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Ann Allergy Asthma Immunol. 2014 Jul;113(1):13-8. doi: 10.1016/j.anai.2014.03.008. Epub 2014 Apr 13.

Stress and anxiety effects on positive skin test responses in young adults with allergic rhinitis.

Author information

  • 1University of Rochester School of Medicine and Dentistry, Department of Psychiatry, Rochester Center for Mind-Body Research, Rochester, New York. Electronic address: kathi_heffner@urmc.rochester.edu.
  • 2The Ohio State University College of Medicine, Department of Psychiatry, The Institute for Behavioral Medicine Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
  • 3The Ohio State University College of Medicine, Department of Molecular Virology, Immunology, and Medical Genetics, The Institute for Behavioral Medicine Research, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
  • 4The Ohio State University, The Institute for Behavioral Medicine Research, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
  • 5Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, Mississippi.

Abstract

BACKGROUND:

Anxiety and psychological stress affect allergy-related immune function. How these relations influence the evaluations of patients with allergic rhinitis is unknown.

OBJECTIVE:

To examine whether anxiety and stress exposure affect skin prick test (SPT) responses to common allergens for which patients with atopy showed no prior positive SPT response.

METHODS:

Patients with allergic rhinitis, evidenced by clinical history and SPT results, were admitted twice to a hospital research unit for 4 hours. In a crossover design, SPT wheals were assessed before and after the Trier Social Stress Test and then the following morning; for comparison, SPT wheals were assessed before and after a laboratory session without a stressor. Analyses focused on wheal responses for common allergens that tested negative (wheal size <3 mm larger than saline) from SPTs performed at multiple baseline assessments.

RESULTS:

After the Trier Social Stress Test, more anxious patients with atopy had a higher incidence of positive SPT reactions to antigens that previously tested negative. Anxiety was unrelated to positive SPT incidence under nonstressful conditions. Based on clinical symptom reports, newly positive SPT reactions after the stressor were apparently corrections of previously false-negative SPT reactions. The SPT wheal responses for allergens previously testing negative were enhanced after a stressor. Histamine (positive control) or saline (negative control) SPT responses were not affected.

CONCLUSION:

A laboratory stressor affected allergen SPT responses in more anxious patients with allergic rhinitis. In addition to clinical history, assessment of anxiety and current stress at the time of the SPT may provide valuable information about a patient's allergic status and aid in clinical decision making.

Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

PMID:
24726195
[PubMed - indexed for MEDLINE]
PMCID:
PMC4131846
Free PMC Article
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