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Can allergies unhinge our minds? - (6/30/2020)

By Dr. Ron Gasbarro

Mrs. Lopez came into the pharmacy for some refills. She commented to the pharmacist, "Why is it when allergy season hits, my family acts like they are unhinged? My 14-year old son becomes quite depressed. He does not want to go to school or even hang with his friends. My husband develops extreme anxiety. He worries about everything, is agitated at minor things, and is constantly tired. What’s going on?” 

The pharmacist explained to Mrs. Lopez that a connection exists between seasonal allergies and various psychiatric conditions. In terms of an anxiety disorder, being unable to breathe, which is a common symptom associated with allergies, is stressful. Coughing and wheezing can also have the same effect on one's mood.

Biological explanations for these mental abnormalities have been uncovered. Allergies cause a release of the stress hormone, cortisol, which can block the "feel good" hormone, a brain chemical called serotonin. Antidepressants called serotonin reuptake inhibitors (e.g., citalopram [Celexa®]; sertraline (Zoloft®]) work by keeping this feel-good hormone coursing through the central nervous system. Researchers speculate that allergens in the air, such as pollen, inhibit the actions of serotonin. Without enough free serotonin to roam the brain, the person can feel anxious or depressed. Another theory is that allergies cause cytokines – natural chemicals that cause destructive inflammation throughout the body – to settle in the nose and sinuses. From there, they leak into the general circulation and wend their way to the central nervous system, where they can disrupt normal brain functioning. 

"OK, that's all well and good," Mrs. Lopez interrupted. "But for the sake of my mental health and my family's sanity, what can I do?" The pharmacist said that her husband and son should continue to take their allergy medication. If those medications are not mitigating the allergy symptoms, these patients should contact their prescriber to see if another medication could work better. Anti-anxiety drugs, such as alprazolam (Xanax®), may calm Mr. Lopez but could also make him drowsy during the day. Antidepressants could lift the mood of her son, yet they can take weeks to kick in. By that time, allergy season may be on the wane, and the drug would not be useful. One can make changes around the house to cut down on allergy symptoms. Wash bedding frequently. Close windows to reduce exposure to outdoor allergens. Use air-conditioning if possible. Rinse out nasal passages with saline spray. 

However, the year is 2020 and the reality of climate change is not going to make allergic symptoms any better. As the planet warms, so does the proliferation of fungi, spores, and pollen. The very fact that the allergy season may be lengthened abbreviates the colder season, which has traditionally given those with seasonal allergies a much-needed break. Severe storms, such as hurricanes, and subsequent flooding can result in damp buildings and secondary mold exposure. Scientists have been warning us about climate change for many years. As more pollution enters the atmosphere, the simple act of breathing has become more laborious. Emergency room visits, hospitalization, and even deaths will increase. 

“All of this is depressing news in itself,” lamented Mrs. Lopez. “I guess I will buy more of their allergy medicine and go home and vacuum the rugs several more times. Maybe I will feel better.” In the meantime, Mrs. Lopez should closely monitor the moods of her family. Anxiety and depression are serious conditions that need to watched and, if necessary, treated along with their allergies. Do not hesitate to call their doctor. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.  

 


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