Effect of maternal sleep, physical activity and screen time during pregnancy on the risk of childhood respiratory allergies: a sex-specific study.

BACKGROUND: Early life exposure in the uterus had a long-term effect on children's health. As the prevalence of allergies is increasing with a remarkable sex difference, very few studies have traced back to their early origins. We sought to investigate if maternal behavioral exposure, herein sleep, physical activity, and screen time during pregnancy is associated with childhood respiratory allergies. The sex difference would be examined. METHODS: Six thousand two hundred thirty-six mother-child pairs from Shanghai Children Allergy Study (SCAS) were enrolled, The International Study of Asthma and Allergies in Childhood questionnaire was adopted to evaluate respiratory allergic diseases. RESULTS: 14.6, 16.2, and 21.0% of children had asthma, wheeze, and allergic rhinitis, respectively. Maternal short sleep duration, lack of physical activity, and too much screen exposure during pregnancy could increase the risk of childhood respiratory allergies, however, the significance was found only in males. Moreover, a dose-response trend was clearly shown, any two of the three combined could increase the risk (OR,1.921; 95% CI,1.217-3.033), and the coexistence of all three further amplified the risk (OR,2.412; 95% CI,1.489-3.906). The findings can be verified in allergen test subgroup and each single type of respiratory allergies in most cases. CONCLUSIONS: Maternal unhealthy behaviors during pregnancy could increase the risk of childhood respiratory allergies with a dose-response pattern. Males were more susceptible to the association. The identification of modifiable maternal risk behaviors lies in the emphasis of intervention in early life to face up increasing childhood allergies.

Maternal Separation as Early-Life Stress Causes Enhanced Allergic Airway Responses by Inhibiting Respiratory Tolerance in Mice.

Epidemiologic studies indicate that exposure to psychosocial stress in early childhood is a risk factor of adult-onset asthma, but the mechanisms of this relationship are poorly understood. Therefore, we examined whether early-life stress increases susceptibility to adult-onset asthma by inhibiting the development of respiratory tolerance. Neonatal BALB/c female mice were aerosolized with ovalbumin (OVA) to induce immune tolerance prior to immune sensitization with an intraperitoneal injection of OVA and the adjuvant aluminum hydroxide. Maternal separation (MS) was applied as an early-life stressor during the induction phase of immune tolerance. The mice were challenged with OVA aerosol in adulthood, and allergic airway responses were evaluated, including airway hyper-responsiveness to inhaled methacholine, inflammatory cell infiltration, bronchoalveolar lavage fluid levels of interleukin (IL)-4, IL-5, and IL-13, and serum OVA-specific IgE. We then evaluated the effects of MS on the development of regulatory T (Treg) cells in bronchial lymph nodes (BLN) and on splenocyte proliferation and cytokine expression. In mice that underwent MS and OVA tolerization, the allergic airway responses and OVA-induced proliferation and IL-4 expression of splenocytes were significantly enhanced. Furthermore, exposure to MS was associated with a lower number of Treg cells in the BLN. These findings suggest that exposure to early-life stress prevents the acquisition of respiratory tolerance to inhaled antigen due to insufficient Treg cell development, resulting in Th2-biased sensitization and asthma onset. We provide the evidence for inhibitory effects of early-life stress on immune tolerance. The present findings may help to clarify the pathogenesis of adult-onset asthma.

Parents' perceptions are that their child's health-related quality of life is more impaired when they have a wheat rather than a grass allergy.

AIM: It is unknown whether food allergies have greater impact on quality of life than respiratory allergies. This study compared health-related quality of life (HRQoL) in children allergic to wheat or grass. METHODS: We surveyed 63 children with wheat allergies (median age of five) and 72 with grass allergies (median age 12), with their parents. The Child Health Questionnaires for parents (CHQ-PF28) and children (CHQ-CF87) were applied. RESULTS: The parents of children in the wheat group recorded significantly lower CHQ-PF28 scores for the impact of their child's allergy on general behaviour, general health perceptions, parental impact of emotions and time and family activities, than the parents of children with grass allergies (p values ≤0.001). However, parents in the grass group recorded lower scores for the change in health item than the parents of children with wheat allergies (p = 0.020). In the grass group, children and parents reported similar scores for the different questions, but there was poorer correlation between parents and children in the wheat allergy group. CONCLUSION: HRQoL was lower in children with wheat than grass allergies according to parental reports, with more consistent perceptions of HRQoL among parents and children in the grass allergy than wheat allergy group.

RHINASTHMA-Adolescents: a new quality of life tool for patients with respiratory allergy.

BACKGROUND: Specific instruments for health-related quality of life (HRQoL) assessment in adolescents with rhinoconjunctivitis or asthma are available. None of them evaluates rhinitis and asthma together, although they often coexist. Our aim was to validate a HRQoL questionnaire for adolescents with rhinoconjunctivitis, asthma, or both. METHODS: A pool of 38 items covering the main symptoms and problems related to respiratory allergy was generated based on literature review, clinical experience, and unstructured interviews to 54 adolescents. The items were randomly listed and presented to 88 consecutive outpatients (44 M; mean age 15.2 ± 3.1). Patients had to indicate which item they had experienced and, for each selected item, its importance on a four-point scale (1 = not at all; 4 = very much). Twelve items were excluded from the list, because of low importance. In the validation phase, 102 patients (54 M; mean age 15.36 ± 1.12) completed the KINDL, a generic HRQoL tool, and the new questionnaire (RHINASTHMA-Adolescents). RESULTS: Factor analysis revealed a five-dimensional structure, which explained up to 71.23% of the total variance. Association between RHINASTHMA-Adolescents and KINDL scores was all in the expected direction. Internal consistency for the extracted factors was satisfactory: Upper Airways (0.81), Lower Airways (0.89), Emotions (0.85), Social Relationship (0.79), Daily life management (0.74). Reliability was good for all factors with a Pearson coefficient ranged from 0.91 to 0.99. CONCLUSIONS: RHINASTHMA-Adolescents is the first tool for evaluating HRQoL in patients with rhinitis and/or asthma. It provides a simple assessment and met the standards of validity, internal consistency, and reliability.

Airway inflammation and hypothalamic-pituitary-adrenal axis activity in asthmatic adults with depression.

OBJECTIVE: To investigate the features of airway inflammation and hypothalamic-pituitary-adrenal axis (HPAA) activity in patients with asthma accompanied by depression. METHODS: Adult asthmatics were recruited and enrolled into one of the two groups based on scores on the Hamilton Depression Rating Scale (HAMD): asthmatics with depression (HAMD score ≥8, n = 23), and asthmatics without depression (HAMD score <8, n = 41). In addition, 27 healthy individuals and 21 adults with depression only were enrolled as controls. Induced sputum and blood samples were collected for measurement of cytokines and other inflammatory factors. The diurnal rhythm profiles of salivary cortisol and other hormones were obtained for assessment of the HPAA activity. RESULTS: For the group of asthmatics with depression, the mean HAMD score was 19.0, and for the group of asthmatics without depression, the HAMD score averaged 4.9(p < .001). Serum and sputum tumor necrosis factor alpha (TNF-α) were significantly higher in asthmatics with depression than those in the other groups (p < .05) while serum interferon-gamma (IFN-γ) was lower in asthmatics with depression than that in the other groups (p < .05). Twenty-four-hour urinary cortisol, salivary cortisol at 8 a.m. and 4 p.m. were lower in asthmatics with depression compared to other groups (p < .05). CONCLUSIONS: As compared to healthy individuals and those with asthma or depression alone, individuals with comorbid depression and asthma showed the highest level of pro-inflammatory cytokines and the lowest level of anti-inflammatory cytokines and cortisol. These observations may serve as a valuable reference for diagnosis and clinic therapies of depression in asthmatics.

Laryngeal hypersensitivity in the World Trade Center-exposed population: the role for respiratory retraining.

Upper airway symptoms among responders to the terrorist attack on 9/11 are progressive and multifactorial. For those symptoms that are laryngeal in origin, we are using a multidisciplinary approach that includes respiratory retraining and laryngeal desensitization through a speech pathologist trained in airway disorders. Our treatment paradigm and laryngeal hypersensitivity are discussed in this essay.

The effects of heated humidifier in continuous positive airway pressure titration.

BACKGROUND: Previous studies have shown that routine heated humidifier (HH) do not provide any benefit during continuous positive airway pressure (CPAP) titration if there are no significant naso-pharyngeal symptoms. In clinical practice, nasal diseases and upper airway symptoms are very common. This study investigates the effects of HH during CPAP titration in subjects with or without naso-pharyngeal symptoms. METHODS: Fifty-two patients who received polysomnography with CPAP titration were randomly assigned to HH and non-HH groups. Their nasal cavity, pharynx, and naso-pharynx were evaluated before CPAP titration, and a questionnaire on subjective sensation, including naso-pharyngeal symptoms, willingness to further use CPAP, and sleep improvement, was used. Objective (e.g., leak, apnea-hypopnea index (AHI) reduction, and optimal CPAP pressure level) and subjective data were analyzed between the two groups. RESULTS: In subjective sensation, the HH group did not have any benefit in further willingness to use CPAP and in sleep improvement, but had improved naso-pharyngeal symptoms (p = 0.043). There were no significant differences in leak, AHI reduction, and optimal CPAP pressure, even in patients with significant naso-pharyngeal symptoms. CONCLUSION: Routine use of HH is not necessary during CPAP titration regardless of naso-pharyngeal symptoms.

The genetics of panic disorder.

Panic disorder (PD) is one of the most common anxiety disorders, with a prevalence of 3.4-4.7%. Although PD seems to have no known cause, and its underlying aetiology is not well understood, studies have consistently shown that genetic factors explain about half of the variance. It is likely that most cases of PD have a complex genetic basis. Existing data suggest, however, that the genetic architecture underlying PD is heterogeneous and differs between cases. For example, the degree of genetic complexity, and the pattern of genes involved might differ in familial versus non-familial cases, in early- versus late-onset cases, or when different comorbid conditions, gender and potential intermediate or sub-phenotypes are considered. At the molecular genetic level, linkage and association studies-the latter including traditional candidate gene and recent genome-wide studies-have been used to study PD. Although no robust molecular genetic findings have emerged so far, it is conceivable that the first PD susceptibility genes will be identified in the coming years via the application of modern molecular genetic methods and through multicentre collaborations to bring together combined, large datasets. Such findings could have a major impact on our understanding of the pathophysiology of this disorder, and would provide important opportunities to investigate genotype-phenotype correlations, as well as the interaction between genetic and environmental factors involved in the pathogenesis of PD. Here, the authors summarise the latest genetics findings about PD, and give an overview of anticipated future developments.

The experience of persons with allergic respiratory symptoms: practicing yoga as a self-healing modality.

The purpose of this study was to describe the experience of persons with allergic respiratory symptoms who practice yoga as a self-healing modality. Fifteen participants were interviewed. Using the content analysis method, 5 themes emerged from the data: perceived positive effects, powerful and harmonious inner energy, mindfulness and self-awareness, understanding self and others, and promoting and achieving a state of balance and harmony. These findings foster the value of knowing the experience of persons who practice yoga as an intervention in holistic nursing.

Factors associated with non-adherence to specific allergen immunotherapy in management of respiratory allergy.

BACKGROUND: Non-adherence to specific allergen immunotherapy is a major hurdle faced by the allergist, contributing to poor clinical outcomes. OBJECTIVES: To assess the independent association of various factors with non-adherence to specific allergen immunotherapy. METHODS: Fifty consecutive (non-adherent) and control (adherent) subjects receiving specific allergen immunotherapy were included in the study and various factors related to non-adherence including socio-demographic, clinical and immunotherapy related variables were compared between the two groups by univariate and multivariate analysis. RESULTS: On univariate analysis, gender, allergic conjunctivitis, family history, progression of disease, perception of immunotherapy, medicine requirement, and the pattern of missed doses greater than two in the last 10, 20 and 30 doses were found to be significantly associated with non-adherence. On multivariate analysis, independent association was observed with allergic conjunctivitis, family history, perception of immunotherapy, missed doses greater than two in the last 10 doses of immunotherapy and medicine requirement. CONCLUSIONS: The independent factors associated with non-adherence may vary between different settings and countries. There is a need for developing individual case holding programmes to improve clinical outcomes in patients receiving specific allergen immunotherapy.

Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial.

BACKGROUND: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. METHODS: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. RESULTS: Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. CONCLUSIONS: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.

Experiences of problems in individuals with hypersensitivity to odours and chemicals.

AIM: The purpose of the study was to describe how individuals with hypersensitivity to odours and chemicals handle their problems. BACKGROUND: One group of patients we often encounter consists of those with upper and lower respiratory problems who also have a pronounced sensitivity to odours and chemicals. Earlier studies have shown that these symptoms can be related to sensory hyperreactivity (SHR). This hyperreactivity is characterised by respiratory tract symptoms triggered by odours and chemicals, along with high sensitivity to inhaled capsaicin and a positive score on the chemical sensitivity scale for SHR. However, there is still a lack of studies in which SHR sufferers describe their situations in their own words. DESIGN: The study was conducted using a qualitative approach. METHODS: Eight individuals with confirmed SHR were selected from a population-based epidemiological study and interviewed. A qualitative content analysis was performed on the data. RESULTS: Four themes emerged from the data analysis: Limitations in one's life situation, Lack of understanding from others, Concern that the symptoms will develop into a serious disease and Disparagement of one's own personal experience. The results show how individuals manage their daily lives with the help of various strategies, how they relate to other people, how they cope with their concerns and the fact that they sometimes choose to disparage their own experience of their problems. CONCLUSION: The results indicate that people with SHR experience limitations in their life situations. These limitations consist of the adjustments they make to avoid triggering factors. RELEVANCE TO CLINICAL PRACTICE: To improve care, nurses need to know how people experience SHR and how they cope with their hypersensitivity to odours and chemicals.

Do psychological distress and somatization contribute to misattribution of asthma? A Chilean study.

OBJECTIVE: The aim of this study was to assess the association between asthma and distress by whether symptoms of asthma present alone or are accompanied by atopy or bronchial reactivity to methacholine [bronchial responsiveness (BHR)], hence, to ascertain whether overreporting of asthma symptoms occurs in those with distress. METHODS: We studied 601 young adults in four groups: those with asthma symptoms and atopy or positive BHR, those with asthma symptoms only, those with atopy or positive BHR only, and controls. The main independent variables were the General Health Questionnaire-12 (GHQ-12) and 45 physical symptoms to assess somatization. RESULTS: The somatization score was highly associated with asthma symptoms alone and asthma symptoms with BHR or atopy, GHQ-12 with asthma alone and asthma and BHR or atopy related to a control group. After adjustment for somatization, GHQ-12 was not associated with the asthma outcomes. CONCLUSIONS: Excess asthma symptom reporting due to psychological distress or somatization as a cause of the association is unlikely.

Allergic rhinitis: continuous or on demand antihistamine therapy?

Allergic rhinitis is an inflammatory disease of the nasal mucosa, caused by an IgE-mediated reaction after exposure to the allergen to which the patient is sensitized. Histamine is the most important preformed mediator released in the early stage of the allergic reaction, and also contributes to the late phase of the latter, exhibiting proinflammatory effects. Minimal persistent inflammation is a physiopathological phenomenon induced by the presence of an inflammatory cell infiltrate, together with ICAM-1 expression in the epithelial cells of the mucosa exposed to the allergen to which they are sensitized, in the absence of clinical symptoms. This molecule is considered to be an allergic inflammatory marker. The priming effect first described by Connell in 1968 consists of the reduction in the allergen concentration required to elicit a nasal hyper-response when performing a daily nasal exposure test. This implies that with natural exposure to inhaled allergens, small amounts of environmental allergen will maintain the patient symptoms, and thus of course minimal persistent inflammation. Considering the above, it is questionable whether antihistamines should be administered on a continuous basis or upon demand. The antihistamines, and fundamentally the second-generation drugs, have been shown to exert an antiinflammatory effect, and this effect is greater when the drug is administered continuously than when administered upon demand. Likewise, a reduction in treatment cost and an improvement in quality of life among patients treated on a continuous basis has been documented. However, no studies have been specifically designed to clarify the indication of treatment on a continuous basis or upon demand, as occurs in the GINA. As a result, the individualization of treatment according to the concrete characteristics of each patient seems to be the best approach, at least for the time being.

Use of antihistamines in pediatrics.

Drugs with antihistamine action are among the most commonly prescribed medicines in pediatrics. According to the International Medical Statistics (IMS), almost two million antihistamine units (in solution) for pediatric use were sold in Spain during 2006--at a cost of nearly 6 million euros. Of this amount, 34% corresponded to first-generation (or sedating) antihistamines. The difficulties inherent to research for drug development increase considerably when the pediatric age range is involved. The use of any medication in this age group must adhere to the strictest safety criteria, and must offer the maximum guarantees of efficacy. For this reason, detailed knowledge of the best scientific evidence available in relation to these aspects is essential for warranting drug use. The first-generation antihistamines have never been adequately studied for pediatric age groups, though they are still widely used in application to such patients. In contrast, studies in children have been made with the second-generation antihistamines, allowing us to know their safety profile, and such medicines are available at pediatric dosages that have been well documented from the pharmacological perspective. The present review affords an update to our most recent knowledge on antihistamine use in children, based on the best scientific evidence available.

Impact of children's respiratory allergies on caregivers.

BACKGROUND: Despite the great attention that has been paid to HRQoL in children with respiratory allergy, few studies have addressed this aspect in relation to caregivers. The aim of our study was to evaluate the impact of childhood respiratory allergies on caregivers by means of a new method. METHODS: 119 parents of children suffering from allergies (75 suffering from asthma and 44 suffering from rhinitis) were recruited from three Italian Allergy Units. Parents were asked to complete the Disease Impact On Caregiver (DIOC), a new non disease specific questionnaire, validated on the Italian population. The questionnaire consists of 31 items grouped in four factors (Performance, Personal gratification, Psychophysical endurance, Socio-emotional domain) and covers the life aspects that could be affected by the assistance duties towards an ill family member. RESULTS: Child's asthma resulted to have a worse impact on many aspects of a parents' life than rhinitis. Differences resulted to be statistically significant in 19 aspects out of the 31 assessed. The worse impact of asthma versus rhinitis was confirmed in the following domains: Performance (24.0 +/- 18.2 vs 11.5 +/- 17.8), Personal gratification (26.3 +/- 20.5 vs 12.1 +/- 16.5) and Psychophysical endurance (35.0 +/- 24.8 vs 18.8 +/- 21.7). In the Socio-emotional domain no difference emerged. CONCLUSIONS: Compared to parents of rhinitics, parents of asthmatic children appear to be more compromised in their resistance to stress, mood, emotional stability, amount of spare time and leisure activities. Our results suggest the need of giving the due attention to these problems both in clinical practice and in research, in order to avoid possible interferences of the caregiver's distress in the optimization of treatment outcome.

Examining the latent class structure of CO2 hypersensitivity using time course trajectories of panic response systems.

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO2) hypersensitivity is hypothesized to be a robust endophenotypic marker of panic spectrum vulnerability. The goal of the current study was to explore the latent class trajectories of three primary response systems theoretically associated with CO2 hypersensitivity: subjective anxiety, panic symptoms, and respiratory rate (fR). METHODS: Participants (n = 376; 56% female) underwent a maintained 7.5% CO2 breathing task that included three phases: baseline, CO2 air breathing, and recovery. Growth mixture modeling was used to compare response classes (1…n) to identify the best-fit model for each marker. Panic correlates also were examined to determine class differences in panic vulnerability. RESULTS: For subjective anxiety ratings, a three-class model was selected, with individuals in one class reporting an acute increase in anxiety during 7.5% CO2 breathing and a return to pre-CO2 levels during recovery. A second, smaller latent class was distinguished by elevated anxiety across all three phases. The third class reported low anxiety reported during room air, a mild increase in anxiety during 7.5% CO2 breathing, and a return to baseline during recovery. Latent class trajectories for fR yielded one class whereas panic symptom response yielded two classes. LIMITATIONS: This study examined CO2 hypersensitivity in one of the largest samples to date, but did not ascertain a general population sample thereby limiting generalizability. Moreover, a true resting baseline measure of fR was not measured. CONCLUSIONS: Two classes potentially representing different risk pathways were observed. Implications of results will be discussed in the context of panic risk research.

Evaluation of non-response bias in a cohort study of World Trade Center terrorist attack survivors.

BACKGROUND: Few longitudinal studies of disaster cohorts have assessed both non-response bias in prevalence estimates of health outcomes and in the estimates of associations between health outcomes and disaster exposures. We examined the factors associated with non-response and the possible non-response bias in prevalence estimates and association estimates in a longitudinal study of World Trade Center (WTC) terrorist attack survivors. METHODS: In 2003-04, 71,434 enrollees completed the WTC Health Registry wave 1 health survey. This study is limited to 67,670 adults who were eligible for both wave 2 and wave 3 surveys in 2006-07 and 2011-12. We first compared the characteristics between wave 3 participants (wave 3 drop-ins and three-wave participants) and non-participants (wave 3 drop-outs and wave 1 only participants). We then examined potential non-response bias in prevalence estimates and in exposure-outcome association estimates by comparing one-time non-participants (wave 3 drop-ins and drop-outs) at the two follow-up surveys with three-wave participants. RESULTS: Compared to wave 3 participants, non-participants were younger, more likely to be male, non-White, non-self enrolled, non-rescue or recovery worker, have lower household income, and less than post-graduate education. Enrollees' wave 1 health status had little association with their wave 3 participation. None of the disaster exposure measures measured at wave 1 was associated with wave 3 non-participation. Wave 3 drop-outs and drop-ins (those who participated in only one of the two follow-up surveys) reported somewhat poorer health outcomes than the three-wave participants. For example, compared to three-wave participants, wave 3 drop-outs had a 1.4 times higher odds of reporting poor or fair health at wave 2 (95% CI 1.3-1.4). However, the associations between disaster exposures and health outcomes were not different significantly among wave 3 drop-outs/drop-ins as compared to three-wave participants. CONCLUSION: Our results show that, despite a downward bias in prevalence estimates of health outcomes, attrition from the WTC Health Registry follow-up studies does not lead to serious bias in associations between 9/11 disaster exposures and key health outcomes. These findings provide insight into the impact of non-response on associations between disaster exposures and health outcomes reported in longitudinal studies.

Intractable sneezing: case report and literature review.

Intractable sneezing is rare; the 12th case is reported here. Various causative factors have been identified in the literature; these include psychologic problems, cervical lymphadenitis, epilepsy, and allergy. The sneeze reflex consists of two phases, nasal and respiratory, which are mediated by cranial nerves V and VII and by brain-stem respiratory centers. Hypotheses that have been proposed to explain the multiple causation of sneezing are the concept of the trigeminal system as a central neuronal pool, optic-trigeminal summation, and parasympathetic generalization.

Anxiety symptoms in allergic patients: identification and risk factors.

OBJECTIVES: Multiple relationships between anxiety, allergic symptoms, and treatment difficulties have been observed. The aim of the present study was to estimate the prevalence of anxiety disorders in outpatients with various allergic diseases, to identify diagnostic cues or possible risk factors, and to test the usefulness of self-administered questionnaire screening at the allergy clinic. METHODS: Six hundred forty-six (646) consecutive patients with rhinoconjunctivitis (59.3%), asthma (26.8%), or "other" allergy (13.9%), aged 16 to 65 years, completed self-administered questionnaires in six outpatient allergy clinics; 60 of the respondents also participated in structured psychiatric interviews. Anxiety was measured with the Spielberger State-Trait Anxiety. RESULTS: According to the interviews, STAI-T > 52 predicted with 86% accuracy a current psychiatric diagnosis, without differentiating between anxiety and depression. Using this threshold, the rate of anxiety and/or depressive disorders is estimated as 19% (95% CI: 15.9-22.1) in our unselected allergic outpatient sample; 46% of these patients never received any psychopharmacological treatment, indicating that anxiety related disorders are underdiagnosed and undertreated. Risk indicators were female gender; asthma; perennial symptoms; sleep problems; nonspecific allergy triggers like strong emotions; stressful situations; and considerable limitation in everyday activities attributed to the allergic symptoms. CONCLUSIONS: Our findings confirm a high rate of anxiety and/or depressive disorders in patients visiting the allergy clinic. Self-administered questionnaires such as STAI-T provide reliable help for the identification of these frequent psychiatric problems.