of comorbidities and optimal screening strategies in AD patients.

Allergic Diseases and Mental Health

Neuropsychiatric symptoms have long been acknowledged as a common comorbidity for individuals with allergic diseases. The proposed mechanisms for this relationship vary by disease and patient population and may include neuroinflammation and/or the consequent social implications of disease symptoms and management. We review connections between mental health and allergic rhinitis, atopic dermatitis, asthma, vocal cord dysfunction, urticaria, and food allergy. Many uncertainties remain and warrant further research, particularly with regard to how medications interact with pathophysiologic mechanisms of allergic disease in the neuroimmune axis. Proactive screening for mental health challenges, using tools such as the Patient Health Questionnaire and Generalized Anxiety Disorder screening instruments among others, can aid clinicians in identifying patients who may need further psychiatric evaluation and support. Although convenient, symptom screening tools are limited by variable sensitivity and specificity and therefore require healthcare professionals to remain vigilant for other mental health "red flags." Ultimately, understanding the connection between allergic disease and mental health empowers clinicians to both anticipate and serve the diverse physical and mental health needs of their patient populations.

Psychological Status as an Effect Modifier of the Association Between Allergy Symptoms and Allergy Testing

OBJECTIVE

Patient-reported outcome measures, while valuable, may not correlate with diagnostic test results. To better understand this potential discrepancy, our objective was to determine whether psychological health is an effect modifier of the association between patient-reported allergy outcome scores and allergy test results.

STUDY DESIGN

Prospective outcomes study.

SETTING

Tertiary care hospital and community-based clinic.

METHODS

This study included 600 patients at least 18 years of age who presented for symptoms related to allergic rhinitis and completed the related sinonasal outcome test (SNOT), which includes validated nasal, allergy, and psychological domains. Stratified analyses of odds ratios and Spearman correlation coefficients were utilized to assess for effect modification by psychological status.

RESULTS

Worse patient-reported allergic rhinitis symptoms were significantly associated with positive allergy test results (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.22-2.34, P = .002) in patients with better psychological health. In contrast, there was no association in patients with worse psychological health (OR 1.06, 95% CI 0.36-3.10, P = .92). These findings were corroborated by assessments of correlation: allergy domain scores were positively correlated with allergy testing scores (Spearman rho 0.18, 95% CI 0.10-0.25, P < .001) in patients with better psychological health, while there was no correlation in patients with worse psychological health (-0.02, 95% CI -0.16-0.12, P = .77).

CONCLUSIONS

Psychological status was an effect modifier of the association between allergy domain and allergy testing data. When assessing the relationship between subjective measures, such as sinonasal validated instruments, and objective measures, such as allergy test results, accounting for effect modifiers such as psychological state can provide clinical and research-related insights.

Airborne Exposure to Pollutants and Mental Health: A Review with Implications for United States Veterans

PURPOSE OF REVIEW

Inhalation of airborne pollutants in the natural and built environment is ubiquitous; yet, exposures are different across a lifespan and unique to individuals. Here, we reviewed the connections between mental health outcomes from airborne pollutant exposures, the biological inflammatory mechanisms, and provide future directions for researchers and policy makers. The current state of knowledge is discussed on associations between mental health outcomes and Clean Air Act criteria pollutants, traffic-related air pollutants, pesticides, heavy metals, jet fuel, and burn pits.

RECENT FINDINGS

Although associations between airborne pollutants and negative physical health outcomes have been a topic of previous investigations, work highlighting associations between exposures and psychological health is only starting to emerge. Research on criteria pollutants and mental health outcomes has the most robust results to date, followed by traffic-related air pollutants, and then pesticides. In contrast, scarce mental health research has been conducted on exposure to heavy metals, jet fuel, and burn pits. Specific cohorts of individuals, such as United States military members and in-turn, Veterans, often have unique histories of exposures, including service-related exposures to aircraft (e.g. jet fuels) and burn pits. Research focused on Veterans and other individuals with an increased likelihood of exposure and higher vulnerability to negative mental health outcomes is needed. Future research will facilitate knowledge aimed at both prevention and intervention to improve physical and mental health among military personnel, Veterans, and other at-risk individuals.

Rhinitis Disease Burden and the Impact of Social Determinants of Health

Social determinants of health (SDHs) have a substantial impact on patient care and outcomes globally, both in low- to middle-income countries and in high-income countries. In the clinic, lack of availability of diagnostic tools, inequities in access to care, and challenges obtaining and adhering to prescribed treatment plans may further compound these issues. This article addresses a case of rhinitis in the context of SDHs and inequities in care that may affect various communities and populations around the world. SDHs may include various aspects of one's financial means, education, access to medical care, environment and living situation, and community factors, each of which could play a role in the rhinitis disease manifestations, diagnosis, and management. Allergic and nonallergic rhinitis are considered from this perspective. Rhinitis epidemiology, disease burden, and risk factors are broadly addressed. Patient evaluation, diagnostic tests, and management options are also reviewed, and issues related to SDHs are noted. Finally, inequities in care, knowledge gaps, and unmet needs are highlighted. It is critical to consider SDHs and care inequities when evaluating and treating patients for rhinitis and other allergic conditions.

Sex Dimorphism in Pain Threshold and Neuroinflammatory Response: The Protective Effect of Female Sexual Hormones on Behavior and Seizures in an Allergic Rhinitis Model

Our previous research demonstrated that allergic rhinitis could impact behavior and seizure threshold in male mice. However, due to the complex hormonal cycles and hormonal influences on behavior in female mice, male mice are more commonly used for behavioral tests. In this study, we aimed to determine whether these findings were replicable in female mice and to explore the potential involvement of sexual hormones in regulating neuroinflammation in an allergic model. Our results indicate that pain threshold was decreased in female mice with allergic rhinitis and the levels of IL-23/IL-17A/IL-17R were increased in their Dorsal root ganglia. However, unlike males, female mice with AR did not display neuropsychological symptoms such as learning and memory deficits, depression, and anxiety-like behavior. This was along with decreased levels of DNA methyl transferase 1 (DNMT1) and inflammatory cytokines in their hippocampus. Ovariectomized mice were used to mitigate hormonal effects, and the results showed that they had behavioral changes and neuroinflammation in their hippocampus similar to male mice, as well as increased levels of DNMT1. These findings demonstrate sex differences in how allergic rhinitis affects behavior, pain sensitivity, and seizure thresholds. Furthermore, our data suggest that DNMT1 may be influenced by sexual hormones, which could play a role in modulating inflammation in allergic conditions.

Which risk factor best predicts coronary artery disease using artificial neural network method?

BACKGROUND

Coronary artery disease (CAD) is recognized as the leading cause of death worldwide. This study analyses CAD risk factors using an artificial neural network (ANN) to predict CAD.

METHODS

The research data were obtained from a multi-center study, namely the Iran-premature coronary artery disease (I-PAD). The current study used the medical records of 415 patients with CAD hospitalized in Razi Hospital, Birjand, Iran, between May 2016 and June 2019. A total of 43 variables that affect CAD were selected, and the relevant data was extracted. Once the data were cleaned and normalized, they were imported into SPSS (V26) for analysis. The present study used the ANN technique.

RESULTS

The study revealed that 48% of the study population had a history of CAD, including 9.4% with premature CAD and 38.8% with CAD. The variables of age, sex, occupation, smoking, opium use, pesticide exposure, anxiety, sexual activity, and high fasting blood sugar were found to be significantly different among the three groups of CAD, premature CAD, and non-CAD individuals. The neural network achieved success with five hidden fitted layers and an accuracy of 81% in non-CAD diagnosis, 79% in premature diagnosis, and 78% in CAD diagnosis. Anxiety, acceptance, eduction and gender were the four most important factors in the ANN model.

CONCLUSIONS

The current study shows that anxiety is a high-prevalence risk factor for CAD in the hospitalized population. There is a need to implement measures to increase awareness about the psychological factors that can be managed in individuals at high risk for future CAD.

Impact of socioeconomic factors on allergic diseases

Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.

Upper Airway-Related Symptoms According to Mental Illness and Sleep Disorders among Workers Employed by a Large Non-Profit Organization in the Mountain West Region of the United States

The relationships between selected upper airway-related symptoms (speech disturbances, voice disorders, cough, and breathing abnormalities) and mental illness and sleep disorders have been previously demonstrated. However, these relationships have not been compared in a single study with consideration of potential confounding variables. The current research incorporates a descriptive study design of medical claims data for employees (~21,362 per year 2017-2021) with corporate insurance to evaluate the strength of these relationships, adjusting for demographic variables and other important confounders. The upper airway-related symptoms are each significantly and positively associated with several mental illnesses and sleep disorders, after adjusting for demographic and other potential confounders. The rate of any mental illness is 138% (95% CI 93-195%) higher for speech disturbances, 55% (95% CI 28-88%) higher for voice disorders, 28% (95% CI 22-34%) higher for cough, and 58% (95% CI 50-66%) higher for breathing abnormalities, after adjustment for the confounding variables. Confounding had significant effects on the rate ratios involving cough and breathing abnormalities. The rate of any sleep disorder is 78% (95% CI 34-136%) higher for speech disturbances, 52% (95% CI 21-89%) higher for voice disorders, 34% (95% CI 27-41%) higher for cough, and 172% (95% CI 161-184%) higher for breathing abnormalities, after adjustment for the confounding variables. Confounding had significant effects on each of the upper airway-related symptoms. Rates of mental illness and sleep disorders are positively associated with the number of claims filed for each of the upper airway-related symptoms. The comorbid nature of these conditions should guide clinicians in providing more effective treatment plans that ultimately yield the best outcome for patients.

[Nutritional recovery of underweight adolescents with anorexia nervosa: analysis of a hospital protocol]

Introduction

Background: anorexia nervosa (AN) is a severe psychiatric pathology that has one of the highest mortality rates among mental illnesses, estimated at 5.1 deaths per 1,000 people/year, and is associated with high comorbidity, both psychiatric and somatic. Aim: to characterize hospitalized adolescents and their nutritional rehabilitation using a standardized protocol. Methods: a descriptive-retrospective study of adolescent patients hospitalized at the San Carlos of Apoquindo Clinic with a diagnosis of AN, hemodynamically stable and without refeeding syndrome criteria, between 2015 and 2021. Epidemiological, clinical, and nutritional data of the patients were analyzed. Results: of 46 patients studied, 37 were female; the average length of stay was 45.4 (SD ± 36.1) days; 53.8 % of the patients had mood disorder as psychiatric comorbidity, and the most common personality trait was obsessive-compulsive (36.9 %); the most frequent somatic comorbidity was thyroid pathology (19.2 %). The initial oral caloric intake was 1467 (SD ± 479) kcal, with an average weekly increase of 400 kcal, reaching 2430 (SD ± 457) kcal at discharge. An average body mass index (BMI%) percentage change of 7.8 % (SD ± 6.1) was obtained. Conclusions: this is the first national study that describes the nutritional rehabilitation of adolescents with AN and the length of hospitalization required to achieve it.

Olfactory impairment in psychiatric disorders: Does nasal inflammation impact disease psychophysiology?

Olfactory impairments contribute to the psychopathology of mental illnesses such as schizophrenia and depression. Recent neuroscience research has shed light on the previously underappreciated olfactory neural circuits involved in regulation of higher brain functions. Although environmental factors such as air pollutants and respiratory viral infections are known to contribute to the risk for psychiatric disorders, the role of nasal inflammation in neurobehavioral outcomes and disease pathophysiology remains poorly understood. Here, we will first provide an overview of published findings on the impact of nasal inflammation in the olfactory system. We will then summarize clinical studies on olfactory impairments in schizophrenia and depression, followed by preclinical evidence on the neurobehavioral outcomes produced by olfactory dysfunction. Lastly, we will discuss the potential impact of nasal inflammation on brain development and function, as well as how we can address the role of nasal inflammation in the pathophysiological mechanisms underlying psychiatric disorders. Considering the current outbreak of Coronavirus Disease 2019 (COVID-19), which often causes nasal inflammation and serious adverse effects for olfactory function that might result in long-lasting neuropsychiatric sequelae, this line of research is particularly critical to understanding of the potential significance of nasal inflammation in the pathophysiology of psychiatric disorders.

Allergic Rhinitis Seasonality, Severity, and Disease Control Influence Anxiety and Depression

OBJECTIVES

Allergic rhinitis (AR) has been associated with anxiety and depression. A possible influence of frequency and intensity of the AR symptoms has remained unclear. Therefore, we evaluated the association between AR, as well as its control, seasonality and severity, and the presence of anxiety and depression.

METHODS

Participants were selected from a preexistent national database and consecutively contacted by phone. AR was classified according to Allergic Rhinitis and its Impact on Asthma. Presence of anxiety and depression was identified by Hospital Anxiety and Depression Scale (HADS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). We built linear regression models assessing the association between any of the assessed anxiety or depression scores and the occurrence, degree of control, seasonality or severity of AR.

RESULTS

We analyzed 115 participants with AR and 38 participants with no respiratory symptoms. Patients with AR presented higher scores of anxiety (HADS: 3.1; 95% confidence interval [CI] = 1.9; 4.3; p < 0.001) and depression (HADS: 3.8; 95% CI = 2.5; 5.0; p < 0.001). Poorer AR control was positively associated with higher prevalence and scores of anxiety (HADS: 3.0; 95% CI = 1.5; 4.5; p < 0.001) and depression (HADS: 1.8; 95% CI = 0.2; 3.4; p = 0.031). Similar results were obtained with BAI and BDI-II scales. A moderate/severe presentation of AR were also related with higher scores of anxiety (HADS: 1.7; 95% CI = 0.1; 3.2; p = 0.040) and depression (HADS: 1.7; 95% CI = 0.1; 3.3; p = 0.037).

CONCLUSION

The presence of AR, a poorer control, and a moderate/severe presentation of the disease were significantly associated with higher scores of anxiety and depression. Thus, it is important to alert to this association to allow a quick diagnosis of AR-associated pathologies. Laryngoscope, 2022.

The predictive value of self-reported allergies for reoperation after index hip arthroscopy

The purpose of this study is to compare the rate of reoperation after index hip arthroscopy for symptomatic femoroacetabular impingement in patients with, and without, at least one self-reported allergy. Data were collected prospectively in 1468 patients whose records were retrospectively reviewed. After the application of inclusion and exclusion criteria, two cohorts were formed: (i) a study cohort (n = 261) composed of patients with a self-reported allergy and (ii) a control cohort. (n = 666). The allergy cohort had a significantly larger [P < 0.001] reoperation rate (24.1% [63/261]) compared to the control cohort (9.6% [64/66]). Univariate analysis (UVA) and multivariate analysis (MVA) were then performed to better understand the implications of allergy status on the arthroscopic outcome. On UVA the presence of an allergy increased the odds of reoperation after index hip arthroscopy by 2.99 [OR (95% CI): 2.99 (2.04, 4.39); P < 0.001] and for each additional allergy a patient reported, their odds of subsequent surgery increased by 1.27 per allergy [OR (95% CI): 1.27 (1.15, 1.39); P < 0.001]. However, on the MVA, allergy status was not an independent risk factor for reoperation. These findings suggest that allergy status is associated with a higher reoperation rate, however, allergy status alone cannot prognosticate the risk of subsequent surgery. Therefore, allergy status and its association with future surgery after hip arthroscopy should be considered in the context of multiple patient-specific factors that influence the surgical outcome. An understanding of this association enables patient-centered care and will strengthen the physician–patient relationship.

Allergies, infections, and psychiatric disorders among Black Americans: findings from the National Survey of American Life

Objectives: An emerging body of literature shows that allergies and infections are associated with psychiatric disorders, though there is little research to confirm these associations among Black Americans in the United States.Design: We analyzed data from the National Survey of American Life, and used multivariable logistic regression models to examine the associations between past 12-month allergies/infections and past 12-month psychiatric disorders, adjusting for socio-demographic characteristics, tobacco use, lifetime diabetes, and body mass index.Results: We found that allergies/infections were associated with mood, anxiety, and eating disorders, but not alcohol or substance use disorders. We detected effect modification by ethnicity, with stronger odds for mood, anxiety disorders, and alcohol use disorders, with no significant associations for substance use or eating disorders among Caribbean Blacks.Conclusions: Our findings underscore the importance of screening for psychiatric disorders among Black individuals complaining of allergies/infections, and the need to also treat allergies/infections among people with psychiatric disorders.

Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis

BACKGROUND

Allergic diseases appear to be associated with mood disorders. However, particularly regarding allergic rhinitis (AR), such association has not been adequately systematically reviewed. Therefore, we conducted a systematic review and meta-analysis to quantify the association between AR and depression and anxiety.

METHODOLOGY

We performed an electronic search of PubMed, Web of Science and Scopus for observational studies assessing the association between AR and depression and anxiety. Such association was quantified by means of random-effects meta-analysis, with estimation of pooled odds ratio (OR). Sources of heterogeneity were explored by subgroup analysis.

RESULTS

We included a total of 24 primary studies, of which 23 assessed depression and 11 assessed anxiety. Of these, 12 studies presented OR from multivariable regression models and were included in our meta-analysis. AR was associated with higher odds of depression and anxiety.

CONCLUSIONS

AR appears to be associated with high risk of depression and anxiety. While our results point to the importance of mental comorbidities among patients with AR, longitudinal studies are needed adopting uniform definitions and presenting results stratified by AR severity.

Predictors and age-dependent pattern of psychologic problems in childhood atopic dermatitis

BACKGROUND/OBJECTIVES

Little is known about the predictors and trends of psychological comorbidities in childhood atopic dermatitis (AD), or whether they occur in an age-dependent pattern. We hypothesized racial/ethnic and socioeconomic disparities lead to increased psychological problems among children with AD and psychological comorbidities occur in an age-dependent manner.

METHODS

We analyzed cross-sectional data on 228 898 children aged 2-17 years from the 1997-2018 National Health Interview Survey.

RESULTS

Children with AD had higher proportions of depression/sadness (17.2% vs 12.6%; odds ratio [95% confidence interval]: 1.44 [1.37-1.51]), attention deficit (hyperactivity) disorder (ADD/ADHD) (10.0% vs 7.1%; 1.46 [1.38-1.55]), emotional/behavioral difficulties (29.9% vs 23.5%; 1.77 [1.69-1.84]), feelings of frequent worry (38.8% vs 23.5%; 1.66 [1.58-1.74]), and autism (1.9% vs 0.9%; 2.00 [1.75-2.29]). Among children with AD, psychologic comorbidity was associated with atopic comorbidities and multimorbidity and white race, households with lower income and education, and no insurance coverage. In children with or without AD, the prevalence of autism peaked during pre-adolescence; ADD/ADHD and emotional/behavioral difficulties peaked in adolescence; and depression/sadness and feelings of frequent worry increased steadily throughout childhood without plateau.

CONCLUSION

Atopic dermatitis was associated with multiple psychologic disorders, particularly among those with atopic comorbidities, white race, and low household income. Psychologic comorbidities increased in an age-dependent pattern, though similar to children without AD.

Residential green space and seasonal distress in a cohort of tree pollen allergy patients

BACKGROUND

Residential green space may improve human health, for example by promoting physical activity and by reducing stress. Conversely, residential green space may increase stress by emitting aeroallergens and exacerbating allergic disease. Here we examine impacts of exposure to residential green space on distress in the susceptible subpopulation of adults sensitized to tree pollen allergens.

METHODS

In a panel study of 88 tree pollen allergy patients we analyzed self-reported mental health (GHQ-12), perceived presence of allergenic trees (hazel, alder, birch) near the residence and residential green space area within 1 km distance [high (≥3 m) and low (<3 m) green]. Results were adjusted for patients' background data (gender, age, BMI, smoking status, physical activity, commuting distance, education level, allergy medication use and chronic respiratory problems) and compared with distress in the general population (N = 2467).

RESULTS

Short-term distress [mean GHQ-12 score 2.1 (95% confidence interval 1.5-2.7)] was higher in the study population than in the general population [1.5 (1.4-1.7)]. Residential green space had protective effects against short-term distress [high green, per combined surface area of 10 ha: adjusted odds ratio OR = 0.94 (95% confidence interval 0.90-0.99); low green, per 10 ha: OR = 0.85 (0.78-0.93)]. However, distress was higher in patients who reported perceived presence of allergenic trees near their residence [present vs. absent: OR = 2.04 (1.36-3.07)].

CONCLUSIONS

Perceived presence of allergenic tree species in the neighbourhood of the residence of tree pollen allergy patients modulates the protective effect of residential green space against distress during the airborne tree pollen season.