Allergic rhinitis (AR) is a common allergic disorder, which manifests as sneezing, nasal congestion, and rhinorrhea (runny nose), and potentially leads to not only physical but also mental distress. The physical and mental stress associated with allergic rhinitis may significantly impair activities and relationships in patients and their families. Associated mental-health related complications include sleep problems, poor school performance, and hyperactivity. Prior to this, there were a number of studies that have reported and demonstrated associations between atopic disorders and psychiatric symptoms, especially anxiety or panic disorder (such as allergic rhinitis and panic disorder). However, these studies were limited by their designs and methodology – cross-sectional study designs, self-reported symptoms, absence of matched controls, and lack of consideration of the influence of steroid and other comorbidities.
In view of this, a group of researchers from multiple institutions in Taiwan decided to explore the longitudinal association between allergic rhinitis and panic disorder in a large population-based cohort of its young people. In Taiwan, the prevalence of physician-diagnosed allergic rhinitis has been reported to be 28.6% and 19.5% in male and female middle-school students, respectively. The increasing prevalence of allergic rhinitis in Taiwan has been attributed to increasing industrialization, urbanisation, higher nonsummer temperatures, and traffic-related air pollutants.
The cohort study to examine the association between allergic rhinitis and panic disorder, comprised 79,917 cases with newly diagnosed AR and 79,917 matched controls retrieved from the National Health Insurance Research Database (NHIRD), covering the period from 1998 to 2012 and both groups were followed until the end of 2013 for incidence of panic disorder. The matching between the two groups was done per case, based on age, sex, residence, and insurance premium.
At the end of the study, Cox regression analysis was performed, adjusting for sex, age, residence, insurance premium, systemic steroids, asthma, atopic dermatitis, allergic conjunctivitis, attention deficit hyperactivity disorder, and depression, and the result revealed that allergic rhinitis was associated with a 2-fold increase in risk for panic disorder after adjustment for other variables. Additionally, it was also found that other independent risk factor of panic disorders were female sex, older age group, and depression.
This nationwide cohort study is the first to show that newly-diagnosed AR, which occurred in one’s early life, is associated with a twofold increased risk in panic disorder (after adjustment for variables mentioned earlier in the regression analysis) In view of this, the team suggested that screening, assessment, and intervention of previous allergy rhinitis among patients with panic disorder are critical. While the design of the study was better than the previous studies, the team still advocated that additional studies exploring the relationship between AR and panic disorder from a large community sample, with longer follow-up duration, are required.
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