Psychological impact of the COVID-19 pandemic on patients with allergic diseases

Sandra Nora Gonzalez-Diaz; Bryan Martin; Rosalaura Virginia Villarreal-Gonzalez; Cindy Elizabeth de Lira-Quezada; Carlos Macouzet-Sanchez; Alejandra Macias-Weinmann; Rosa Ivett Guzman-Avilan; Mariano Garcia-Campa; Andres Noyola-Perez; David Uriel Garcia-Gonzalez

doi:10.1016/j.waojou.2021.100510

Psychological impact of the COVID-19 pandemic on patients with allergic diseases

World Allergy Organ J. 2021 Mar;14(3):100510. doi: 10.1016/j.waojou.2021.100510. Epub 2021 Jan 22.

Affiliations

¹ Regional Center of Allergy and Clinical Immunology, University Hospital "Dr. José Eleuterio González", Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico.
² Allergy and Immunology at the Ohio State University in Columbus, Ohio, USA.

Abstract

Background: On March 2020, World Health Organization (WHO) declared COVID-19 to be a pandemic disease. Interactions between allergy-related inflammatory and psychiatric disorders including depression, anxiety, and post-traumatic stress disorder (PTSD) have been documented. Therefore, those who have pre-existing allergic conditions may have an increased psychiatric reaction to the stresses of the COVID-19 pandemic.

Objective: Identify the psychological impact of COVID-19 in patients with allergic diseases and determine if these individuals have a greater risk of presenting with post-traumatic stress disorder (PTSD).

Methods: It is a cross-sectional, survey-based study designed to assess the degree of symptoms of depression and the risk of PTSD using the Patient Health Questionnaire (PHQ-9) and the Impact of Event Scale-Revised (IES-R), respectively, in allergic patients.

Results: A total of 4106 surveys were evaluated; 1656 (40.3%) were patients with allergic disease, and 2450 (59.7%) were non-allergic (control) individuals. Of those with allergies, 76.6% had respiratory allergic disease including asthma and allergic rhinitis. Individuals with allergic disease reported higher scores regarding symptoms of PTSD on the IES-R scale (p = 0.052, OR 1.24 CI 0.99-1.55) as well as a higher depression risk score in the PHQ-9 questionnaire (mean 6.82 vs. 5.28) p = 0.000 z = -8.76.The allergy group presented a higher score in the IES-R questionnaire (mean 25.42 vs. 20.59), being more susceptible to presenting PTSD (p = 0.000, z = -7.774).The individuals with allergic conditions were further divided into subgroups of those with respiratory allergies such as allergic rhinitis and asthma vs those with non-respiratory allergies such as drug and food allergy, urticaria and atopic dermatitis. This subgroup analysis compares respiratory versus non-respiratory allergic patients, with similar results on the IES-R (mean 25.87 vs 23.9) p = 0.0124, z = -1.539. There was no significant difference on intrusion (p = 0.061, z = -1.873) and avoidance (p = 0.767, z = -0.297), but in the hyperarousal subscale, patients with respiratory allergy had higher scores (mean 1.15 vs. 0.99) p = 0.013 z = -2.486.

Conclusions: Psychological consequences such as depression and reported PTSD are present during the COVID-19 pandemic causing an impact particularly in individuals with allergic diseases. If we acknowledge the impact and how it is affecting our patients, we are able to implement interventions, follow up, and contribute to their overall well-being.

Keywords: Allergic; COVID 19, coronavirus disease 2019; COVID-19; CoV-2, coronavirus 2; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition; IFN-g, interferon gamma; IL-1, interleukin 1; IL-4, interleukin 4; IL-6, interleukin 6; Impact; NK cells, natural killer cells; OR, odds ratio; Psychologic; SARS, severe acute respiratory syndrome; TNF- α, tumoral necrosis factor alfa.