Stress, mindfulness, and the allergic patient.

INTRODUCTION: The global incidence and prevalence of allergic diseases are increasing as is the intensity and duration of excessive psychological stress due to multiple factors associated with living in today's world such as personal, social and political unrest, increased fear and anxiety, and/or depression often leading to hopelessness. Both allergy and chronic psychological stress are characterized by immune imbalances that have similar characteristics. Thus, it is reasonable to posit that the two are interactive and stress may induce as well as complicate at least some allergic diseases. Areas covered: Stress management/reduction has been proposed with various physical, pharmacological, and psychological interventions for both preventive and therapeutic reasons. A useful intervention involves mindfulness techniques, which allow the individual to put their life situation in context for better personal management. Expert commentary: Future studies must be developed that will further examine the role of excess psychological stress in specific allergic diseases and evaluate the effectiveness of various stress intervention protocols, particularly those involving mindfulness, to determine which individual would best respond clinically to which intervention. When this is accomplished, assessment and treatment of psychological stress will become a standard component of clinical care for allergy, asthma, and other immune-based diseases.

Sense of coherence in selected allergic diseases.

According to "holistic" model of physician's approach to the patient, physical, psychological and social aspects should be taken into account when we assess disease and effects of diagnostics and treatment. Those attributes form health related quality of life. Patient's disposition to disease depends on many psychological factors, among them sense of coherence (SOC). Sense of coherence is a health-promoting life orientation, perceiving the world as comprehensible, manageable and meaningful. The prevalence of allergic diseases is dramatically increasing. This epidemy strongly influences comfort of patient's life. In our paper we try to present the current knowledge on sense of coherence as a factor potentially influencing the course of allergic diseases.

Health-Related Quality of Life During Routine Treatment with the SQ-Standardised Grass Allergy Immunotherapy Tablet: A Non-Interventional Observational Study.

BACKGROUND AND OBJECTIVE: Allergy immunotherapy (AIT) with the SQ(®) grass sublingual immunotherapy (SLIT)-tablet has been shown to be efficacious, well-tolerated and to improve disease-specific health-related quality of life (HRQoL) in controlled clinical trials. The aim of our study was to investigate HRQoL in patients with allergic rhinoconjunctivitis routinely treated with the SLIT-tablet and taking symptomatic medication as needed compared with patients treated only with symptomatic medication. METHODS: In a non-interventional, open-label study, patients treated with the SLIT-tablet were observed for about 12 months compared with patients only symptomatically treated. Patients assessed their HRQoL with the 12-Item Short Form Health Survey (SF-12) and the Rhinitis Quality of Life Questionnaire (RQLQ) in the grass pollen seasons (GPS) at baseline (GPS1, HRQoL1), after GPS1 (HRQoL2) and in the following GPS (GPS2, HRQoL3). Tolerability, compliance, symptoms and medication use were assessed in the SLIT-tablet group by the physician. RESULTS: Overall, data were analysed in 576 patients. Mean differences (±SD) in overall scores for HRQoL3 versus HRQoL1 (186 patients) of SF-12 were +11.4 ± 16.8 (SLIT-tablet) and -3.4 ± 15.7 (symptomatic medication), (p < 0.0001), and of RQLQ -1.31 ± 1.07 and +0.10 ± 0.74 (p < 0.001), and for HRQoL3 versus HRQoL2 (238 patients) of SF-12 -1.6 ± 15.3 and -10.0 ± 14.1 (p = 0.0003), and of RQLQ +0.22 ± 1.29 and +1.24 ± 1.30 (p < 0.0001). Tolerability and adherence for the SLIT-tablet were comparable with data of other non-interventional studies. CONCLUSIONS: Routine treatment with the SQ(®) grass SLIT-tablet resulted in clear improvements in disease-specific and general quality of life, while no improvements were observed in patients treated only symptomatically.

Allergic constitution theory of Chinese medicine and its assessment criterion and related studies.

Constitution factor plays an important role in the occurrence, development, and transformation of diseases. The occurrence of allergic diseases is mainly caused by the disorganized physiological function and suitability regulation of patients, except for their exposure to outside allergens. Moreover, it represents susceptibility and hypersensitivity to allergens. The current study expresses the concept of allergic constitution from the perspective of Chinese medicine (CM) and presents the criterion of allergic constitution. In addition, the distribution of allergic constitution in population, its factors, and its relation to health-related quality of life (HRQOL) were investigated. The HRQOL scores of allergic constitution were found to be lower than those of the Pinghe constitution. After making a study on the gene expression profile of allergic constitution, the characteristics of up-regulated or down-regulated genes were found. Finally, CM drug was researched and developed to improve allergic constitution. Based on clinical trials and animal experiments, CM is found to have good regulatory effects on allergic constitution.

Online support for children with asthma and allergies.

Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Children (n = 27) aged 7 to 11 from across Canada participated. GoToMeeting was employed for the support group sessions and Club Penguin for social connections during and between support group meetings. Content included: strategies for coping with asthma and allergies, role playing and games to help children deal with difficult situations, fun and enjoyment, and presentations by positive role models. Participation in the online peer support intervention was high, 86.3% on average over the 8-week intervention. By sharing their experiences, listening to peers' experiences, and role playing, children were introduced to practical skills: problem solving, communicating, seeking support, and self-advocacy.

Allergy narratives in Italy: 'naturalness' in the social construction of medical pluralism.

Based on an ethnographic study conducted in both biomedical and complementary and alternative medicine settings in north Italy, I explore how people and practitioners make sense of allergy and how patients utilize plural healing options. Despite a wide range of medical modalities, people categorize and use medicine according to whether they are 'natural' or 'not-natural,' thus dissolving any potential confusion between diverse therapies. I analyze how the concept of naturalness relates to allergy and medical pluralism. Nature is perceived as opposed to pollution, the first associated with a reassuring and idealized past and the latter to a modernity riddled with uncertainties. Participants associated a diverse set of meanings with nature, permitting them the syncretism of different medical modalities. Medical pluralism in the study area is an uneven platform for discussion and experimentation, the outcome of historical and cultural context and local entanglements of power.

Attention deficit hyperactivity disorder, tic disorder, and allergy: is there a link? A nationwide population-based study.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) and tic disorder usually co-occur in the same individuals, but the underlying mechanisms remain unclear. Previous evidence has shown that a frequent coexistence of allergic diseases was noted in patients with ADHD or tic disorder. We attempted to investigate the possible link among ADHD, tic disorder, and various allergic diseases. METHODS: Utilizing the Taiwan National Health Insurance Research Database from 1996 to 2010, 5,811 patients with ADHD alone, 1,816 patients with tic disorder alone, and 349 patients with dual diagnoses of ADHD and tic disorder were identified and compared with age-/gender-matched controls (1:4) in an investigation of the association among ADHD, tic disorder, and allergic diseases. RESULTS: Patients with dual diagnoses of ADHD and tic disorder had a significantly higher prevalence of allergic diseases and psychiatric comorbidities, including allergic rhinitis (43% vs. 28.4% vs. 33.6% vs. 19.7%, p < 0.001), asthma (27.5% vs. 17.2% vs. 18.2% vs. 11.9%, p < 0.001), atopic dermatitis (10.6% vs. 8.4% vs. 7.0 vs. 5.9%, p < 0.001), allergic conjunctivitis (55.6% vs. 34.7% vs. 43.5% vs. 26.3%, p < 0.001), obsessive compulsive disorder (4.0% vs. 1.3% vs. 2.0% vs. 0.1%, p < 0.001), and anxiety disorder (22.1% vs. 18.0% vs. 6.0% vs. 0.5%, p < 0.001) than the ADHD alone group, the tic alone group, and the control group. Furthermore, ADHD patients with more allergic diseases (≥ 3 comorbidities: OR: 3.73, 95% CI: 2.65~5.25; 2 comorbidities: OR: 2.52, 95% CI: 1.82~3.47; 1 comorbidity: OR: 1.87, 95% CI: 1.41~2.49) exhibited an increased risk of tic disorder compared with ADHD patients without allergic disease. CONCLUSION: A significant association among ADHD, tic disorder, and allergic diseases was noted in our study. The results may inspire further studies to clarify the underlying mechanisms and help us understand more about the complex etiology of ADHD, tic disorder, and their co-occurrence.

Analgesic effects of JCM-16021 on neonatal maternal separation-induced visceral pain in rats.

AIM: To investigate the pharmacological effect of JCM-16021, a Chinese herbal formula, and its underlying mechanisms. METHODS: JCM-16021 is composed of seven herbal plant materials. All raw materials of the formula were examined according to the quality control criteria listed in the Chinese Pharmacopeia (2005). In a neonatal maternal separation (NMS) model, male Sprague-Dawley rats were submitted to daily maternal separation from postnatal day 2 to day 14, or no specific handling (NH). Starting from postnatal day 60, rats were administered JCM-16021 (2, 4, 8 g/kg per day) orally twice a day for 28 d. Pain threshold pressure and electromyographic activities of external oblique muscles in response to colorectal distention recorded with a Power Lab System (AD Instruments International), were tested as pain indices. Changes in serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations in the colon of rats were analyzed; the enterochromaffin cell numbers and serotonin transporter in the colon of rats were also evaluated with an immunohistochemistry method. RESULTS: NMS treatment significantly reduced pain threshold pressure (37.4 +/- 1.4 mmHg), as compared to that of NH rats (57.7 +/- 1.9 mmHg, P < 0.05). After JCM-16021 treatment, the pain threshold pressure significantly increased when compared to that before treatment (34.2 +/- 0.9 mmHg vs 52.8 +/- 2.3 mmHg in the high dose group, 40.2 +/- 1.6 mmHg vs 46.5 +/- 1.3 mmHg in the middle dose group, and 39.3 +/- 0.7 mmHg vs 46.5 +/- 1.6 mmHg in the low dose group, P < 0.05). Also JCM-16021 significantly and dose-dependently decreased electromyographic activity to the graded colorectal distension (CRD), (the mean DeltaAUC values were: 0.17 +/- 0.03, 0.53 +/- 0.15, 1.06 +/- 0.18, 1.22 +/- 0.24 in the high dose group; 0.23 +/- 0.04, 0.68 +/- 0.17, 1.27 +/- 0.26, 1.8 +/- 0.3 in the middle dose group; and 0.29 +/- 0.06, 0.8 +/- 0.16, 1.53 +/- 0.24, 2.1 +/- 0.21 in the low dose group for the pressures 20, 40, 60, 80 mmHg), as compared to the NMS vehicle group. The mean DeltaAUC values were: 0.57 +/- 0.12, 1.33 +/- 0.18, 2.57 +/- 0.37, 3.08 +/- 0.37 for the pressures 20, 40, 60, 80 mmHg (P < 0.05). JCM-16021 treatment significantly reduced the 5-HT concentrations (from high, middle and low dosage groups: 60.25 +/- 5.98 ng/100 mg, 60.32 +/- 4.22 ng/100 mg, 73.31 +/- 7.65 ng/100 mg), as compared to the NMS vehicle groups (93.11 +/- 9.85 ng/100 mg, P < 0.05); and increased the 5-HIAA concentrations (after treatment, from high, middle and low dosage groups: 54.24 +/- 3.27 ng/100 mg, 50.34 +/- 1.26 ng/100 mg, 51.37 +/- 2.13 ng/100 mg) when compared to that in the NMS vehicle group (51.75 +/- 1.98 ng/100 mg, P < 0.05); but did not change the enterochromaffin cell numbers in the colon of rats. In addition, NMS rats had higher SERT expression (n = 10) than NH rats (n = 8, P < 0.05). JCM-16021 treatment significantly decreased SERT expression when compared to the NMS group (P < 0.01-0.001). CONCLUSION: JCM-16021 can attenuate visceral hypersensitivity, and this analgesic effect may be mediated through the serotonin signaling pathway in the colon of rats.

Stress and allergy.

In recent years it has been seen that the nervous and immune systems regulate each other reciprocally, thus giving rise to a new field of study known as psychoneuroimmunology. Stress is defined as a general body response to initially threatening external or internal demands, involving the mobilization of physiological and psychological resources to deal with them. In other words, stress is characterized by an imbalance between body demands and the capacity of the body to cope with them. The persistence of such a situation gives rise to chronic stress, which is the subject of the present study, considering its repercussions upon different organs and systems, with special emphasis on the immune system and--within the latter--upon the implications in relation to allergic disease. Activation of the neuroendocrine and sympathetic systems through catecholamine and cortisol secretion exerts an influence upon the immune system, modifying the balance between Th1/Th2 response in favor of Th2 action. It is not possible to affirm that chronic stress is intrinsically able to cause allergy, though the evidence of different studies suggests than in genetically susceptible individuals, such stress may favor the appearance of allergic disease on one hand, and complicate the control of existing allergy on the other.

[Psychoneuroimmunology: an update]. / Psychoneuroimmunologie: Ein Update.

Psychoneuroimmunology (PNI) is closely associated with the bidirectional pathways between mind/brain and the immune system. PNI research represents a rapidly growing area within psychosomatic research. Recent studies in PNI are based mainly on the immunological concepts of Th1/Th2 dichotomy and inflammation. This review covers human PNI studies dealing with stress-associated changes in cytokine (Th1, Th2) levels in immune-related processes such as wound healing, atopic diseases as well as autoimmune and other inflammatory diseases. It is shown that PNI studies measuring immune activity near the site of the disease (e. g. woundhealing) and dealing with objective stressors show more consistent findings (stress-associated Th1/Th2 shift, stress-associated proinflammatory activation) than those dealing with chronic and complex diseases (e. g., autoimmune disease). This warrants the expansion of the methodological repertoire in future PNI research toward designs allowing for the investigation of complex psychosomatic phenomena.

Incidence, knowledge and health seeking behaviour for perceived allergies at household level: a case study in Ilala district Dar es Salaam Tanzania.

OBJECTIVES: To determine incidence of perceived allergies, causes and management, of disorders associated with allergies at household level in Ilala district. METHOD: A cross sectional study was conducted in Ilala district involving a total of 400 households randomly selected 8 wards out of 22 wards in the district and head of the household interviewed using a structured questionnaire. RESULTS: Of the household members interviewed, 66.8% being females, about 60.0% reported to be allergic to different substances. Food 16.7%, animal dander and fur 15.4%, pollen 13.3%, house dust 11.7%, medicines 8.3%, cosmetics 5.8, and plants 6.3% were the most common causes of allergy within the households. Most individuals were not aware of the source of allergy. Only few (40.4%) respondents had some knowledge about allergy, and they acquired the information through different sources such as mass media, school, friends, other families etc. In terms of prevention, 39.2% knew how the allergies could be prevented, and 41.2% had knowledge on appropriate medicines for the control and treatment of different allergic symptoms. Skin allergies 35.9%, respiratory allergies 13.3%, and allergies of the eye 10.8% were observed to be the most common complains. CONCLUSION: The study shows high prevalence of perceived allergy disorders in the community associated with poor understanding on the possible causes and preventive measures. This highlights the need conduct public education to raise awareness on allergy with a focus on causes and avoidance of exposure to allergens to mitigate effects of allergy in the society.

Anxiety in allergy and atopic dermatitis.

PURPOSE OF REVIEW: Individuals suffering from allergies often exhibit a specific psychological profile characterized by anxiety, depression and emotional excitability. Emotional stress precipitates allergic symptoms not only by heightening anxiety levels but also by dysregulating immune-cell functions. The primary objective of this report is to review recent findings of the relationship between anxiety and hypersensitivity responses in the context of psychoneuroimmunology in allergic individuals, notably patients with atopic dermatitis. RECENT FINDINGS: Atopic subjects with emotional problems develop a vicious cycle between anxiety and clinical symptoms. Acute stresses, which repeatedly and chronically affect patients with atopic dermatitis, raise anxiety in general more preferentially than anxiety at present. This psychological failure enhances Th2-type responses due to dysregulation of the neuroimmune system, leading to worsening of allergic symptoms. Tandospirone, a 5-hydroxytryptamine 1A receptor agonist with anxiolytic and antidepressant effects, attenuates itching through successful control of emotional difficulties. These data suggest the efficacy of administrating drugs with anxiolytic effects as part of the management strategy of stress-associated itching in patients with atopic dermatitis. SUMMARY: Psychological interventions such as periodic monitoring of anxiety levels in the context of immune functions and skin conditions are fundamental in therapy of allergic patients with emotional problems.

A systematic review of treatments for electromagnetic hypersensitivity.

BACKGROUND: Electromagnetic hypersensitivity (EHS) is a poorly understood condition in which patients report symptoms following perceived exposure to weak electromagnetic fields (EMFs) such as those produced by mobile phones or visual display units. Little is known about the aetiology of the condition although experimental data suggest that EMFs are an unlikely causal agent. In this systematic review we assessed the efficacy of any treatment for people reporting EHS. METHODS: Twelve literature databases were examined to identify relevant studies. We also hand-searched conference proceedings and examined the reference sections of reviews and other papers. Only clinical trials that compared the efficacy of a potential treatment for EHS against a control condition were included in the review. RESULTS: Nine controlled clinical trials were identified, examining the effects of cognitive behavioural therapy (4 studies), visual display unit screen filters (2 studies), 'shielding' EMF emitters (1 study), supplementary antioxidant therapy (1 study) and acupuncture (1 study). The quality of these studies was limited. Nevertheless, their results suggest that cognitive behavioural therapy is more effective than providing no treatment. None of the other therapies have had their efficacy adequately demonstrated. CONCLUSIONS: The evidence base concerning treatment options for EHS is limited and more research is needed before any definitive clinical recommendations can be made. However, the best evidence currently available suggests that cognitive behavioural therapy is effective for patients who report being hypersensitive to weak EMFs.

Clinical holistic medicine: developing from asthma, allergy, and eczema.

This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. Consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.

Alternative medicine and allergies: life satisfaction, health locus of control and quality of life.

OBJECTIVES: Little is known on psychosocial characteristics of subjects with allergies who use or do not use alternative medicine (AM). We aimed to assess health-related quality of life (QoL), life satisfaction and health locus of control of adults with allergies and to compare users and nonusers of AM in a population-based setting. METHODS: In a population-based nested case control study, computer-assisted telephone interviews were performed in subjects (n=351, age median 46 years, response 76.1%) who had reported allergies (hay fever, asthma, atopic eczema and food hypersensitivity) in a previous survey. Questions on health-related QoL and evaluated instruments measuring life satisfaction ("Questions on Life Satisfaction" (FLZ(M))) and health locus of control ("Fragebogen zur Erhebung von Kontrollüberzeugungen zu Krankheit und Gesundheit" (KKG)) were applied. RESULTS: A total of 93 subjects (26.6%), who were younger and better educated than the remaining participants (n=257), reported experiences with AM. General and health-related life satisfaction was not statistically different between users (71.5 and 71.6) and nonusers (68.5 and 67.0) of AM. Nonusers scored significantly higher for fatalistic externality (21.6) than users (19.0) of AM (P=.005, adjusted age, gender and school education). The impact on overall health-related QoL was significantly higher for users (11.7) than nonusers (10.3) of AM. This difference was also significant for the domains "physical," "psychological," "friends and family" and "leisure activities" (adjusted P<.001). CONCLUSIONS: Users and nonusers of AM with allergies can be distinguished by psychosocial characteristics such as health locus of control and QoL.

Adherence issues in clinical practice.

To combat the millions of days of restricted activity and the billions of dollars spent in respiratory clinical practice, national health objectives are targeting people with asthma. Research data depict nurses and other health care providers as encountering patients with asthma and allergies who do not adhere to their medical and nursing care management plans. The skills and success with which these professional caregivers are able to assist these patients depends on an understanding of how to measure and evaluate compliance and adherence issues. In turn, this implementation of effective strategies for optimal patient outcomes can be actualized. Patient-related, practice-related, and health care provider-related factors must be considered to ensure that patients get the best chance to succeed and to be compliant. Achieving adherence with regimens not only reduces health care expenditures but ultimately results in patients' reaching their highest level of wellness.

Reduction in skin reactions to histamine after a hypnotic procedure.

This study sought to test whether a cognitive-hypnotic intervention could be used to decrease skin reactivity to histamine and whether hypnotizability, physiological variables, attitudes, and mood would influence the size of the skin weals. Thirty eight subjects undertook three individual laboratory sessions; a pretest session to determine sensitivity to histamine, a control session, and an intervention session during which the subject experienced a cognitive-hypnotic procedure involving imagination and visualization. Compared with the control session, most subjects (32 of 38) decreased the size of their weals measured during the intervention session, and the differences between the weal sizes produced in the two sessions were highly significant (N = 38; t = 4.90; p < .0001). Mood and physiological variables but not hypnotizability scores proved to be effective in explaining the skin test variance and in predicting weal size change. Feelings of irritability and tension and higher blood pressure readings were associated with less change in weal size (i.e., a continuation of reactivity similar to that found in the control session without the cognitive-hypnotic intervention), and peacefulness and a lower blood pressure were associated with less skin reactivity during the intervention. This study has shown highly significant results in reducing skin sensitivity to histamine using a cognitive-hypnotic technique, which indicates some promise for extending this work into the clinical area.

[Extensive psychological study in managing patients with asthma]. / Apports de l'investigation psychologique approfondie à la prise en charge du patient asthmatique.

Extensive psychological investigation was proposed to 20 adults hospitalized in an emergency setting for severe acute asthma. The investigations demonstrated the various personality organizations in these patients and the complexity of external and internal factors participating in triggering asthma which then constitutes a supplementary element the patients must deal with. The data collected were divided into a small number of basic categories according to the nature of the spontaneous relationship, the quality of the mental functions or the overall psychosomatic economy, yielding prognostic value and information to formulate and adjust management decisions.