Seasonal allergies can cause more than just a stuffy nose. In some people, the condition can exacerbate mood disorders or related symptoms.
Multiple studies have suggested an overlap between seasonal allergies, or allergic rhinitis, with anxiety, depression and suicidal behavior. Study findings also suggest an association between allergic rhinitis and increased risk for psychiatric disorders, including eating disorders.
Allergists frequently work with patients who have both a diagnosed allergy and mood discovery, says Dr. Jeanne Lomas, a board-certified pediatric and adult allergist and director of allergy and immunology at WellNow Allergy, a full-service allergy testing and immunology clinic with sites in New York, Ohio and Indiana. But when it comes to the exact overlay, the conditions tend to “affect each one of those patients with those conditions a little bit differently,” says Lomas, who is a member of the American Academy of Asthma, Allergy and Immunology and the American College of Asthma, Allergy and Immunology.
Seasonal allergies impact about 1 in 4 adults and 1 in 5 children in the United States, according to the Centers for Disease Control and Prevention. More than 21% of adults have some kind of mood disorder throughout their lives, according to the National Institute of Mental Health.
The prevalence of these conditions is no small deal. On their own, symptoms of allergies or mood disorders can be very serious and even life-threatening. Combined, the two could work against each other by aggravating existing discomforts and health risks.
[Read: How to Treat Seasonal Allergies.]
How Seasonal Allergies and Mental Health Are Connected
Individually, seasonal allergies and mood disorders are both common health conditions. However, it’s not entirely clear how seasonal allergies and mood disorders are linked or if the relationship infers causation.
There are several factors that may contribute to the connection between the two:
— Inflammation in the immune system
— Psychological symptoms
— Medications
Immune system
People with seasonal allergies experience a continuous inflammatory response in their immune system. And multiple studies link inflammation in the immune system to mental health conditions.
Exactly how inflammation and mental health conditions interact is complex, and some questions remain under investigation. Studies suggest inflammation may impair the blood-brain barrier, inducing neurological changes that could lead to depression. But studies suggest the reverse could also be true. For example, neurological changes from depression may lead to an impaired blood-brain barrier, increasing inflammation.
Cytokines in the immune system, which are signals the body uses to help cells communicate and respond to infections, could also influence inflammation’s connection to mental health. Cytokines can be elevated in people with inflammatory conditions — including seasonal allergies — and in people with depression. They can play a role in regulating stress too.
People with seasonal allergies may experience a continuous inflammatory response that is mediated by some cytokines.
“There’s some really interesting research being done to help identify how cytokines (which are little signals that all kinds of cells use to communicate within the immune system) play a role in various conditions including stress, anxiety and depression,” says Dr. Farah Khan, an allergist and immunologist with the Nationwide Children’s Hospital in Columbus, Ohio.
Preclinical models show that some pro-inflammatory cytokines can be “associated with inflammatory changes that are seen in anxiety and depression,” she adds. “However, more research needs to be done.”
[See: Drinks to Boost the Immune System.]
Psychological symptoms
Cytokines aside, dealing with seasonal allergies — or allergies of any kind — can impact a person’s quality of life, or how they go about their day. This can cause stressors, which, depending on the person, may trigger psychiatric disorders like anxiety.
“If environmental allergy symptoms are making a person miserable every day, and they can’t stop sneezing and going through boxes of tissues, it inevitably impacts how one lives their life, how they sleep, how rested they are, being able to show up to work, being able to pay attention in school,” Khan says.
She adds that to an onlooker, “the weight of a congested nose and itchy eyes” may appear lighter than that of other chronic diseases, but it’s important not to dismiss or overlook the impact allergies can have on one’s life — which can be substantial.
Medications
Some allergy medications may contribute to unwanted emotional side effects or mood disorder development.
One of these is the drug class of antihistamines, which include over-the-counter medications like Benadryl, Lomas says.
A common side effect of antihistamines is feeling tired or drowsy. While this isn’t a bad thing for everyone, it may intensify depressive symptoms like lethargy and fatigue for someone who already deals with depression, Lomas says.
If this sounds like you, it can be helpful to evaluate what time you are taking the medication. If you tend to take it in the morning, switching to a nighttime routine may increase your energy throughout the day, Lomas says.
Another potential mood offender is an albuterol inhaler, particularly for people with anxiety, Lomas says.
With some of these inhalers, known side effects include an irregular or sped-up heartbeat. This can be an unsettling side effect for people with anxiety, who may also experience a racing pulse during high-anxiety times, or in a panic attack.
Providers should always inform patients about the side effects before prescribing the medication. From there, they can help patients understand that the symptoms they are feeling may be from the treatment and not a sign of panic, or they may be able to help direct patients to an alternative line of care. You should also talk with your provider about personal or family histories, including mood disorders, before starting a new medication.
Not everyone will experience these side effects, however. Many people with allergies can still safely use medications, as side effects don’t impact everyone, Lomas says.
In fact, treatments can help with effective symptom management — which can be a stress-reducer on its own, she adds.
[READ: When Allergy or Cold Medicine Makes You Drowsy.]
It’s Not Just Seasonal Allergies
Seasonal allergies aren’t the only type of allergy that can influence a person’s emotional state. People with eczema, known as atopic dermatitis, or food allergies may also be at risk for mood disorders.
Eczema and mental health
Eczema is an allergic skin disease characterized by its dry, flakey rash, which can come and go and impact different areas of the body, including the face.Especially for teenagers who may be self conscious about their looks, experiencing a visible eczema rash may impact mood or social anxiety, Lomas says.
Other than aesthetics, eczema can be sensitive or itchy. Depending on the severity of physical symptoms, this can impact a person’s ability to sleep, Lomas says. As sleep hygiene is an essential component of physical and mental health, this can also impact mood.
Food allergies and mental health
Food allergies may influence risks for psychological symptoms like social anxiety, food aversions or eating disorders, Lomas says.
For example, when it comes to social anxiety, a child who is allergic to wheat or dairy may feel excluded at a birthday party where everyone else is eating pizza. “Things that we take for granted if we don’t have food allergies are just a part of everyday life,” Lomas says.
Also, because people with food allergies often follow restrictive diets (cutting out the food they are allergic to), they may be at risk for restricting other aspects of their food intake or developing an eating disorder. For the same reason, when a person with a food allergy develops eating an disorder, it isn’t always easy to catch, Lomas says.
In some cases, people will have had allergies for a long time before people realize they’ve also had an otherwise “really restrictive diet,” she adds.
Eating disorders impact people of all sizes and backgrounds and include a range of conditions like avoidant restrictive food disorder, binge eating disorder, bulimia nervosa and anorexia nervosa, all of which can have severe or life-threatening consequences.
However, don’t jump to conclusions. It’s important not to assume that a person with food allergies has a co-occurring mood disorder, Lomas says.
Particularly when it comes to diagnosing restrictive eating disorders, practitioners should consider why a person with allergies is cutting down on their food intake and what factors are at play. For instance, people with food allergies may also be at risk for conditions like eosinophilic esophagitis, or EoE, which impacts the esophagus and makes it difficult to swallow food. This is a physical (not mood) disorder that can impact eating habits and anxiety around food.
Allergies and Mood Management
Because there are so many different types of allergies and mood disorders — not to mention types of people — out there, managing co-occurring allergies and mood disorders requires individualized, multifactorial approaches.
For people who are unsure how to manage their conditions, talking to a provider can be a good first step. While your provider may not have all the answers for you right away, they can help you begin to address your symptoms and get you on the road to feeling better.
“If someone is miserable and missing days from school or calling out from work because symptoms have progressively worsened, it’s time to reevaluate how symptoms are being managed,” Khan says. “It’s my job as an allergist to have the discussion about how symptoms can be controlled so that patients can get back to life.”
Whatever treatment plan Khan comes up with, she says the goal is for “improvement in symptoms to correlate to an improvement in quality of life and engagement.”
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How Seasonal Allergies Can Impact Mental Health originally appeared on usnews.com
Correction 08/24/23: A previous version of this story incorrectly stated Dr. Lomas’s title.
