Anyone who lives with an allergy – or who cares for someone who does – will be very familiar with the distress that allergy can cause. From the itch and attraction-drawing of allergies such as eczema, to the sheer discomfort of others such as hay fever – the itchy eyes, the runny nose, the constant sneezing, the distress caused to patients by allergies is often almost palpable.
In addition to the physical impact of allergy however, there is increasingly strong evidence that allergies of all types – hay fever, eczema, food sensitivities – also have an impact on both the psychological distress levels and on the quality of life of those affected – as well as their families.
The psychological impact can be particularly strong in patients, who have had difficulty in obtaining a definite diagnosis of their allergy, probably because, in addition to the psychological impact of the allergy on the sufferer themselves, there is a secondary impact due to the negative reaction or scepticism of others to their suffering.
The powerful effect of the mind on the body has long been recognised. This effect – known as ‘conditioning’ – was first noted in 1889, when the Russian scientist, Ivan Petrovich Pavlov, carried out his famous dog-and-dinner-bell experiment.
The experiment involved Pavlov ringing a bell every time he fed his dog. Eventually the dog would begin to salivate at the sound of the bell regardless of whether or not Pavlov was feeding it!
But are the symptoms of allergies such as hay fever simply ‘in the mind’? According to a 2012 study by Paul Marshall, PhD, Director of the Neuropsychology Section at Hennepin County Medical Center in Minneapolis, they most certainly are not! Marshall’s study aimed to determine if a connection between hay fever and psychological conditions such as depression and fatigue did actually exist. After studying a wide range of allergy subjects, Marshall concluded that more of them reported mental and motivational fatigue during the hay fever season, but were not affected by physical fatigue.
In addition to Marshall’s research, two large epidemiological studies also indicated a link between hay fever and depression. In one, of 700 children, who were randomly selected, those with hay fever were found to be twice as likely to experience a major depressive episode in the next few years as opposed to those, who didn’t have hay fever. In the other study – this time with adults – those with hay fever were once again twice as likely to have been diagnosed with depression in the year prior to the study as those, who weren’t hay fever sufferers.
Researchers have hypothesised over the years as to the reasons why hay fever sufferers may experience more negative moods during the hay fever season. One theory is that sufferers will naturally feel mentally depleted due to the physical symptoms of the allergy. Another is that the mental depletion is the result of the sleep loss created by the mental distress, while a third – the one that is favoured by Marshall and his colleagues – is that hay fever leads to negative mental effects because it is acting directly on the brain.
When it comes to skin conditions, there is no doubt that long-lasting skin reactions have a psychological impact. Psoriasis, eczema and contact dermatitis not only lead to feelings of embarrassment, but also cause sleep disruption (around 80 per cent of sufferers will be affected), with sufferers impacted negatively as discussed with hay fever sufferers above. The fact that 60 per cent of sufferers have reported that their skin condition has impacted negatively on their daily activities is another source of low mood and possible depression.
According to some psychologists, particularly those who have studied eczema at length, the fallout from severely itchy skin in early life can create long-lasting psychological problems. If a child is unwilling to be touched, for example, due to their skin discomfort, this is likely to interfere with normal interaction with others and early relationships.
When it comes to psoriasis, the situation is even worse.
Chronically-inflamed, cracked and dry skin is viewed as unattractive and this can, naturally, lead to anxiety and depression. Various studies have suggested that at least 25 per cent of patients who live with psoriasis will experience significant psychological distress as a result of the condition. It’s estimated, for example, that between 27 and 40 per cent of patients will experience difficulties in sexual activities. Patients have also reported reduced quality of life, anxiety, depression and excessive worrying.
When you factor in the associated sleep disturbance caused by scratching, it is perhaps unsurprising that the patient experiences psychological distress.
Alarmingly, research has indicated that around five per cent of patients with psoriasis have experienced thoughts of suicide, with a further ten per cent declaring a wish to be dead.
Occupational function is also impacted, with one study highlighting that almost a quarter of patients with psoriasis having missed work due to their condition, leading – naturally – to heightened stress levels.
It has long been mooted that the course of psoriasis is greatly affected by the levels of stress experienced by patients. Studies have indicated that up to 80 per cent of patients report that their condition actually worsened during periods of increased stress.
It has been suggested that patients suffering from psoriasis aim, where possible, to cover up the disease by walking about, for example, with their hands in their pockets to hide psoriasis on their hands or nails, while others will wear long sleeves to trousers to disguise the condition on their arms or legs.
Food sensitivities and food allergies have become increasingly prevalent over the last few years, and there has been an increase in admissions to A & E with severe reactions to food.
The reason why there has been such an increase in allergies is unclear, and while various different theories abound – such as lifestyle changes and environmental factors – to date, there is no conclusive answer.
Food sensitivities can manifest themselves in many physical ways, such as sinus headaches, sleeping difficulties and irregular or rapid heartbeats, but there is also a plethora of psychological symptoms, including attention deficiency, anxiety, panic attacks, mental dullness and mood swings.
Signs of severe reaction can include a rash or hives appearing anywhere on the body, a sense of impending doom, vomiting, difficulty in breathing, a drop in blood pressure and loss of consciousness.
In really severe cases the patient can experience anaphylactic shock: a severe and rapid onset allergic response, which can result in circulatory collapse, coma and death.
If a patient has a reaction to something like caffeine, then they may experience dizziness, shortness of breath and palpitations. Until the patient is diagnosed as having a sensitivity to the caffeine, it may be implied to them that they are suffering from anxiety – a misdiagnosis, which, in itself, can lead to further low mood and distress.
Treatment for allergic reactions is needed quickly, and involves the use of antihistamines and adrenaline (EpiPens).
Unfortunately, the psychological and social impact of living with a severe food allergy is not yet fully embedded into allergy care, and A & E and hospital clinics usually focus simply on the physical aspects of managing the condition, such as training the patient on how to use an EpiPen.
As such, people with severe allergies – children in particular – and their families are forced to adapt quickly to living with this chronic condition. While living with a severe food allergy can mean being well most of the time if certain restrictions are adhered to, there is always the potential to become very seriously ill. The threat or previous experience of an anaphylactic reaction or a significant allergic reaction can leave patients and, in the case of children, their parents, feeling anxious and traumatised both by the memories of it and the fear of it happening again. This may result in the patient experiencing difficulties in the simple process of eating on a daily basis.
Perhaps unsurprisingly, there have been various studies which have shown that food allergy has a significant and continuing impact on the daily activities and quality of life of those affected and their families. Research by Marklund et al (2007) concluded that several domains of quality of life were affected, including emotional issues, family and social activities and the family economy, while a study by Cummings et al (2010) found that food allergy can impact upon quality of life for sufferers and their families. Cummings’ report found that there is a poorer quality of life for people, who have a larger number of food allergies combined with other atopic diseases, like asthma, and who have suffered a large number of previous reactions.
As people become more confident about using Epipens and about controlling their allergy by avoiding trigger foods etc they can adjust over time. Children in particular can become more confident as they reach different developmental stages. They can, for example, learn to manage their own medical kit and can become more confident about asking about food preparation, so this can make them feel safer and better protected and this can, naturally, remove some of the anxiety.