Allergies and Mental Health

During the middle part of the twentieth century, allergy was often seen as a psychosomatic illness, a physical manifestation of psychological problems. In the case of asthma, the asthmogenic (or asthma-producing) home, often featuring a smothering, overbearing mother, was often seen as the cause of children’s asthma. This led to suggestions for “parentectomies” as a possible cure. Many patients for some reason improved when they were removed to a hospital (devoid of pets, carpets, molds, dust and yes, less stress).

The mental health / allergies connection

The mind is a powerful modulator of the immune system, one shouldn’t be surprised that stress can flare skin diseases such as psoriasis, urticaria, rosacea, eczema and cold sores. Stress is linked to flares of asthma, migraines and Irritable Bowel Syndrome. However can this process go the other way? Can ingesting, inhaling or contacting an allergen lead to a mental reaction? Maybe this is not causative or directly related. Maybe the patient has a mental illness and allergies?

Data from hospital/clinics and community settings suggest that asthma and mental disorders do co-occur more often than would be expected by chance.

Several studies have found elevated rates of anxiety disorders, including panic attacks and symptoms of generalized anxiety disorder (GAD), among clinical samples of patients with asthma. Several studies have also noted elevated rates of asthma among psychiatric inpatients and outpatients with anxiety disorders. As the severity of the asthma or the mental illness increases, so does the correlation between the two¹.

The strongest link is between Bipolar (manic-depression) illness and asthma (If you have one you have almost five times more chance of having the other than a normal patient). There is clinical evidence that psychopharmacological treatment for bipolar disorder improves symptoms of asthma as well as evidence of an interactive effect of treatment for asthma on mood and somatic symptoms². There is evidence that when asthma is well treated, panic and fears lessen³. There also is evidence linking hyperactivity with allergies and even impetigo⁴.

The research shows a correlation between allergies and mental health. Treatment of one can help the treatment of symptoms of the other. The connection is fairly well established, proven by medical evidence and born out in my 35 years of practice.

What are the triggers?

The formidable question remains, can an acute exposure to an allergen lead to a direct and measurable change in mental state? If a normal patient without mental illness gets a venom sting or penicillin drug and develops a severe whole body allergy reaction do they have mental symptoms? The overwhelming answer is yes. In fact a sense of doom, foreboding, fear, anxiety or panic is often elicited from a patient after one of these reactions.

What then of less severe reactions? What about ingestion of food in a patient with a history of anaphylaxis to the food? In many of these patients, at the first signs of an allergic reaction they do experience the above sense of doom as they know they may die or at the least end up spending the night in the hospital.

What about the person who has less of a reaction (sub-clinical) or ingests a small amount of food unbeknownst to them? My experience tells me that, in small children, they can exhibit unusual behavior that is correctly read by the parents as potential food ingestion. In my own food allergic child, she could become more irritable followed by urticaria, angioedema and vomiting with asthma in the hour after an irritable outburst.

Could diet or food allergies lead to behavior such as ADD or ADHD? This has been discussed by others and led to the Feingold’s diet (1975), further studies suggested many patients improved on a restricted diet (Trites, 1979) and this led to strong proponents such as Dr. Doris Rapp (1979) publishing books and doing the talk circuit blaming food allergies for a host of ills.

Different diet approaches led to polarization among different medical groups. The medical literature published several articles suggesting diets help hyperactivity⁵. Diets to reduce symptoms associated with ADHD include sugar-restricted, additive/preservative-free, oligoantigenic/elimination, and fatty acid supplements. Omega−3 supplement is the latest dietary treatment with positive reports of efficacy, and interest in the additive-free diet of the 1970s revives occasionally. A provocative report draws attention to the ADHD-associated “Western-style” diet, high in fat and refined sugars, and the ADHD-free “healthy” diet, containing fiber, folate, and omega-3 fatty acids⁶.

We have some evidence that diet may play a role in hyperactivity. What about other brain diseases like Autism Spectrum Disorder or PANDAS? Some studies indicate allergic diseases produce differences in brain development. Recent food allergy articles suggest irritability, hyperactivity, migraines, fatigue and behavior problems improved with restriction of allergenic foods.

In a recent study on autistic children, the restriction of skin test and foods for more than three weeks led to significant improvements in autistic behaviors. These behaviors worsened with the reintroduction of the eliminated foods. Serum IgE and IgE testing to specific food antigens may be helpful in some cases.

Also important to consider is the allergen itself may impact a patient more if they already have an abnormal brain or blood brain barrier.

A 2012 study found the first evidence of a link between physician-diagnosed allergy and DSM-IV mood and anxiety disorders in a representative sample. Treatment for allergy may mitigate much of this relationship⁷.

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As an M.D. or D.O. have you noticed a correlation between allergies and mental health in a patient? Have you ever seen one set of issues resolve while you were treating the other? Join allergists, including Dr. Sharon, inside the Sermo community.

Bio:

Dr. Sharon is a board certified allergist who specializes in the treatment of allergic and immunologic diseases. He tries to incorporate psychoimmunobiology into his practice. This tries to figure out the “Why I got sick” along with the conventional medicine approach of “What I am sick from.”  He looks at stress and mood disorders as one more confounding illness that impacts the health of the patient not a separate and disparate illness. The integrative approach is necessary when we see so many new allergic diseases of the twenty-first century.

Resources

1. Psychic disturbances and severity of asthma. Teiramaa E J Psychosom Res. 1978;22401- 408
2. Coincidental improvement in asthma during lithium treatment. Nasr SJ, Atkins RW. Am J Psychiatry. 1977;1341042- 1043
3. Panic-fear in asthma: request for as needed (PRN) medications in relation to pulmonary function measures. Dahlem NWKinsman RAHorton R J Allergy Clin Immunol. 1977;60295­
4. Association of childhood attention-deficit/hyperactivity disorder with atopic diseases and skin infections? A matched case-control study using the General Practice Research Database Eelko Hak, Annals of Allergy, Asthma & Immunology Volume 111, Issue 2, August 2013, Pages 102–106
5. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomized controlled trial Dr Lidy M Pelsser, The Lancet Volume 377, Issue 9764, 5–11 February 2011, Pages 494–503
6. The Diet Factor in Attention-Deficit/Hyperactivity Disorder J. Gordon Millichap, PEDIATRICS Vol. 129 No. 2 February 1, 2012 pp. 330 -337
7. Impact of allergy treatment on the association between allergies and mood and anxiety in a population sample. Goodwin RD, Galea S, Perzanowski M, Jacobi F. Clin Exp Allergy. 2012 Dec;42(12):1765-71. doi: 10.1111/j.1365-2222.2012.04042.x. Abstract