Each year when spring and summer arrive, primary care offices are filled with patients experiencing a variety of vague symptoms: itchy eyes, runny noses, exhaustion, and fogginess. While navigating this diagnostic ambiguity, clinicians often don’t recognize that the immune response driving nasal passages into overdrive may also be destabilizing their patients’ mental health.
The relationship between allergic disease and psychiatric conditions is well documented. Patients with a history of seasonal allergies are 43% more likely to report anxiety disorders, 28% more likely to report mood disorders, and 38% more likely to report eating disorders compared to those without seasonal allergies, pointing to something more than inconvenience when it comes to seasonal allergies.
Clinicians should understand this connection between allergies and psychiatric conditions, especially during spring and summer allergy seasons. A thorough symptom history and allergy diagnostic testing can help confirm a clinical allergy, as well as be a starting point for addressing the full burden these patients are carrying.
Uncertainty as a driver of psychological burden
Uncertainty around the underlying cause of symptoms can make spring allergy season particularly difficult for patients, especially considering how respiratory viruses like infectious rhinitis and perennial respiratory allergens like dust mites and pet dander extend symptom overlap.
A sudden onset of congestion, fatigue, and brain fog during this season can be confusing and cause uncertainty about the actual cause of symptoms – whether it’s seasonal allergies, a respiratory virus, perennial allergies, or a combination. For patients who haven’t received a formal allergy diagnosis or who are experiencing new or heightened symptoms, it can be especially confusing.
When patients can’t identify the source of their symptoms, some may use inappropriate medications or adopt avoidance behaviors well beyond what’s needed to manage their symptoms, while others may assume their symptoms are stress-related and not seek care at all. Both responses leave the root cause of their allergy symptoms unaddressed and extend the period of uncertainty that may also contribute to their anxiety.
If there is any uncertainty about allergic triggers and reactions, this may also intensify worry and leave caregivers, patients’ families, and patients themselves on edge. But it’s not just environmental allergies that can affect mental health and well being. More than 77% of parents and caregivers of food-allergic children report experiencing allergy-related anxiety, and 68% of adults with food allergies say their condition causes them ongoing stress. Meanwhile, only about 8.7% of food-allergic patients have ever been screened for mental health concerns during an allergy-related appointment, despite one in three expressing that they would welcome such screening.
For patients with seasonal allergies, this gap is compounded by the diagnostic complexity of spring and summer, since allergic rhinitis, viral rhinitis, and nonallergic rhinitis share a near-identical symptom cluster. One study found that up to 65% of patients who had received multiple prescriptions for nonsedating antihistamines had a negative IgE test result, meaning most were being treated for a condition they didn’t have. When patients experience repeated treatment failures without explanation, it can erode their confidence, drive unnecessary healthcare resource utilization, and sustain the uncertainty that may make anxiety worse.
Diagnostic clarity as a mental health intervention
The diagnostic process should begin with the clinician capturing the patient’s comprehensive symptom history. This is the most important ‘test’ a clinician can perform. It helps them understand when symptoms occur, under what conditions, and if those reactions are reproducible. Once a thorough symptom history is established, specific IgE blood testing can help clinicians confirm a clinical allergy.
Patients with a clinical allergy diagnosis can then develop a symptom management plan alongside their care team. This may include taking targeted actions like reducing exposure in the environments they control and timing medications appropriately. A management plan can also help reduce the anxiety-driven avoidance behaviors that restrict daily life, replacing them with evidence- and safety-driven decision-making.
Patients with persistent anxiety even after receiving an allergy diagnosis may also need psychosocial support like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) in addition to allergy management. Both have shown utility here, helping patients identify avoidance patterns and challenge the narratives that make symptoms feel more unmanageable than they are. However, those interventions work best when there is a diagnosis – a patient cannot meaningfully reframe their response to an allergen they cannot name.
Rethinking the spring and summer allergy visit
For patients who present with persistent, unclear, or treatment-resistant symptoms, an allergy visit to their clinician is an opportunity to get to the root cause, reduce the uncertainty that is quietly fueling their anxiety, and treat physical and psychological well-being as the linked concerns they are. Screening for mental health symptoms in patients with significant allergic disease is not overreach. Given what the research shows, it may be closer to standard of care than most practices currently recognize.
Image: Flickr user William Brawley
Gary Falcetano, PA, is the U.S. Scientific Affairs Manager for Allergy in ImmunoDiagnostics at Thermo Fisher Scientific. A licensed physician assistant with more than 25 years of diverse experience in emergency and disaster medicine, primary care, and allergy and immunology.
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