Is Stress Making Your Patient's Allergies Worse?

Medical science and research continue to recognize that allergic rhinitis is a "trojan horse" for other chronic conditions and vice versa, likely attributed to systemic chronic inflammation (SCI). As the allergy crisis continues to rise, more than sixty million Americans suffer from an allergic disease. Approximately 47% of American adults have some form of hypertension, and less than half of those individuals have their blood pressure under control. We know that stress levels among members of modern American society are higher than ever. 

What's the connection between the two conditions?

According to the NIH, stress is a "psychophysiological process that is a product of both the appraisal of a given situation to assess potential adversity and the ability (either perceived or actual) to cope with that potentially adverse situation." We believe that chronic, low-level stress among members of society is increasing more than ever because of modern living environments such as having to commute, work longer hours at desk jobs, opt for convenient, fast food over nutritious meals, and exercise less and less. However, stress can also be acute and the result of an unfortunate circumstance, like job loss or other traumatic life events. Regardless of type, stress can worsen allergy symptoms in those with the condition. 

Furthermore, the NIH provides historical context on this relationship, noting that "allergic conditions have long been considered psychosomatic disorders, which had worsened outcomes in patients with high levels of psychosocial stress. For example, asthma was commonly referred to in most early medical texts as "asthma nervosa" based on the belief that, in many children, it resulted from a conversion reaction from living with a histrionic mother." 

As research has evolved, there is a more apparent correlation between stress and allergies, developing the evidence base linking the two conditions. According to Harvard affiliate Dr. Ahmad Sedaghat, the impact of stress and allergies is two-fold, both psychological and physical. "Stress amplifies our emotional reaction to any symptoms we are having. Stress can make the allergic response worse. We don't know why exactly, but we think stress hormones can ramp up the already exaggerated immune system response to allergens." 

A study conducted by Drs. Diaa El-Din Mohamed El Hennawi, Mohamed Rifaat Ahmed, and Alaa Mohamed Farid evaluated the relationship between persistent allergic rhinitis (PAR) and stress and the impact on a patient's overall quality of life. The 166 patients with persistent allergies were analyzed using the Kessler Distress Scale, a baseline assessment of 10 questions that evaluate a patient's emotional state, using a "five-level response scale." Of the 166 patients surveyed, 73.5% were positive on the Kessler Scale, citing conditions of emotional distress, demonstrating a clear correlation between allergy suffering and a patient's emotional health. The group also noted that "when stress is well controlled, allergic rhinitis symptoms improved, and patients noted a better quality of life." 

What can physicians do?

It's crucial to manage both conditions. Managing stress is vital, and there are options to monitor and control blood pressure with today's technology, including at-home monitoring and mobile apps. In an article published by Jeffrey M. Weinfeld, MD, MBI; Kathryn M. Hart, MD; and Jose D. Vargas, MD, PhD from Georgetown University, describes home blood pressure monitoring as "practical and accessible to patients," although "ambulatory blood pressure monitoring is the diagnostic standard for measurement."

Another study in the American Journal of Rhinology and Allergy assessed the "The 22-Item Sinonasal Outcome Test as a Tool for the Assessment of Quality of Life and Symptom Control in Allergic Rhinitis" and found that The SNOT-22 has utility to assess QOL and symptom control in AR. It is both reliable and responsive in its application to patients with AR. The SNOT-22 is a convenient and versatile tool for assessing patients with AR.

QHSLab introduces an innovative healthcare solution by seamlessly combining the Q-Scale or "Quality of Life" Scale and SNOT-22 assessments, providing healthcare providers with a comprehensive overview of patient health. This integration allows healthcare professionals to gauge the severity of sinus and nasal symptoms and assess the patient's emotional well-being. This approach emphasizes the interconnected relationship between stress and the exacerbation of allergy symptoms, underlining how psychological factors can impact physical conditions. The combined assessments enable healthcare providers to create tailored treatment plans that address a patient's health's physical and emotional aspects, ultimately enhancing the quality of care and overall well-being.

Regarding allergy symptoms, AllergiEnd® offers a straightforward three-step program for non-specialty physicians to screen, test, and treat their patients for allergies within their practices. This often saves patients the time and expense of visiting a specialist. Initially, healthcare providers can screen patients for allergy symptoms and their severity using a user-friendly digital screening tool from QHSLab, including the SNOT-22. An additional emotional symptom assessment, known as the "Q-Scale," can also be offered to identify signs of emotional distress through a brief set of questions. Following this, healthcare providers can confirm the assessment results through a virtually painless skin test that provides rapid results. If treatment is necessary, AllergiEnd® offers immunotherapy options, including injections or convenient sublingual drops. These assessments are reimbursable through proven CPT codes, creating a new revenue stream for your practice.

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