Poor allergic rhinitis control may worsen mental health symptoms

Key takeaways:

• The study used an online QHSLab platform to collect patient data.
• Higher SNOT-22 scores were associated with higher PHQ-GAD-16 scores, which showed a link between AR control and depressive and anxiety symptoms.

BOSTON — Poor allergic rhinitis control was associated with an increase of depressive and anxiety symptoms, according to a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“For years we started to recognize the association between mental health and allergy control,” Marcos A. Sanchez-Gonzalez, MD, PhD, vice president for medical and scientific affairs at QHSLab and adjunct professor of health services administration for Lake Erie College of Osteopathic Medicine, told Healio. “We were looking at the role of medications. What if patients took their medications the right way? Their allergies get better and that means their mental health is going to get better.”

This cross-sectional study included patients recruited from Feb. 20 to June 25 of this year from primary care clinics and payer plans in Florida. Data on allergic rhinitis and mental health symptoms were collected through various questionnaires including: Patient Health Questionnaire 9 (PHQ-9) for depression; Generalized Anxiety Disorder 7 (GAD-7) for anxiety; and the sino-nasal outcome test for AR control. The Health Assessment questionnaire was administered digitally via the QHSLab Platform and recorded data on patient’s behavioral health, sleep quality, sleep disorder risk, persistent pain, allergy symptoms and severity. The platform included scoring for rhinosinusitis control, psychological and sleep dysfunction, stress linked to over-the-counter allergy medication use, obstructive sleep apnea and chronic pain.

Among the 5,768 patients (65% female), mean scores included 2.5 ± 5.99 on the PHQ-9, 2.54 ± 4.62 on the GAD-7, 5.03 ± 8.67 on the PHQ-GAD-16 and 22.71 ± 16.75 on the SNOT-22. A higher score on the SNOT-22 was significantly associated with higher PHQ-GAD-16 scores, meaning worse AR control was associated with more depressive and anxiety symptoms (P < .0001). Researchers found that medications such as intranasal antihistamines, decongestants, steroids and oral leukotriene blockers did not mediate the effect of SNOT-22 scores on PHQ-GAD-16 scores.

“The bottom line of the study is that yes, this association exists,” Sanchez-Gonzalez told Healio. “Many of these patients use over-the-counter medications. They don’t necessarily have their allergy symptoms under control and these allergy symptoms might feed into that anxiety and depression.”

While the mechanism behind this association is unknown, Sanchez-Gonzalez suggests the inflammatory state of allergy has something to do with the development of these symptomatology.

“We need to do more, not only focusing on the allergy, but the whole person,” he said. “We don’t treat symptoms, we have to treat the person and start looking at ways that we can offer the patients other tools to address both their allergy symptomatology and their mental health symptoms.”

For more information:

Marcos A. Sanchez-Gonzalez can be reached at masanchez@qhslab.com.