Allergic Diseases Potentially Increase Risk of Select Mental Health Conditions

Allergic diseases such as allergic rhinitis, food allergy, atopic dermatitis, and asthma are associated with increased risk of a range of mental health conditions, with the strongest association found between asthma and the risk of developing attention deficit/hyperactivity disorder (ADHD), according to a review published in the Journal of Allergy and Clinical Immunology.¹

Allergic diseases such as rhinitis may be associated with an increased risk of developing mental health conditions. | Image Credit: © Volha Zaitsava | stock.adobe.com

The burden of allergic diseases is massive across the country. Though treatments exist to manage patients, these allergic diseases can also impact mental health conditions due to the interaction of somatic and psychological factors. These interactions have a complex mechanism that can involve a variety of factors, including genetics, environment, immunity, and others.²

Interestingly, among patients with allergic diseases—especially those that are severe and widely affect the patient—a higher prevalence of adverse mental health conditions has been reported from numerous studies, including an investigation by Budu-Aggrey et al. Although those investigators found observational associations, the evidence of a true association between allergic diseases and mental health conditions has yet to be published.^1,3

In this umbrella review, the investigators sought to summarize evidence from systematic reviews of mental health conditions in allergic diseases to determine the accuracy of this evidence. They noted that, if this association were to be confirmed, it could indicate a shared pathological mechanism that could aid in future studies of association between allergic diseases and mental health conditions.¹

The investigators included 21 eligible articles in the review. The degree of overlap between an allergic disease and mental health condition was measured using the corrected covered area (CCA). In total, 15 overlapping associations were found; of those, 10 had high overlapping associations, with CCA ranging from 10.71% to 47.37%, while 1 had moderate overlapping association and 4 had slight overlapping associations.¹

Diving into the associations themselves, only 1 association was graded as “convincing evidence," with the association between asthma and the risk of developing ADHD (OR, 1.34; 95% CI, 1.24-1.44). Twelve other associations were graded as “highly suggestive evidence,” and included associations such as allergic rhinitis and the risk of tic or sleep disorders, atopic dermatitis and risk of anxiety or suicidal ideation, asthma and risk of depression or anxiety, and food allergy and risk of autism spectrum disorder (ASD).¹

To assess the methodological quality of the selected reviews, the AMSTAR 2 quality assessment was utilized. Of the 21 articles included, 8 (38%) were graded as high-quality, 5 (24%) were graded as moderate quality, 3 (14%) were graded as low quality, and 5 (24%) were graded as critically low quality. Some of the main reasons that an article quality was downgraded was the absence of appropriate bias assessment tools and lack of adequate research into publication bias.¹

The investigators noted “that although we tentatively identified associations between allergic diseases and mental health conditions, these associations do not necessary imply causality,” due to the basis of the review being observational studies. Critically, they write that “the scientific basis for some of these speculations and assumptions remains as yet insufficient.”¹

Furthermore, the study authors could not completely rule out the influence of potential confounders on the results, which they discuss “is important in interpretation and requires caution.” There was also large heterogeneity among these studies, with more “high-quality preliminary studies” necessary to identify causality.¹

REFERENCES

1. Xu X, Li S, Chen Y, et al. Association between allergic diseases and mental health conditions: An umbrella review. Journal of Allergy and Clinical Immunology. 2024. doi:10.1016/j.jaci.2024.10.030

2. Badura-Brzoza K, Piegza M, Błachut M, et al. Evaluation of the relationship between some mental state parameters and the quality of life in patients with allergic diseases. Psychiatr Pol. 2022;56(2):297-308. doi:10.12740/PP/127952

3. Budu-Aggrey A, Joyce S, Davies NM, et al. Investigating the casual relationship between allergic disease and mental health. Clin Exp Allergy. 2021;51(11):1449-1458. doi:10.1111/cea.14010